Daijiworld Media Network – Boston

Boston, Jun 21: In a medical case that has now prompted a change in national transplant policy in the United States, a 61-year-old man who underwent a kidney transplant faced a life-threatening parasitic infection just two months after the procedure.

The man, who initially showed signs of recovery post-surgery, returned to Massachusetts General Hospital with troubling symptoms – fatigue, nausea, vomiting, excessive thirst, and frequent urination. As his oxygen levels dipped and fluid filled his lungs, he was quickly moved to the ICU. Despite intensive treatment, his condition continued to worsen.

Doctors at the hospital, including Dr Camille Kotton, Clinical Director of Transplant and Immunocompromised Host Infectious Diseases, embarked on a thorough investigation. With the patient on immunosuppressive drugs, the list of possible infections was vast. However, a combination of elevated eosinophil levels and a rash on his abdomen pointed toward a parasitic infection.

Dr Kotton suspected Strongyloides – a gastrointestinal parasitic roundworm – and contacted the regional organ-procurement agency. It was revealed that the kidney donor was from the Caribbean, a region where Strongyloides is commonly found.

Though the donor was never screened for this parasite, blood samples showed antibodies indicating infection. Meanwhile, the recipient had tested negative before the transplant. Lab tests confirmed the presence of worm larvae in the patient's lungs and stool.

Due to the severity of the infection, the patient was administered ivermectin – an FDA-approved deworming drug – through subcutaneous injection under special approval. He slowly began to recover. Soon after, it was reported that the recipient of the donor's other kidney was also critically ill with the same infection. Following a coordinated medical response, both patients survived.

This rare yet serious case, detailed in the New England Journal of Medicine, has now led the United Network for Organ Sharing (UNOS) to recommend universal screening for Strongyloides in all organ donors – a move aimed at preventing such avoidable complications in future transplants.