Aspectos epidemiológicos, clínicos e fatores de risco para síndrome de hiperinfecção por strongyloides stercoralis em pacientes submetidos a transplante renal

• Ano de defesa: 2018
• Autor(a) principal: Galvão, Lísia Miglioli [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300001r8wx
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Strongyloides stercoralis; Estrongiloidíase; Síndrome; Transplante de Rim
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6619586; https://repositorio.unifesp.br/handle/11600/53146

Objective: to describe epidemiological, clinical, diagnostic and treatment characteristics of Strongyloides stercoralis hyperinfection syndrome in kidney transplant patients, identify risk factors for hyperinfection syndrome and 30day mortality, compare early and late occurring cases. Methods: In a retrospective, multicenter, 1:2 casecontrol study, we assessed clinical outcomes and risk factors for Strongyloides stercoralis hyperinfection in kidney transplant patients in Brazil. Results: Forty six cases of Strongyloides stercoralis hyperinfection and 92 controls were included. Diagnosis was made after a median of 117 days after transplantation and 39.1% occurred after 6 months. Gastrointestinal (78.3%) and pulmonary (39.1%) symptoms were the most frequent clinical findings. Fever and eosinophilia were present in 32.6% and 43.5% of the patients respectively. Thirtyday crude mortality was 28.3% and was significantly higher for disease occurring before 3 months of transplantation (47% x 17.2%, p0.04). Independent risk factors for Strongyloides stercoralis hyperinfection were receiving a graft from a deceased donor (OR6.16, 95%CI 2.0518.5), a previous bacterial infection (OR3.04, 95%CI 1.27.5) and cumulative corticosteroid dose (OR1.005, 95%CI 1.0011.009). Respiratory failure (OR 98.33, 95%CI 4.462169.77) and bacteremia (OR 413.00, 95%CI 4.8335316.61) were independent predictors of mortality. Conclusions: Strongyloides stercoralis hyperinfection is associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, disease may occur later after transplantation, although it seems more severe earlier after transplantation. Specific risk factors (cumulative corticosteroid dose, previous bacterial infections and receiving a graft from a deceased donor) along with typical clinical manifestations (gastrointestinal and pulmonary symptoms) may be employed to identify patients at risk for prophylaxis or for early treatment.