Dyal, Natasha Priya

Abstract Background Strongyloides stercoralis is an intestinal parasitic nematode with a 2% - 7% prevalence in the United States. Immunosuppression can predispose to disseminated infection, concurrent bacterial sepsis and significant morbidity and mortality. We sought to review positive Strongyloides serology (PSS) results across 3 academic medical centers. Methods Electronic medical records of patients with PSS were reviewed between 2012 and 2023. Extracted data included demographics, country of origin, travel history, testing indication, clinical presentation, treatment regimen and duration. Patients were classified into chronic infection (PSS without additional clinical manifestations), hyper infection syndrome (cutaneous, gastrointestinal tract, or lung involvement), and disseminated infection (evidence of involvement of distant sites beyond hyper infection such as the brain, liver, kidneys, or bloodstream). Results Overall PSS rate across the 3 sites was 5.5%. A total of 412 patients with PSS were identified with a mean age of 56.7 years (SD ±14.2); 272 (66%) were male. The primary indication for testing was transplant evaluation in 230 (56%), eosinophilia workup in 84 (20%), suspicion of active infection in 74 (18%), travel history in 27 (7%), and pre-immunosuppression screening in 27 (7%). 401 (97.3%) were categorized as chronic infection,10 (2%) as hyper infection, and one patient (0.2%) as disseminated infection. Treatment was administered to 366 (89.3%) patients: 226 (61.7%) received 2 doses of Ivermectin on consecutive days, 94 (25.7%) received a single dose, 26 (7.1%) received 2 doses repeated 2 weeks later, and 20 (5.5%) received alternative regimens. The patient with disseminated infection received 2 weeks of Ivermectin followed by monthly dosing. Conclusion Majority of the patients with PSS were asymptomatic, and treatment regimens were not uniform. Screening should be considered for patients currently receiving or initiating long-term immunosuppression that can potentiate Strongyloides dissemination. Developing a targeted testing algorithm based on epidemiologic factors, clinical suspicion, laboratory parameters and nature of immunosuppression can help identify at-risk patients who can receive pre-emptive therapy if infected. Disclosures All Authors: No reported disclosures

Abstract Background Recipients of solid organ transplant (SOT) have higher risk for infections, and the prevalence of mycobacterium tuberculosis liver abscess (MTB-LA) without pulmonary/disseminated MTB is 0.34%. However, there is little research on MTB-LA in SOT recipients. Mycobacterium tuberculosis Liver Abscess Cases Upon extensive literature review, this chart details all published, English-language cases of mycobacterium tuberculosis liver abscess in solid organ transplant recipients. Methods We conducted an extensive literature review of MTB-LA in adult SOT recipients. Results Our review showed 4 cases of MTB-LA in SOT recipients (table below). We detail 1 additional case. A 58-year-old male with ESRD due to type 2 diabetes mellitus, and latent MTB underwent kidney transplantation in March 2023. He completed a 6-month course of isoniazid and vitamin B6 for latent MTB 1 month before transplant. His post-operative course was uncomplicated; he was discharged to follow up with his nephrologist. He later developed norovirus illness with fever, which was conservatively managed. He developed new fevers 3 months post-transplant and CT of the abdomen/pelvis revealed a liver abscess, which was treated with empiric broad spectrum antibiotics, and was not amenable to aspiration. At his 4-month post-transplantation, he complained of fatigue, night sweats, poor appetite, and weight loss requiring hospitalization, wherein an MRI of the abdomen/pelvis identified a 3.6 x 3.2 x 6.2 cm liver abscess. The liver abscess aspirate was positive on acid fast bacilli smear and MTB polymerase chain reaction. He was initiated on antituberculosis therapy with isoniazid, rifabutin, pyrazinamide, and ethambutol. Susceptibilities identified pyrazinamide resistance, and led to substitution with levofloxacin. Labs, imaging and microbiology testing were negative for evidence of pulmonary/disseminated MTB. His donor’s information was reviewed; no obvious risk factors for active MTB were found. The recipient of the mate kidney is doing well without evidence of MTB infection. After 2 months of 4-drug antituberculosis therapy, ethambutol was discontinued. CT scan of the abdomen and pelvis at 4 months post anti-tuberculosus therapy revealed a 3 cm area of residual inflammation at the site of prior MTB-LA, in the setting of resolution of prior symptoms. Conclusion Early imaging and diagnostic aspiration of liver abscess with specific stains, culture and PCR testing can facilitate rapid diagnosis and initiation of antituberculosis therapy. Disclosures All Authors: No reported disclosures