Allogeneic hematopoietic stem cell transplant recipients and parasitic diseases: A review of the literature of clinical cases and perspectives to screen and follow-up active and latent chronic infections.

Background: Solid organ transplant (SOT) recipients have a high risk for a variety of infections depending on numerous factors: the graft itself, degree of immunosuppression, host factors, and period after transplantation. Bacterial, fungal, viral, as well as parasitic infections can occur with high morbidity and mortality. Objectives: The aim of this study was to evaluate the magnitude of the occurrence of parasitic infections in SOT recipients. Materials and Methods: We systematically reviewed literature records on post-transplant parasitic infections, identified through PubMed database searching, using no language or time restrictions. Search was concluded on December 31st 2015. In the present review we only discussed post-transplant parasitic infections in SOT. In a previous review we discussed allogeneic haematopoietic stem cell transplant (HSCT). The only exclusion criterion was the absence of sufficient information on the transmission of parasitic infection. The methods and findings of the present review have been reported based on the preferred reporting items for systematic reviews and meta-analysis checklist (PRISMA). Results: From data published in the literature the real burden of parasitic infections, among SOT recipients, cannot be really estimated. Nevertheless, a positive trend on publication number exists, probably due to more than one reason: i. the increasing number of patients transplanted and then treated with immunosuppressive agents; ii. the “population shift” resulting from immigration and travels to endemic areas, and iii. the increased attention directed to diagnosis/notification/publication of cases. Conclusions: Considering parasitic infections as emerging and potentially serious in their evolution, additional strategies for the prevention, careful screening and follow-up, with a high level of suspicion, identification, and pre-emptive therapy are necessary in transplant recipients.