Strongyloides stercoralis Infection Incidence, Risk Factors and Outcomes Among Solid Organ Transplant Candidates and Recipients; a Florida Center Experience

BACKGROUND: Most infections of Strongyloides stercoralis are asymptomatic but can be fulminant in the immunosuppressed. Fatal infections in transplant patients have been reported in United States but incidence estimates are lacking. Our protocol for Strongyloides until 2009 screened immigrants and those with travel history to endemic areas. In 2010, we began universal screening of SOT candidates due to a case of disseminated Strongyloidiasis in an unscreened lung transplant recipient with unknown risk factors. We calculated the incidence of Strongyloides stercoralis in our SOT candidates and associated risk factors, treatment, and outcomes since protocol change. METHODS: A retrospective review was performed of patients who underwent transplant evaluation from January 2014 to July 2016. Patients positive for Strongyloides stercoralis were reviewed for age, sex, ethnicity, place of birth, travel history, occupation, eosinophilia, treatment, and outcome. We report descriptive statistics. RESULTS: Of a total of 2,351 SOT patients, 116 tested positive (heart 33, lung 24, kidney 26, liver 31, pancreas 2) with an incidence of 4.9%. A total of 113 charts were available for review. The characteristics of the patients are summarized in Table 1. Fifty patients had traditional risk factors (44%) and 63 lacked them (56%). Eosinophilia was present in 15% of cases. Of those transplanted, 87% received prophylaxis and none developed active Strongyloidiasis. CONCLUSION: Our results show that S. stercoralis infection has a relatively high incidence in SOT patients and universal screening identified a substantial number that otherwise would go undetected, placing the transplant patient at risk of a fatal, yet preventable complication. DISCLOSURES: All authors: No reported disclosures.