Pre- and post-kidney transplant gnathostomiasis: Clinical manifestations, treatment, and outcomes

Gnathostomiasis (GNT) is a foodborne parasitic infection endemic to Southeast and East Asia. Its clinical relevance in transplant populations remains poorly defined. We assessed the clinical presentation, management, and outcomes of GNT in kidney transplant candidates and recipients in Thailand (2017-2023). Eighteen patients were identified (median age 51.5 years; 72.2% male), with 61.1% diagnosed at a median of 8.4 months posttransplant. Diagnosis was based on compatible clinical features and a positive Gnathostoma immunoblot test. Eosinophilia was more common in kidney transplant candidates than recipients (85.7% vs. 27.3%, P = .050). Posttransplant recipients predominantly presented with relative eosinophilia (72.7%), skin manifestations (36.4%), and leukopenia (36.4%). Strongyloidiasis coinfection occurred in 3 patients (16.7%), 2 of whom had gastrointestinal symptoms. All patients responded to antiparasitic therapy; however, 27.8% of patients required at least 1 retreatment course for persistent eosinophilic abnormalities. At 1 year after diagnosis of GNT, the median serum creatinine was 1.4 mg/dL (range, 0.7-11.8). Pretransplant cases had favorable posttransplant outcomes, with preserved graft function for 1 year. No deaths occurred. GNT is underrecognized in transplant recipients and often presents atypically, underscoring the need for clinical vigilance, evaluation for coinfection, and longitudinal posttreatment monitoring in endemic regions.