Prevalence and risk factors of Strongyloides stercoralis infection among kidney transplant candidates in a tertiary hospital: a cross-sectional study

Objective: Strongyloides stercoralis infection poses a serious risk to kidney transplant (KT) candidates due to the potential for hyperinfection under immunosuppression, yet Philippine data remain limited. This study estimated the prevalence of S. stercoralis infection and identified associated risk factors among KT candidates in a tertiary transplant center. Patients and Methods: A cross-sectional study was conducted among 236 Filipino KT candidates evaluated at the National Kidney and Transplant Institute from September 2024 to September 2025. Stool samples were examined using direct smear and Harada-Mori culture, while sera were tested for anti-Strongyloides IgG by ELISA. Logistic regression was used to assess crude and adjusted associations between demographic, environmental, and clinical variables and seropositivity. Results: No infections were detected by stool-based methods. ELISA identified 45 positive (19.1%) and 16 borderline (6.8%) results, yielding a combined seroprevalence of 25.8%. In univariable analysis, walking barefoot increased the odds of infection (OR 2.43, 95% CI 1.34-4.42, p = 0.003), while female sex was associated with lower odds (OR 0.54, 95% CI 0.29-0.96, p = 0.044). In multivariable analysis, walking barefoot remained an independent risk factor (aOR 2.85, 95% CI 1.51-5.35, p = 0.001), while female sex was associated with lower odds (aOR 0.49, 95% CI 0.26-0.91, p = 0.025). Other sociodemographic and clinical characteristics were not significantly associated with seropositivity. Conclusions: A substantial burden of S. stercoralis infection was observed among asymptomatic Filipino KT candidates, detectable only through serology. The strong association with walking barefoot highlights a modifiable behavioral risk factor. Given the potential for fatal hyperinfection, serological screening with consideration of giving prophylaxis to both positive and borderline cases should be evaluated for integration into pre-transplant protocols. Larger multicenter studies incorporating molecular diagnostics are needed to refine screening strategies and confirm the clinical impact.