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Parasitic infections in transplant recipients

Nature Clinical Practice Nephrology volume 2, pages 490–503 (2006)Cite this article

Abstract

Parasitic infections are important complications of organ transplantation that are often overlooked in the differential diagnosis of post-transplantation pyrexial illness. Although their frequency is unknown, they seem to be much less prevalent than bacterial and viral infections. Only 5% of human pathogenic parasites have been reported to cause significant illness in transplant recipients. Infection can occur via transmission with the graft or blood transfusion, or be acquired de novo from the environment. Recrudescence of dormant infection can lead to active disease. Post-transplantation parasitic disorders tend to cluster into two clinical profiles. First, an acute systemic illness with anemia, constitutional manifestations and variable stigmata of organ involvement; acute graft dysfunction can lead to confusion and acute rejection. Protozoa including malarial Plasmodium, Leishmania, Trypanosoma and Toxoplasma are associated with this profile. The second typical manifestation encompasses a few localized syndromes, usually associated with the lower gastrointestinal tract, caused by either protozoa (Cryptosporidium and microsporidia) or nematodes (Strongyloides and Ascaris). Dissemination of localized infections can lead to life-threatening systemic manifestations. A high index of suspicion is essential, as diagnosis requires special sampling techniques and laboratory procedures. Definitive diagnosis is usually achieved by detecting the parasite in the patient's tissues or body fluids by histological examination or culture, or by polymerase chain reaction amplification of the parasite-specific antigen sequence. Antibody detection using serological techniques is also possible in a few parasitic infections. Certain lesions have characteristic radiological appearances, hence the value of imaging, particularly in the cerebral syndromes. Treatment is usually straightforward (broad spectrum or specific drugs), yet some species are drug resistant.

Key Points

  • Although only 5% of human pathogenic parasites have been reported to cause significant illness in transplant recipients, this phenomenon is increasingly recognized, particularly in industrialized countries

  • Infection with protozoa including malarial Plasmodium, Leishmania, Trypanosoma and Toxoplasma is associated with an acute systemic illness with anemia, constitutional manifestations and variable stigmata of organ involvement

  • Infection with the protozoa Cryptosporidium and microsporidia, or the nematodes Strongyloides and Ascaris, causes localized syndromes, usually of the lower gastrointestinal tract

  • Diagnosis can involve detecting the parasite (via histology or culture), parasite-specific antigens (via polymerase chain reaction), antibodies (via serology) or characteristic lesions (via radiology)

  • Pharmacological treatment of post-transplantation parasitic infection is usually straightforward, although some parasites have become drug resistant

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Figure 1: Global distribution of important reported parasitic infections of transplant recipients.
Figure 2: Broad schema of the life cycles of human pathogenic parasites, displaying the mechanisms of disease acquisition by transplant recipients.
Figure 3: Giemsa-stained blood films showing red cells infected with malaria and babesiosis.
Figure 4: Leishmaniasis.
Figure 5: Toxoplasmosis.
Figure 6: Chagas' disease.
Figure 7: Intestinal protozoa in transplant recipients.
Figure 8: Corneal opacity caused by Acanthamoeba castellanii keratitis.
Figure 9: Strongyloidiasis.
Figure 10: Schistosoma mansoni.

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  1. Professor of Medicine, Kasr-El-Aini Medical School, and Chairman of the Cairo Kidney Center, Cairo, Egypt

    Rashad S Barsoum

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Barsoum, R. Parasitic infections in transplant recipients. Nat Rev Nephrol 2, 490–503 (2006). https://doi.org/10.1038/ncpneph0255

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