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Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)

BACKGROUND: Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis...

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Autores principales: Al-Obaidi, Mohanad, Hasbun, Rodrigo, Vigil, Karen J, Edwards, Angelina R, Chavez, Violeta, Hall, David R, Dar, Wasim A, De Golovine, Aleksandra, Ostrosky-Zeichner, Luis, Bynon, John S, Nigo, Masayuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656655/
https://www.ncbi.nlm.nih.gov/pubmed/31363770
http://dx.doi.org/10.1093/ofid/ofz172
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author Al-Obaidi, Mohanad
Hasbun, Rodrigo
Vigil, Karen J
Edwards, Angelina R
Chavez, Violeta
Hall, David R
Dar, Wasim A
De Golovine, Aleksandra
Ostrosky-Zeichner, Luis
Bynon, John S
Nigo, Masayuki
author_facet Al-Obaidi, Mohanad
Hasbun, Rodrigo
Vigil, Karen J
Edwards, Angelina R
Chavez, Violeta
Hall, David R
Dar, Wasim A
De Golovine, Aleksandra
Ostrosky-Zeichner, Luis
Bynon, John S
Nigo, Masayuki
author_sort Al-Obaidi, Mohanad
collection PubMed
description BACKGROUND: Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center. METHODS: Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed. RESULTS: A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P < .05). In multivariate analysis, eosinophilia (P = .01), diabetes mellitus (P = .02), and Asian race (P = .03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation. CONCLUSIONS: We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation.
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spelling pubmed-66566552019-08-02 Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017) Al-Obaidi, Mohanad Hasbun, Rodrigo Vigil, Karen J Edwards, Angelina R Chavez, Violeta Hall, David R Dar, Wasim A De Golovine, Aleksandra Ostrosky-Zeichner, Luis Bynon, John S Nigo, Masayuki Open Forum Infect Dis Major Article BACKGROUND: Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center. METHODS: Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed. RESULTS: A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P < .05). In multivariate analysis, eosinophilia (P = .01), diabetes mellitus (P = .02), and Asian race (P = .03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation. CONCLUSIONS: We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation. Oxford University Press 2019-04-13 /pmc/articles/PMC6656655/ /pubmed/31363770 http://dx.doi.org/10.1093/ofid/ofz172 Text en © The Author(s) 2019. 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 Major Article
Al-Obaidi, Mohanad
Hasbun, Rodrigo
Vigil, Karen J
Edwards, Angelina R
Chavez, Violeta
Hall, David R
Dar, Wasim A
De Golovine, Aleksandra
Ostrosky-Zeichner, Luis
Bynon, John S
Nigo, Masayuki
Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title_full Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title_fullStr Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title_full_unstemmed Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title_short Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012–2017)
title_sort seroprevalence of strongyloides stercoralis and evaluation of universal screening in kidney transplant candidates: a single-center experience in houston (2012–2017)
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656655/
https://www.ncbi.nlm.nih.gov/pubmed/31363770
http://dx.doi.org/10.1093/ofid/ofz172
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