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Strongyloides stercoralis  is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for  Strongyloides stercoralis  hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for  Strongyloides stercoralis  seropositivity by established ELISA testing. Positive  Strongyloides stercoralis  serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His  Strongyloides  IgG signal had been elevated for years before the outbreak of the disease.  Stronglyoides  infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as S trongyloides  infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some  Strongyloides stercoralis  seropositive individuals develop hyperinfection syndrome and others do not.

Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe