United States: Two American men unknowingly became hosts to parasitic worms after undergoing kidney transplants from a single donor, according to a disquieting case disclosed in the New England Journal of Medicine on June 18.
The source of the infection? A deceased donor who had previously lived in the Caribbean — a region where certain parasites, like Strongyloides stercoralis, silently linger within hosts for years.
The first recipient, aged 61, had his surgery at Massachusetts General Hospital. Roughly ten weeks post-operation, his health took a rapid downturn. Initially checked into another hospital, he was soon rerouted back to MassGen in a deteriorating state — gripped by relentless nausea, vomiting, an unquenchable thirst, stomach pain, and burning fever. Fluid began to collect in his lungs, making each breath feel like a desperate gasp. His oxygen saturation plunged. Blood pressure collapsed. His body slipped into a dangerous state of respiratory failure and circulatory shock.
A sprawling bruise-colored rash began blooming across his torso — a sinister sign of internal turmoil. Doctors escalated the case to intensive care, launching a full-spectrum investigation. With his immune defenses intentionally suppressed to safeguard the transplant, the man had little resistance to lurking infections.
The task of unraveling his condition fell heavily on a multidisciplinary team, including renowned infectious disease authority Dr. Camille Kotton. With bacterial causes ruled out, and no viral suspects detected (including SARS-CoV-2), parasitic infiltration moved to the top of the list. Bloodwork revealed a spike in eosinophils — the body’s frontline soldiers against worms and parasites — tipping the scales further in that direction. Drug reactions and rejection were unlikely. The mystery grew clearer, according to livescience.com.
Kotton, familiar with cases of parasitic cross-contamination via transplants, zeroed in on Strongyloides stercoralis. This tiny nematode can lurk undetected in donors from tropical climates. Reaching out to New England Donor Services, she asked them to test preserved blood from the donor. The results confirmed her hunch: the donor had antibodies against Strongyloides, a clear signal of prior infection.
Further lab studies confirmed the recipient had developed antibodies to Strongyloides after the transplant, not before — locking in the diagnosis. The worms had traversed deep within him — burrowing into abdominal tissues, invading his lungs, even reaching his skin.
While infections from transplants are rare in the US — just 14 out of every 10,000 over a decade — this case illuminated how a single unseen threat could slip through. Organ screening protocols, while thorough, aren’t infallible. Some pathogens hide too well.
A review cited in the case report found Strongyloides was responsible for 42% of parasitic infections caught through transplant transmissions. Despite this, fewer than 25% of transplant agencies were regularly screening for the parasite until recently. In 2023, the national transplant network finally mandated universal testing.
For treatment, the medical team turned to ivermectin — a high-powered antiparasitic. But the standard approach wouldn’t cut it. Given the severity of the body-wide infestation, they got clearance to administer it subcutaneously, injecting it beneath the skin for broader absorption. The strategy worked. The man’s health rebounded.
Meanwhile, alarm bells rang across transplant centers. Other hospitals that had used organs from the same donor were alerted. At Albany Medical Center, a 66-year-old man — who’d received the other kidney — was now struggling with fatigue, low white blood cell counts, and failing kidney metrics, as reported by livescience.com.
Thanks to inter-hospital communication and the shared findings from MassGen, his doctors acted quickly. They identified the parasitic culprit and treated him in time, averting a similar collapse.
An Albany Medical Center spokesperson later noted, “Organ transplants are lifesaving. But in rare scenarios like this, fast coordination between hospitals, infectious disease experts, and our regional procurement network was absolutely vital.”
Key Takeaways:
- Transplant infections are rare but potentially deadly.
- Strongyloides can live undetected in hosts from tropical areas for years.
- Universal screening for this parasite only became standard in 2023.
- Fast communication between hospitals can mean the difference between life and death.
- Advanced treatment options, like subcutaneous ivermectin, may be necessary in severe systemic infections.