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Chagas disease is a vector-borne infection caused by the protozoan Trypanosoma cruzi that is endemic in Latin America. More recently, the geographic distribution of the disease has changed due to immigration of asymptomatic infected individuals from endemic to non-endemic regions. Therefore, Chagas disease involving acute infection among negative recipients receiving a transplant graft from positive donors and reactivation episodes among positive recipients due to posttransplant...
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Free-living amoebae (FLA) are ubiquitous in the environment. Although they rarely cause infection in humans, when they do so, the infection is often severe and diagnosed late. The three most clinically relevant genera of FLA are Acanthamoeba spp., Naegleria fowleri, and Balamuthia mandrillaris. An increasing body of literature points to these organisms as potential diseasecausing agents in immunocompromised and transplant patients, particularly with regard to donor-derived infections. This...
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Although a less common cause of gastrointestinal illness in transplant recipients than bacterial or viral etiologies, intestinal parasitic infections can result in severe and prolonged disease in this population. In the developed world, diagnostic delays stemming from low clinical suspicion for intestinal parasites (and the limitations of standard diagnostics) can worsen outcomes in these patients. As travel becomes more frequent among patients both before and after transplant, and with the...
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Background Cryptosporidium enteritis can be devastating in the immunocompromised host. In pediatric liver transplant recipients, infection may be complicated by prolonged carriage of the parasite, rejection, and biliary tree damage and fibrosis. Herein, we report on six patients and their long-term outcomes following cryptosporidiosis. Methods We reviewed all cases of cryptosporidiosis in a pediatric liver transplant population over a 17-year period at a single center. Six patients with...
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<h2>Summary</h2><h3>Background</h3><p><i>Strongyloides stercoralis</i> infection is a neglected condition that places people who are immunocompromised at risk of hyperinfection and death. Ivermectin is the drug of choice for the treatment of <i>S stercoralis</i> infection, but there is no definitive evidence on the optimal dose. This trial aimed to assess whether multiple doses of ivermectin were superior to a single dose for the treatment of non-disseminated...
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Toxoplasma gondii and Strongyloides stercoralis are important parasitic infections in transplant recipients. These helminths can lead to severe and often life-threatening disease in immunocompromised patients. Toxoplasma gondii can cause an undifferentiated febrile syndrome, encephalitis, pneumonitis, myocarditis, hepatitis, and retinochoroiditis, whereas S. stercoralis infestation, can lead to the hyperinfection syndrome, which carries a high mortality rate. Effective therapies are...
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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a...
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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tissue and blood protozoal infections in the pre- and post-transplant period. Significant new developments in the field have made it necessary to divide the previous single guideline published in 2013 into two sections, with the intestinal parasites separated from this guideline devoted to tissue and blood protozoa. The...
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We report the case of a 65-year-old patient with pseudolymphoma who developed acute toxoplasmosis following 6 cycles of rituximab and bendamustine therapy. Acute toxoplasmosis in the setting of biological response modifiers, rather than reactivation, is a unique unreported infection. The patient developed severe disease with multi-organ involvement, including retinitis, myocarditis, and myositis. We discuss the clinical findings, epidemiology, and laboratory diagnosis.
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Toxoplasma disease in non-OHT predominantly occurs in pretransplant seronegative recipients- mostly in Dþ/R- group and is rare in seropositive recipients. Posttransplant prophylaxis should be targeted against the high-risk Dþ/R- group and should be considered in seropositive recipients in whom unusually high immunosuppression is implemented. Toxoplasma serologies and PCR should be used in combination for the diagnosis of toxoplasmosis in non-OHT patients.
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Background Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is...
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After a cluster of fatal toxoplasmosis among stem cell transplant recipients at 2 hospitals, surveillance with polymerase chain reaction (PCR) (blood) was instituted. Rate of reactivation among seropositive recipients was 2.2 and 16%. Parasitemia was successfully managed with preemptive treatment. For seropositive recipients unable to take prophylaxis, toxoplasma PCR surveillance should be routinely performed.
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Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney–pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed. S. stercoralis larvae were detected in duodenal aspirates, bronchial...
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Although Trypanosoma cruzi, the parasite that causes Chagas disease, can be transmitted via organ transplantation, liver and kidney transplantation from infected donors may be feasible. We describe the outcomes of 32 transplant recipients who received organs from 14 T. cruzi seropositive donors in the United States from 2001 to 2011. Transmission was confirmed in 9 recipients from 6 donors, including 3 of 4 (75%) heart transplant recipients, 2 of 10 (20%) liver recipients and 2 of 15 (13%)...
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GUIDELINES
- AST Guidelines 2019 (2)
- ECIL Guidelines (1)
TEXTBOOKS
ORGANISMS
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PARASITES AND PROTOZOA
- Chagas (10)
- Protozoa (12)
- Strongyloides (14)
- Toxoplasmosis (12)
- FUNGI (1)
DIAGNOSTICS
- Parasites (3)
SYNDROMES AND CONDITIONS
- Diarrhea (2)
HEME-ONC AND CELLULAR THERAPIES
- BMT-specific ID (1)
- Heme malignancies (1)
- Heme-onc prophylaxis (1)