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1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area

BACKGROUND: Strongyloidiasis can lead to hyperinfection and dissemination after transplantation with significant morbidity and mortality. Treatment for Strongyloidiasis prior to transplantation can reduce the risk of disseminated infection. Targeted screening based on travel history and country of o...

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Autores principales: Kottkamp, Angelica, Mehta, Sapna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253492/
http://dx.doi.org/10.1093/ofid/ofy210.970
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author Kottkamp, Angelica
Mehta, Sapna
author_facet Kottkamp, Angelica
Mehta, Sapna
author_sort Kottkamp, Angelica
collection PubMed
description BACKGROUND: Strongyloidiasis can lead to hyperinfection and dissemination after transplantation with significant morbidity and mortality. Treatment for Strongyloidiasis prior to transplantation can reduce the risk of disseminated infection. Targeted screening based on travel history and country of origin incompletely identifies at-risk patients. Data on universal screening prior to solid-organ (SOT) or hematopoietic stem cell transplantation (HSCT) are limited. We implemented universal serology-based screening for strongyloides at our transplant center, located in a metropolitan non-ndemic area. METHODS: We identified patients screened with serum Strongyloides IgG by ELISA during pre-transplant evaluation for SOT or HSCT from August 1, 2017 to April 25, 2018. We reviewed adherence to the screening recommendation by program type and the medical record of seropositive patients for country of origin, history of eosinophilia (>500 cell/μL), Gram-negative bacteremia, ova and parasite (O&P) examination and treatment. RESULTS: A total of 812 patients were evaluated for transplant during the study period: 484 for kidney, 152 for liver, 12 for liver/kidney transplant, 40 for heart, 24 for lung, and 100 for HSCT. 201 (24.7%) of the 812 patients were screened for Strongyloides; 107 (17%) evaluated for abdominal transplant, 32 (50%) for thoracic transplant, and 62 (60%) for HSCT. Seventeen (8.4%) of 201 patients screened tested positive: nine evaluated for kidney transplant, four for heart, one for liver, and three for HSCT. Nine of 17 patients (53%) were treated with Ivermectin or referred to Infectious Diseases clinic prior to our review. Ten (59%) seropositive patients were from the United States and 70% had no documented travel to endemic areas; six patients were from countries other than the United States; and one from Puerto Rico. Two patients with Strongyloidiasis had eosinophilia, one had history of Klebsiella pneumoniae bacteremia and one had stool O&P examination. Screening was higher when using an electronic order set (57% vs. 17%). CONCLUSION: Universal screening for Strongyloidiasis identified individuals with latent infection who did not have epidemiological or clinical findings suggestive of Strongyloidiasis. Screening for Strongyloidiasis was higher in transplant programs that incorporated the recommendation into an electronic order set. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62534922018-11-28 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area Kottkamp, Angelica Mehta, Sapna Open Forum Infect Dis Abstracts BACKGROUND: Strongyloidiasis can lead to hyperinfection and dissemination after transplantation with significant morbidity and mortality. Treatment for Strongyloidiasis prior to transplantation can reduce the risk of disseminated infection. Targeted screening based on travel history and country of origin incompletely identifies at-risk patients. Data on universal screening prior to solid-organ (SOT) or hematopoietic stem cell transplantation (HSCT) are limited. We implemented universal serology-based screening for strongyloides at our transplant center, located in a metropolitan non-ndemic area. METHODS: We identified patients screened with serum Strongyloides IgG by ELISA during pre-transplant evaluation for SOT or HSCT from August 1, 2017 to April 25, 2018. We reviewed adherence to the screening recommendation by program type and the medical record of seropositive patients for country of origin, history of eosinophilia (>500 cell/μL), Gram-negative bacteremia, ova and parasite (O&P) examination and treatment. RESULTS: A total of 812 patients were evaluated for transplant during the study period: 484 for kidney, 152 for liver, 12 for liver/kidney transplant, 40 for heart, 24 for lung, and 100 for HSCT. 201 (24.7%) of the 812 patients were screened for Strongyloides; 107 (17%) evaluated for abdominal transplant, 32 (50%) for thoracic transplant, and 62 (60%) for HSCT. Seventeen (8.4%) of 201 patients screened tested positive: nine evaluated for kidney transplant, four for heart, one for liver, and three for HSCT. Nine of 17 patients (53%) were treated with Ivermectin or referred to Infectious Diseases clinic prior to our review. Ten (59%) seropositive patients were from the United States and 70% had no documented travel to endemic areas; six patients were from countries other than the United States; and one from Puerto Rico. Two patients with Strongyloidiasis had eosinophilia, one had history of Klebsiella pneumoniae bacteremia and one had stool O&P examination. Screening was higher when using an electronic order set (57% vs. 17%). CONCLUSION: Universal screening for Strongyloidiasis identified individuals with latent infection who did not have epidemiological or clinical findings suggestive of Strongyloidiasis. Screening for Strongyloidiasis was higher in transplant programs that incorporated the recommendation into an electronic order set. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253492/ http://dx.doi.org/10.1093/ofid/ofy210.970 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Kottkamp, Angelica
Mehta, Sapna
1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title_full 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title_fullStr 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title_full_unstemmed 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title_short 1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
title_sort 1137. implementation of universal screening for strongyloidiasis among solid-organ and hematopoietic stem cell transplantation candidates in a non-endemic area
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253492/
http://dx.doi.org/10.1093/ofid/ofy210.970
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