Roxby Alison C, Gottlieb Geoffrey S, Limaye Ajit P
Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA.
Clin Infect Dis. 2009 Nov 1;49(9):1411-23. doi: 10.1086/630201.
Strongyloides stercoralis is an intestinal nematode that can persist in the human host for decades after the initial infection and can progress to fulminant hyperinfection syndrome in immunocompromised hosts. We describe a patient who died of Strongyloides hyperinfection syndrome 2 months after orthotopic heart transplantation and discuss approaches to prevention, diagnosis, and treatment. Current practice guidelines recommend screening for and treatment of Strongyloides infection before transplantation, but physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Screening tests have limitations, and clinical suspicion remains an important component of the evaluation before transplantation. After immunocompromised patients develop hyperinfection syndrome, diagnosis is often delayed and mortality is high, so emphasis must be placed on screening and treatment before transplantation. We review current strategies for prevention, diagnosis, and treatment of chronic intestinal strongyloidiasis in patients who will undergo transplantation and discuss the clinical features and management of Strongyloides hyperinfection syndrome in transplant recipients.
粪类圆线虫是一种肠道线虫，初次感染后可在人体宿主中持续数十年，并可在免疫功能低下的宿主中发展为暴发性重度感染综合征。我们描述了一名患者，该患者在原位心脏移植术后2个月死于粪类圆线虫重度感染综合征，并讨论了预防、诊断和治疗方法。目前的实践指南建议在移植前筛查和治疗粪类圆线虫感染，但美国的医生常常错过识别慢性粪类圆线虫病患者的机会。筛查试验存在局限性，临床怀疑仍然是移植前评估的重要组成部分。免疫功能低下的患者发生重度感染综合征后，诊断往往延迟且死亡率很高，因此必须强调移植前的筛查和治疗。我们回顾了目前对即将接受移植的患者慢性肠道粪类圆线虫病的预防、诊断和治疗策略，并讨论了移植受者粪类圆线虫重度感染综合征的临床特征和管理。
