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Trichomonas Vaginalis Case

57:33 recording · AUTO · 3 speakers

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Brief overview

A positive strongyloides serology before kidney transplant should be treated with ivermectin; the worm is endemic stateside.

  1. Strongyloides can be acquired without leaving the United StatesDaniel stresses that parts of the US are endemic, which is why every pre-transplant patient is screened.
  2. Negative stool testing does not rule strongyloides outStool microscopy and PCR lack sensitivity because a chronically infected person may not be shedding larvae.
  3. Treat presumptively with ivermectin before immunosuppressionTwo doses of ivermectin are well tolerated and prevent hyperinfection once transplant steroids begin.
Executive Summary AI
  • Daniel Griffin presents a real case: a man in his 20s admitted with electrolyte problems from end-stage renal disease, found on pre-transplant evaluation to have a positive strongyloides serology despite no international travel and no interesting exposures.6:16
  • Listeners from Vienna, Sydney, Tennessee, Germany, Europe and Innsbruck weigh false positives and cross-reactivity against the risk of hyperinfection, one noting that roughly 60% of hyperinfection cases are associated with corticosteroid use.10:59
  • Daniel and Christina Naula walk the life cycle: filariform L3 larvae penetrate intact skin, adult females live in the small intestine, and larvae maturing in the gut can set up decades-long autoinfection that steroids accelerate.24:41
  • Because stool studies and PCR are not sensitive enough to rule out low-level infection, the team confirmed the serology and treated the patient with two doses of ivermectin, a well-tolerated cure that keeps him on the transplant list.30:07
  • Christina's hero is Welsh helminthologist Florence Gwendolyn Rees, who finished her liver-fluke PhD in eighteen months, published 68 original papers, and in 1971 became the first Welsh woman elected to the Royal Society.44:02
Key Quote
“And it is the larvae will actually penetrate through intact skin.”
— Daniel Griffin24:41
Key Quote
“You do not need to go overseas.”
— Daniel Griffin32:25
Key Quote
“So I would have, knowing this now, I would have said, yeah, treat them with ivermectin because of this for sure.”
— Vincent Racaniello35:01