# P-2115. Seroprevalence of Strongyloides stercoralis amongst pediatric solid organ transplant candidates at a tertiary pediatric medical center in the United States

## TL;DR

This study found a low rate of Strongyloides infection in children awaiting organ transplants, even among those without typical risk factors.

## Contribution

The study identifies seropositivity in pediatric transplant candidates in a non-endemic region and suggests universal screening for Strongyloides.

## Key findings

- Strongyloides seropositivity was found in 3.1% of pediatric SOT candidates.
- Some seropositive patients lacked classic risk factors like travel to endemic regions.
- Universal screening for Strongyloides in SOT candidates over 2 years old is recommended.

## Abstract

Strongyloides stercoralis is an intestinal nematode endemic to Appalachia and the southeastern United States. Solid organ transplant (SOT) recipients are at risk of Strongyloides hyperinfection, characterized by massive parasite burden and disseminated infection. Screening of SOT candidates with risk factors for strongyloidiasis is recommended to prevent infection. The prevalence of Strongyloides infection in the United States and how to identify at-risk patients is not well understood. This study sought to define Strongyloides seropositivity in pediatric SOT candidates in a region not considered endemic for infection.Table 1Demographic and clinical characteristics of patients in the cohort

Demographic and clinical characteristics of patients in the cohort

This was a retrospective study of patients who underwent evaluation for SOT during 2023-2024 at Cincinnati Children’s Hospital Medical Center, where all SOT candidates undergo screening for Strongyloides infection. Demographic and clinical data were collected and described. Variables were compared between groups using the Chi-square test and Wilcoxon rank sum test for continuous variables.

A total of 97 patients underwent evaluation for SOT. The cohort was majority White, non-Hispanic males (Table 1). Strongyloides seropositivity was noted in 3/97 patients (3.1%, 95% confidence interval 0.6%-8.7%), only one of which had traveled to or lived in Appalachia. When excluding children < 2 years of age, 3/69 (4.3%, 95% CI 0.9-12.2%) were seropositive. Overall, 25/97 (25.8%) of patients in the cohort had exposure to the Appalachian region, while 10/97 (10.3%) were born, lived in, or traveled to other countries. Between seropositive and seronegative patients, there was no difference in exposure to Appalachian regions or other risk factors of Strongyloides infection. Seropositive patients were more likely to have eosinophilia (2/3 versus 16/94, p = 0.03). Other clinical signs or symptoms of infection were similar between groups.

In this cohort of pediatric SOT candidates cared for at a transplant center adjacent to an endemic region, Strongyloides -seropositivity was low. There were seropositive patients without classic risk factors for Strongyloides infection. Universal screening for Strongyloides in SOT candidates > 2 years of age should be considered to minimize risk of Strongyloides hyperinfection in at-risk patients.

Grant C. Paulsen, MD, Moderna, Inc: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi: Grant/Research Support Lara A. Danziger-Isakov, MD, MPH, Aicuris: Grant/Research Support|Ansun BioPharma: Grant/Research Support|Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer (Any division): Grant/Research Support|Takeda: Grant/Research Support