Seroprevalence of Strongyloides stercoralis in Patients on Hemodialysis

Résumé fourni par la source

Background: Strongyloides stercoralis (S. stercoralis) is a parasitic infection endemic to tropical areas. Its prevalence is rising in Europe. In kidney transplant (KTX) recipients, corticosteroids can cause hyperinfection syndrome, marked by accelerated autoinfection, high parasite burden, hyperinflammation, and sepsis. Hyperinfection syndrome can be prevented with a short course of ivermectin. Given this risk, routine S. stercoralis screening in KTX candidates is warranted. We assessed S. stercoralis prevalence in all hemodialysis patients with end-stage renal disease in Vienna, Austria. Methods: Blood samples were collected from all consenting hemodialysis patients (N=704) and tested for IgG-antibodies via ELISA. A questionnaire assessed soil exposure, medical history, transplant status, travel, helminthic symptoms, and immunosuppressive therapy. Positive serologies were reanalyzed by the Austrian reference center for parasitosis; three stool samples were examined for eggs/larvae. Results: Of the 704 patients, 116 (16.1%) had a history of organ transplantation. IgG antibodies against S. stercoralis were found in 50 patients (6.9%), including four with a prior KTX. No significant differences were observed between IgG-positive and negative patients regarding travel to endemic areas, pet ownership, soil contact, symptoms of helminthic infection, immunosuppressant use, or history of KTX (p-values: 0.76, 0.19, 0.15, 0.95, 0.96, 0.22, respectively). Patients from Western Europe were less likely to be IgG-positive (p=0.02), while those from the Middle East & North Africa (MENA) were more likely to test positive (p=0.03). Serum-IgE and CRP levels did not predict IgG presence, but absolute and relative eosinophilia were significantly associated with IgG positivity, with cut-offs of ≥0.19G/L and ≥1.95%, respectively ([AUC=0.87 (0.81–0.92)], [AUC=0.84 (0.79–0.90)]). Conclusion: S. stercoralis prevalence has been underestimated and is rising globally. Due to the risk of hyperinfection syndrome and the growing immunocompromised population, screening should be included in pre-KTX protocols—especially in patients from MENA regions or with absolute eosinophil counts ≥0.19G/L. Funding: Government Support – Non-U.S.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.