Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Classification of Parasitic Infections
3.2. The Evidence of Infections in Europe
3.3. Risk Factors
3.4. Major Parasitic Infections in Transplant Patients
3.5. Protozoan Infections Causing Diarrhoea
3.6. Other Parasitic Infections in Transplant Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Disease | Parasite | Endemic Areas | Diagnosis | Treatment |
---|---|---|---|---|
Malaria | Plasmodium falciparum, P. malariae, P. ovale, P. vivax, P. knowlesi | Tropical | Microscopic diagnosis (thick and thin blood smears); rapid diagnostic tests for malarial antigen; PCR assay testing | Uncomplicated malaria: P. falciparum—atovaquone with proguanil or artemether with lumefantrine P. vivax, P. ovale—chloroquine phosphate with primaquine phosphate Severe malaria: artesunate or quinine iv with doxycycline or clindamycin. |
Visceral leishmaniasis | Leishmania donovani | Tropical and temperate regions in Africa, China, India, Nepal, South America, southern Europe | Microscopic examination of bone marrow, peripheral blood or liver aspirate; PCR assay testing; serology | Systemic therapies: pentavalent antimonial compounds (sodium stibogluconate), pentamidine, liposomal amphotericin B, paromomycin, miltefosine Alternative treatment: fluconazole, itraconazole, ketoconazole, allopurinol, dapsone. Local therapies: cryotherapy, infiltration of sodium stibogluconate, topical paromomycin or urea |
L. infantum, L. chagasi | Mediterranean countries, Latin America | |||
Dermal leishmaniasis | L. tropica, L. major | The Middle East, China, India, Pakistan, Africa, Mediterranean countries | Microscopic examination of skin lesion specimens; PCR assay testing | |
L. aetiopica | Africa (Ethiopia, Kenya, Yemen) | |||
L. mexicana, amazonensis, brazilensis et al. | America | |||
Toxoplasmosis | Toxoplasma gondii | Cosmopolitan | Microscopic examination of infected tissue, blood or CSF; serology; PCR assay testing; imaging studies; fundoscopic examination | Pyrimethamine + folinic acid + sulfadiazine or clindamycin. Alternative treatment: pyrimethamine + folinic acid +azithromycin or clarithromycin or atovaquone or dapsone or trimethoprim/sulfamethoxazole Pregnant women: spiramycin, pyrimethamine + folinic acid + sulfadiazine |
Babesiosis | Babesia microti | Europe | Microscopic diagnosis (thick and thin blood smears); PCR assay testing; serology | Quinine + clindamycin Atovaquone + azithromycin |
B. divergens | USA | |||
GAE | Acanthameba sp. Balamuthia mandrillaris | Cosmopolitan | Histological examination of biopsied tissue; serology; PCR assay testing | Surgical resection with medical treatment. Amphotericin, miltefosine, rifampicin, fluconazole, azithromycin, pentamidine + sulfadiazine |
Amoebiasis | Entamoeba histolytica | Tropical Subtropical | Stool examination; histological examination of biopsied tissue; serology | Metronidazole, tinidazole Luminal amebicide: Paromomycin, diloxanide furoate |
Giardiasis (lambliosis) | Giardia duodenalis | Cosmopolitan | Stool examination; duodenal biopsy and aspirates | Metronidazole, albendazole, nitazoxanide |
Cryptosporidiosis | Cryptosporidium sp. | Cosmopolitan | Stool examination | Nitazoxanide |
Cystoisosporiasis | Cystoisospora belli | Trimethoprim/sulfamethoxazole, pyrimethamine, ciprofloxacin | ||
Cyclosporiasis | Cyclospora cayetanensis | Trimethoprim/sulfamethoxazole | ||
Microsporidiosis | Enterocytozoon bieneusi Encephalitozoon intestinalis | Cosmopolitan | Stool and urine examination; PCR assay testing; histologic examinations | Topical and oral fumagillin Albendazole |
Strongyloidiasis | Strongyloides stercoralis | Cosmopolitan, endemic in the tropics and limited foci in USA, Europe, Australia and Japan | Stool examination; serology | Ivermectine, albendazole |
Schistosomiasis | S. japonicum | The Far East | Stool or urine examination; serology; histological examination of biopsied tissue | Praziquantel |
S. mansoni | The Middle East, Western Africa, South America | |||
S. haematobium | Africa, The Middle East, India | |||
Taeniasis | Taenia solium, T. saginata, T. asiatica | Cosmopolitan | Stool examination; serology | Praziquantel, albendazole |
Cysticercosis | T. solium | Cosmopolitan | Imaging studies | Praziquantel, albendazole; surgery |
Hymenolepiasis | Hymenolepis nana | Cosmopolitan | Stool examination | Praziquantel, nitazoxanide, niclosamide |
Alveolar echinococcosis | Echinococcus multilocularis | Northern hemisphere | Serology; imaging studies | Albendazole, mebendazole, surgery (partial resection of a liver, hemihepatectomy, liver transplantation), biliary stenting |
Cystic echinococcosis | Echinococcus granulosus | Cosmopolitan | Albendazole, mebendazole, surgery (total pericystectomy or partial hepatectomy), percutaneous treatment (PAIR) | |
Norwegian scabies | Sarcoptes scabiei hominis | Cosmopolitan | Microscopic visualization of mites, larvae, ova or feces in skin scrapings | Ivermectin, permethrin, lindane |
Demodicosis | Demodex folliculorum | Cosmopolitan | Microscopic visualization of Demodex mites in skin scrapings | Crotamiton cream, permethrin cream, topical or systemic metronidazole, ivermectin |
Disease | Type of Transmission | Importance | |||
---|---|---|---|---|---|
Donor Derived | Reactivation | New Onset | Population in Danger | Mortality | |
Malaria | Possible, few cases were reported in Europe | Possible in P. vivax and P. ovale infections | The most common | One of the most important causes of fever in travellers to tropics | 6% mortality after KTx, 40% mortality after LTX. |
Visceral leishmaniasis | Suggested in literature | Possible | The most common | Travelers to tropics, inhabitants of South Europe | 20% mortality after Tx. |
Toxoplasmosis | Possible, serological examination of donors is recommended | The most common | Possible | High prevalence in Europe | 60% mortality in disseminated disease. |
Amoebiasis | Unlikely | Possible | Possible | Travelers to tropics | High mortality in disseminated disease. Liver amoebic abscess is a typical complication in patient with IS. |
Other protozoan infections causing diarrhoea | Unlikely, although cases of donor derived microsporidosis were reported | Possible | Possible | Giardiasis is relatively common in Europe. The real danger is a possiblity of epidemic caused by contaminated food or water. | Relatively mild when only diarrhoea occurs. High mortality in disseminated disease. |
Strongyloidiasis | Not reported | Possible | Possible | Travelers to tropics. | HIS is a typical manifestation of disseminated disease with high mortality. |
Schistosomiasis | Not reported | Possible, especially when schistosomiasis was an indication for LTx | Possible | Travelers to tropics | Relatively good prognosis with low mortality. |
Infections caused by tape worms | Unlikely | Possible, especially when AE was an indication for LTx | Possible | Rare but still present in in Europe | Relatively good prognosis with low mortality. |
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Wołyniec, W.; Sulima, M.; Renke, M.; Dębska-Ślizień, A. Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients. Medicina 2018, 54, 27. https://doi.org/10.3390/medicina54020027
Wołyniec W, Sulima M, Renke M, Dębska-Ślizień A. Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients. Medicina. 2018; 54(2):27. https://doi.org/10.3390/medicina54020027
Chicago/Turabian StyleWołyniec, Wojciech, Małgorzata Sulima, Marcin Renke, and Alicja Dębska-Ślizień. 2018. "Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients" Medicina 54, no. 2: 27. https://doi.org/10.3390/medicina54020027