Chap 117 -- Infections In Transplant Recipients

CHAPTER 117 INFECTIONS IN TRANSPLANT RECEPIENTS

-lymphopriliferative disease (LPD) - 13 months after engrfment

A. BONE MARROW TRANSPLANT

- tx: ? EBV specific T cells; Rituximab ,

INFECTIONS: 1st month of bone marrow

ganciclovir; zidovudine

transplant

HHV -8 - Kaposi' s Sarcoma, primary effusion

LEVOFLOXACIN: decreases bacteremia

sarcoma, castle man

maong bone marrow transplant px

RSV and Parainfluena- fatal pneumonia on

1st few days: common org: aerobic( E coli,

BMT

klebsiella, Pseudomonas and thru skin or

- tx: aerosolized Ribavirirn, RSV Ig

catheter ( Staph coag -/+)

,Palivizumab

beyond 1st few days; Filamentous bacteria

Influenza- Oseltamivir and Zanamivir

( Nocardia/ Actininomyctes)

Rotavirus- gastoenteritis

Late posttransplant: encapsualted org (>6

Polyomavirus BK- hemorrhagic cystitis

months after BM reconstitution)

B. SOLID ORGAN TRANSPLANT

beyond 1st week: fungal (candida)

Early period( <1 month)- extracellular

TMP-SMX- prophylactic for Pneumocystis; 1

( Staph, strep, e coli,)

month after engrafment and continiung for at least 1 year - prophylactic also for Toxoplasma,

- origin : surgical wound or anostomotic sites CMV- 1st 6 months; sever systemic disease

Listeria, Nocardia, Strep and haemophilus

HHV 6 reactivation- w/in 1st 2 to 4 wks; fever

ACYCLOVIR: prophylactic for seropositve

and granulocytopenia

BMT/SCT; reduce mucositis and prevent HSV

CMV rejection related syndromes:

pneumonia

- glomerulopathy- kidney

: 2 wks after BMT excretion of virus of seropositve HSV 1

-bronchilitis obliterans- lung transplant

_ also good for Varicella- Zoster virus

-vanishing bile duct syndrome- liver

(low dose for the entire year)

transplant

CMV: 30- 90 days after transplant: great

Beyond 6 months: defects on CMI ( listeria ,

concern on the 2nd month

nocardia, fungi other intracellular org)

-assoc w/ used of alpha CD52 antibody among GVHD px -Ganciclovir- delay the devt of normal

EBV_LPD- 2 months to many years after transplant; heart and lung transplants 1) KIDNEY TRANSPLANTS

immune rsponse to CMV, not really protective - IVIg and Ganciclovir: tx for CMV

-Early: due ti skin and wound infections; Tx: Cephalosporins

pneumonia

-UTI- due to anatomical alterations

HHV-6 / Roseola- 2-4 wks after surgery: ?

from surgery (pyelonephritis)-longer duration

foscarnet

of tx

EBV- fatal to transplant recepients

appear after 6 mos: shorter duration of tx

-Prophylaxis: TMP-SMX -Middle period- lung infections w/ T-

- operation >12 hrs - inc incidence of infection

celldef( ICbacteria, nocardia, fungi, virus, parasite)

-PERITONITIS and Intraabdominal Abscess- Common complication

-Legionella pnuemophilia- high mortality

-Peritonitis- from biliary leak and primary or 2ndary infx,polymicrobil

- CMV- 1 to 4 months -fever,

-Abscess- w/in 1st month, spleen,

glomerulopathy; tx: administer Ig w/

liver, pericolic and pelvis,Tx: antibiotic and

antibodies w/ CMV

drainage

-EBV reactivation- extranodal prolif of

-middle: Cholangitis- devt postsurgical

B cells; invade CNS, nasopharynx, liver, small

stricture on biliary- fever abdominla paina nd

bowel heart and transplanted kidney

jaundice

-PAPOVAVIRUS:BK-nepropathy; JC

-Viral hepatitis- lamiduvine and

virus- progressive multifocal

adefovir for hepa B

leukoencephalopathy

5) Pancreas

- L. monocytogenes- most common

-infection prevented by draining

cause of bacteremia >= 1 month after renal

pancreas to urinary tract or bladder

transplantation

INdwelling cathter- S. aureus- bloodstream

-NOCARDIA- skin, bones, lungs and CNS, multiple abscess -Late infection (>6 months) - CMV

infxn w/in a week Tuberculosis- w/in 12 months VACCINATION:

retinitis, transplant ebow?, invasive fungal

For autologous and allogenic BMT recepients-

2) HEART TRANSPLANTS

(1 year and 2 years after)

-early: sternal wound infxn and

1) pneumococcal

mediastinitis -dx: sternal instability and failure to

-repeated every 5 years for px on immunosuppresants

heal

-every 3 years w/ significant exposure -middle: toxoplasmosis, CMV ,CNS

infxn

risk 2) H. Influenza type b conjugate vaccines

- late: EBV-lymphoma like 3) LUNG TRANSPLANTS -eearly: ischemia and mucosal

Add: (12-14and 16 months after) 3) N. meningitides polysaccharide disease 4) diphtheia vaccines

damage, denervtion and lack of lymph

5) tetanus vaccine

drainage

6) inactivated polio vaccine

- prophylactic broad spectrum 1st 3

OTHERS:

to 4 days antibiotics

7) Live virus MMR- BMT recepients 24 mos

4) LIVER TRANSPLANTS

after transplant

- infection on early; systemic broad spectrum antibiotic for the 1st 5 days