腎臟移植病患者伴隨糞小桿線蟲感染之案例報告

Strongyloides stercoralis Infection in a Patient with Renal Transplantation

糞小桿線蟲 （Strongyloides stercoralis） 是一種藉由土壤傳播的腸道線蟲，依世界衛生組織統計，目前全球約有一億人口受到感染，感染者通常產生慢性或無症狀感染的情況。然而，免疫功能低下患者在受到糞小桿線蟲感染後，卻有極高機率產生重度感染甚至死亡。近年來，由於器官移植率增加，糞小桿線蟲藉由器官移植而造成傳染之議題已逐漸受到重視。本論文為在中國進行第二次腎臟移植之患者，受到糞小桿線蟲繼發感染之報告。由於該患者在進行第二次移植後約三個月出現了非典型腸胃道症狀和嗜酸性白血球增多的情形，以汞磺醛液離心沉澱法 （MIF; Merthiolate-Iodine Formaldehyde concentration method） 進行糞便鏡檢分析，發現檢體中具有糞小桿線蟲的桿狀幼蟲（rhabditiform larvae）。以每鞭達挫 （Mebendazole） 及絲每妥錠 （Ivermectin） 進行治療後，患者恢復健康。依據此患者之病例分析，器官之捐贈者可能患有糞小桿線蟲症，導致移植後免疫力低下之受贈者產生嚴重的感染症狀。因此，身處在具有高度流行好發之地，由於透過器官移植感染之情況在臨床上極有可能被忽略，建議進行糞小桿線蟲篩檢。此外，若受贈者在接受移植後表現出非典型症狀並伴隨有嗜酸性白血球增多情況，應考慮器官移植導致糞小桿線蟲感染的可能性。

Strongyloides stercoralis (S. stercoralis), a soil-transmitted intestinal nematode, usually causes chronic and asymptomatic infection with approximately 100 million people worldwide. However, in immunocompromised patients, infection of Strongyloides stercoralis may result in hyperinfection and disseminated infection with high mortality rates. Recently, transmission of S. sterco ralis through solid organ transplantation is gradually noticed due to the increase in transplants. We repo rt a case of S. stercoralis infection in a patient who has underwent the second renal transplantation in Chin a. This patient presented the non-specific gastrointestinal symptoms and eosinophilia approximately 3 months after his second transplantation. The rhabditiform larvae of S. stercoralis was identified by stool examination using Merthiolate-Iodine Formaldehyde (MIF) concentration method. This patient was successfully treated with Mebendazole and Ivermectin. In this case, the donor was considered as a possibl e source of S. stercoralis infection. Given that donor-derived Strongyloidiasis is often neglected but has a pot ential risk to cause severe syndromes, pre-transplant screening of S. stercoralis should be strongly consider ed in transplant recipients or donors with epidemiological risk factors or unexpected eosinophilia. Moreover, Strongyloidiasis might be taken into consideration after organ transplantation in the recipients showing non-specific symptoms accompanying with eosinophilia.