Epidemiological, clinical and risk factors for Strongyloides stercoralis hyperinfection syndrome in kidney transplant patients.

Objective: to describe epidemiological, clinical, diagnostic and treatment characteristics of Strongyloides stercoralis hyperinfection syndrome in kidney transplant patients, identify risk factors for hyperinfection syndrome and 30day mortality, compare early and late occurring cases. Methods: In a retrospective, multicenter, 1:2 casecontrol study, we assessed clinical outcomes and risk factors for Strongyloides stercoralis hyperinfection in kidney transplant patients in Brazil. Results: Forty six cases of Strongyloides stercoralis hyperinfection and 92 controls were included. Diagnosis was made after a median of 117 days after transplantation and 39.1% occurred after 6 months. Gastrointestinal (78.3%) and pulmonary (39.1%) symptoms were the most frequent clinical findings. Fever and eosinophilia were present in 32.6% and 43.5% of the patients respectively. Thirtyday crude mortality was 28.3% and was significantly higher for disease occurring before 3 months of transplantation (47% x 17.2%, p0.04). Independent risk factors for Strongyloides stercoralis hyperinfection were receiving a graft from a deceased donor (OR6.16, 95%CI 2.0518.5), a previous bacterial infection (OR3.04, 95%CI 1.27.5) and cumulative corticosteroid dose (OR1.005, 95%CI 1.0011.009). Respiratory failure (OR 98.33, 95%CI 4.462169.77) and bacteremia (OR 413.00, 95%CI 4.8335316.61) were independent predictors of mortality. Conclusions: Strongyloides stercoralis hyperinfection is associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, disease may occur later after transplantation, although it seems more severe earlier after transplantation. Specific risk factors (cumulative corticosteroid dose, previous bacterial infections and receiving a graft from a deceased donor) along with typical clinical manifestations (gastrointestinal and pulmonary symptoms) may be employed to identify patients at risk for prophylaxis or for early treatment.Objetivo: descrever as características epidemiológicas, clínicas, diagnósticas e terapêuticas da síndrome de hiperinfecção por Strongyloides stercoralis em transplante renal, identificar os fatores de risco para síndrome de hiperinfecção e para mortalidade em 30 dias, comparar os casos de ocorrência precoce e tardia. Métodos: estudo retrospectivo, multicêntrico, 1:2 casocontrole, com análise univariada e multivariada para os fatores de risco. Resultados: foram incluídos 46 casos e 92 controles. A mediana para o diagnóstico foi de 117 dias pós o transplante e 39,1% dos casos ocorreram pós 6 meses. Sintomas gastrointestinais (78,3%) e respiratórios (39,1%) foram os achados clínicos mais frequentes. Febre e eosinofilia estavam presentes em 32,6% e 43,5% dos casos respectivamente. Mortalidade em 30 dias foi de 28,3% e foi significativamente maior para casos que ocorreram nos primeiros 3 meses pós transplante (47% x 17,2%, p0,04). Fatores de risco independentes foram doador falecido (OR6,16, IC95% 2,0518,5), infecção bacteriana prévia (OR3,04, IC95% 1,27,5) e dose acumulada de corticoide (OR1,005, IC95% 1,0011,009). Insuficiência respiratória (OR 98,33, IC95% 4,462169,77) e bacteremia (OR 413,00, IC95% 4,8335316,61) foram preditores independentes para mortalidade. Conclusões: hiperinfecção por Strongyloides stercoralis está associada a uma significante morbidade e mortalidade no pós transplante. Em áreas endêmicas, a doença pode ocorrer em períodos mais tardios, apesar de ser mais grave no período mais precoce do póstransplante. Fatores de risco específicos (dose acumulada de corticoide, infecção bacteriana prévia e doador falecido) associado a manifestações clínicas (sintomas gastrointestinais e respiratórios) podem ser utilizados para identificar pacientes de risco para profilaxia ou para tratamento precoce.Dados abertos - Sucupira - Teses e dissertações (2018

Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study.

BackgroundSevere Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection.Methodology/principal findingsThis was a retrospective, multicenter, case-control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5-965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05-18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2-7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001-1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46-2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83-35316.61).Conclusions/significanceSevere S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment