Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Sci Rep. 2018 Oct 18;8(1):15406. doi: 10.1038/s41598-018-33775-3.


Strongyloides stercoralis is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for Strongyloides stercoralis hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for Strongyloides stercoralis seropositivity by established ELISA testing. Positive Strongyloides stercoralis serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as Strongyloides infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some Strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Animals
  • Case-Control Studies
  • Europe / epidemiology
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Immunosuppression Therapy / statistics & numerical data
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / statistics & numerical data*
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Seroepidemiologic Studies
  • Strongyloides stercoralis* / immunology
  • Strongyloides stercoralis* / isolation & purification
  • Strongyloidiasis / blood
  • Strongyloidiasis / epidemiology*
  • Systemic Inflammatory Response Syndrome / epidemiology*
  • Transplant Recipients / statistics & numerical data*
  • Transplantation, Homologous