Multiple parasitic infections in a cardiac transplant recipient

Area of Science:

• Transplant Medicine
• Infectious Diseases
• Parasitology

Background:

• Infectious complications are a major cause of mortality in transplant recipients.
• Parasitic infections are less common but often overlooked in this patient population.
• Immunosuppressive therapy increases susceptibility to opportunistic infections.

Observation:

• A 13-year-old adolescent, post-cardiac transplant and on immunosuppression, presented with gastrointestinal symptoms.
• Stool analysis revealed Strongyloides stercoralis, Schistosoma intercalatum, and Cystoisospora belli.
• The patient had a history of residing in São Tomé Island, an endemic area for parasitic infections.

Findings:

• The patient was treated with a combination of ivermectin, albendazole, praziquantel, and ciprofloxacin.
• Successful clinical and microbiological resolution of the parasitic infections was achieved.
• Reduction in immunosuppressive therapy was implemented during hospitalization.

Implications:

• This case suggests that parasitic infections can reactivate in transplant recipients due to immunosuppression.
• It underscores the importance of considering parasitic infections, especially in patients with a history of travel to endemic regions.
• This report is the first to describe co-infection with Cystoisospora belli and Schistosoma intercalatum in a heart transplant recipient.