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

Autor: Miglioli-Galvão L; Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil., Pestana JOM; Kidney Transplant Unit, Hospital do Rim and Universidade Federal São Paulo, São Paulo, Brazil., Santoro-Lopes G; Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Torres Gonçalves R; Kidney Unit, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Requião Moura LR; Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil., Pacheco Silva Á; Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Kidney Unit, Universidade Federal de São Paulo,São Paulo, Brazil., Camera Pierrotti L; Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil., David Neto E; Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil., Santana Girão E; Kidney Transplant Unit, Universidade Federal do Ceará, Ceará, Brazil., Costa de Oliveira CM; Kidney Transplant Unit, Universidade Federal do Ceará, Ceará, Brazil., Saad Abboud C; Infectious Diseases Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Dias França JÍ; Department of Epidemiology and Statistics, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Devite Bittante C; Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil., Corrêa L; Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil., Aranha Camargo LF; Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil.; Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2020 Jan 31; Vol. 14 (1), pp. e0007998. Date of Electronic Publication: 2020 Jan 31 (Print Publication: 2020).
DOI: 10.1371/journal.pntd.0007998
Abstrakt: Background: Severe 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 Findings: This 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/significance: Severe 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.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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