Terminal ileum resection as a trigger for Strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated Crohnʼs disease: a case report

AbstractThe nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host.In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease.We present a case of S. stercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn’s disease. S. stercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy.

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JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease

Transplantology ◽

10.3390/transplantology2010004 ◽

2021 ◽

Vol 2 (1) ◽

pp. 37-48

Author(s):

James E. K. Hildreth ◽

Donald J. Alcendor

Keyword(s):

Inflammatory Responses ◽

Rare Complication ◽

Organ Transplant ◽

Solid Organ ◽

Virus Reactivation ◽

Jc Polyomavirus ◽

Hematological Disorders ◽

Transplant Patients ◽

Immunosuppressed Patients ◽

Life Threatening

The JC polyomavirus (JCPyV/JCV) is a member of the Polyomaviridae family and is ubiquitious in the general population, infecting 50–80% of individuals globally. A primary infection with JCV usally results in an asymptomatic, persistent infection that establishes latency in the renourinary tract. Reactivation from latency via iatrogenic immununosuppression for allograft transplantation may result in organ pathology and a potential life-threatening neuropathological disease in the form of progressive multifocal leukoencephalopathy (PML). Currently, no treatment exists for PML, a rare complication that occurs after transplantation, with an incidence of 1.24 per 1000 persons a year among solid organ transplant patients. PML is also observed in HIV patients who are immununosuppressed and are not receiving antiretroviral therapy, as well as individuals treated with biologics to suppress chronic inflammatory responses due to multiple sclerosis, Crohn’s disease, non-Hodgkin’s lymphoma, rheumatoid arthritis, and other autoimmune-mediated hematological disorders. Here, we describe the proposed mechanisms of JCV reactivation as it relates to iatrogenic immunosuppression for graft survival and the treatment of proinflammatory disease, such as biologics, proposed trafficking of JCV from the renourinary tract, JCV central nervous system dissemination and the pathology of PML in immunosuppressed patients, and potential novel therapeutics for PML disease.

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Strongyloides stercoralis Infection Incidence, Risk Factors and Outcomes Among Solid Organ Transplant Candidates and Recipients; a Florida Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.026 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S10-S11 ◽

Cited By ~ 2

Author(s):

Robert Castro ◽

Sadaf Aslam ◽

Christopher Albers ◽

Louise Gutierrez ◽

Marijesmar Gonzalez ◽

...

Keyword(s):

Risk Factors ◽

Universal Screening ◽

Organ Transplant ◽

Strongyloides Stercoralis ◽

Solid Organ ◽

Travel History ◽

Transplant Patients ◽

Incidence Risk ◽

Traditional Risk Factors ◽

Associated Risk Factors

Abstract Background Most infections of Strongyloides stercoralis are asymptomatic but can be fulminant in the immunosuppressed. Fatal infections in transplant patients have been reported in United States but incidence estimates are lacking. Our protocol for Strongyloides until 2009 screened immigrants and those with travel history to endemic areas. In 2010, we began universal screening of SOT candidates due to a case of disseminated Strongyloidiasis in an unscreened lung transplant recipient with unknown risk factors. We calculated the incidence of Strongyloides stercoralis in our SOT candidates and associated risk factors, treatment, and outcomes since protocol change. Methods A retrospective review was performed of patients who underwent transplant evaluation from January 2014 to July 2016. Patients positive for Strongyloides stercoralis were reviewed for age, sex, ethnicity, place of birth, travel history, occupation, eosinophilia, treatment, and outcome. We report descriptive statistics. Results Of a total of 2,351 SOT patients, 116 tested positive (heart 33, lung 24, kidney 26, liver 31, pancreas 2) with an incidence of 4.9%. A total of 113 charts were available for review. The characteristics of the patients are summarized in Table 1. Fifty patients had traditional risk factors (44%) and 63 lacked them (56%). Eosinophilia was present in 15% of cases. Of those transplanted, 87% received prophylaxis and none developed active Strongyloidiasis. Conclusion Our results show that S. stercoralis infection has a relatively high incidence in SOT patients and universal screening identified a substantial number that otherwise would go undetected, placing the transplant patient at risk of a fatal, yet preventable complication. Disclosures All authors: No reported disclosures.

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Survey of Alternative Medicine Use among Organ Transplant Patients

Journal of Transplant Coordination ◽

10.1177/090591999700700307 ◽

1997 ◽

Vol 7 (3) ◽

pp. 123-130 ◽

Cited By ~ 3

Author(s):

Catherine C Crone ◽

Thomas N Wise

Keyword(s):

Drug Interactions ◽

Organ Transplant ◽

Herbal Medicines ◽

Food Supplements ◽

Solid Organ ◽

Health Food ◽

Transplant Patients ◽

Increased Risk ◽

Life Threatening ◽

Pharmacologically Active

Herbal medicine and health food supplements have become increasingly popular. However, many of these pharmacologically active compounds remain poorly understood. Patients with chronic and life-threatening conditions often use alternative therapies while receiving conventional medical care, and this population is at increased risk for complications and adverse drug interactions due to poor health and complex drug regimens. Patients awaiting or who had received solid organ transplants were surveyed about their use of herbal medicines and health food supplements. Twenty percent of respondents acknowledged experience with these products, which they used to prolong the function of a failing organ or to obtain relief from fatigue and insomnia. Transplant staff often were unaware of their patients' use of these treatments, despite patients' claims to the contrary. The potential for unexpected drug interactions, toxicity, and other adverse reactions resulting from the use of herbal medicines or supplements must be recognized and identified by transplant teams.

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Contraception for Solid Organ Transplant Patients: Utilizing Social Media

Case Medical Research ◽

10.31525/ct1-nct03979950 ◽

2019 ◽

Author(s):

Keyword(s):

Social Media ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Patients

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Reinforcing the Immunocompromised Host Defense against Fungi: Progress beyond the Current State of the Art

Journal of Fungi ◽

10.3390/jof7060451 ◽

2021 ◽

Vol 7 (6) ◽

pp. 451

Author(s):

Georgios Karavalakis ◽

Evangelia Yannaki ◽

Anastasia Papadopoulou

Keyword(s):

Host Defense ◽

Hematopoietic Cell Transplantation ◽

State Of The Art ◽

Fungal Infections ◽

Solid Organ Transplantation ◽

Immunocompromised Host ◽

Antifungal Drugs ◽

Solid Organ ◽

Cell Immunotherapy ◽

Life Threatening

Despite the availability of a variety of antifungal drugs, opportunistic fungal infections still remain life-threatening for immunocompromised patients, such as those undergoing allogeneic hematopoietic cell transplantation or solid organ transplantation. Suboptimal efficacy, toxicity, development of resistant variants and recurrent episodes are limitations associated with current antifungal drug therapy. Adjunctive immunotherapies reinforcing the host defense against fungi and aiding in clearance of opportunistic pathogens are continuously gaining ground in this battle. Here, we review alternative approaches for the management of fungal infections going beyond the state of the art and placing an emphasis on fungus-specific T cell immunotherapy. Harnessing the power of T cells in the form of adoptive immunotherapy represents the strenuous protagonist of the current immunotherapeutic approaches towards combating invasive fungal infections. The progress that has been made over the last years in this field and remaining challenges as well, will be discussed.

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From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant

Journal of Travel Medicine ◽

10.1093/jtm/taaa229 ◽

2020 ◽

Author(s):

Brice Autier ◽

Adélaïde Chesnay ◽

Claire Mayence ◽

Stéphanie Houcke ◽

Hélène Guégan ◽

...

Keyword(s):

Immune Deficiency ◽

Strongyloides Stercoralis ◽

The Body ◽

Life Threatening ◽

Disseminated Strongyloidiasis ◽

Disseminated Mucormycosis

Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.

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Targeting the latent human cytomegalovirus reservoir for T-cell-mediated killing with virus-specific nanobodies

Nature Communications ◽

10.1038/s41467-021-24608-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Timo W. M. De Groof ◽

Elizabeth G. Elder ◽

Eleanor Y. Lim ◽

Raimond Heukers ◽

Nick D. Bergkamp ◽

...

Keyword(s):

Gene Expression ◽

Human Cytomegalovirus ◽

Early Gene ◽

Latent Reservoir ◽

Solid Organ ◽

Cell Transplant ◽

Viral Receptor ◽

Transplant Patients ◽

Latently Infected ◽

Infected Cells

AbstractLatent human cytomegalovirus (HCMV) infection is characterized by limited gene expression, making latent HCMV infections refractory to current treatments targeting viral replication. However, reactivation of latent HCMV in immunosuppressed solid organ and stem cell transplant patients often results in morbidity. Here, we report the killing of latently infected cells via a virus-specific nanobody (VUN100bv) that partially inhibits signaling of the viral receptor US28. VUN100bv reactivates immediate early gene expression in latently infected cells without inducing virus production. This allows recognition and killing of latently infected monocytes by autologous cytotoxic T lymphocytes from HCMV-seropositive individuals, which could serve as a therapy to reduce the HCMV latent reservoir of transplant patients.

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Hookworm infection in infants: a case report and review of literature

Italian Journal of Pediatrics ◽

10.1186/s13052-021-00981-1 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

G. Umbrello ◽

R. Pinzani ◽

A. Bandera ◽

F. Formenti ◽

G. Zavarise ◽

...

Keyword(s):

Rural Areas ◽

Simulation Models ◽

Developed Countries ◽

Hookworm Infection ◽

Case Presentation ◽

Abdominal Symptoms ◽

Asymptomatic Children ◽

Ancylostoma Duodenale ◽

Stool Analysis ◽

The Tropics

Abstract Background Hookworm infections (Necator americanus, Ancylostoma duodenale) are common in rural areas of tropical and subtropical countries. Human acquisition results from direct percutaneous invasion of infective larvae from contaminated soil. Overall, almost 472 million people in developing rural countries are infected. According to simulation models, hookworm disease has a global financial impact of over US$100 billion a year. Hookworm infection in newborn or infancy is rare, and most of the cases reported in literature are from endemic countries. Here, we describe the case of an infant with an Ancylostoma duodenale infection and review the literature currently available on this topic. Case presentation An Italian 2-month-old infant presented with vomit and weight loss. Her blood exams showed anemia and eosinophilia and stool analysis resulted positive for hookworms’ eggs, identified as Ancylostoma duodenale with real time-PCR. Parasite research on parents’ stools resulted negative, and since the mother travelled to Vietnam and Thailand during pregnancy, we assumed a transplacental transmission of the infection. The patient was treated successfully with oral Mebendazole and discharged in good conditions. Discussion Hookworm helminthiasis is a major cause of morbidity in children in the tropics and subtropics, but rare in developed countries. Despite most of the patients is usually asymptomatic, children are highly exposed to negative sequelae such as malnutrition, retarded growth and impaired cognitive development. In infants and newborns, the mechanism of infection remains unclear. Although infrequent, vertical transmission of larvae can occur through breastfeeding and transplacentally. Hookworm infection should be taken into account in children with abdominal symptoms and unexplained persistent eosinophilia. The treatment of infants infected by hookworm has potential benefit, but further studies are needed to define the best clinical management of these cases.

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Consequences of antepartum hemorrhage and its maternal and perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191203 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1480

Author(s):

Himang Jharaik ◽

Bishan Dhiman ◽

S. K. Verma ◽

Aditi Sharma

Keyword(s):

Perinatal Outcome ◽

Placenta Previa ◽

Developed Countries ◽

Perinatal Morbidity ◽

Antepartum Haemorrhage ◽

High Risk Factors ◽

Fetal Complications ◽

Life Threatening ◽

One Year ◽

Life Threatening Event

Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications.

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