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Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients, but is rare among recipients of hematopoietic stem cell transplant (HSCT). Infection often occurs a year after transplantation; however early infections are common in HSCT. Among SOT patients, donorderived infections have been described within 3 months after transplant. The most common disease manifestations are meningitis and pneumonia. The fungi Cryptococcus neoformans and C. gattii are the main causes of cryptococcosis.

Polyomavirus-associated nephropathy (PyVAN) and hemorrhagic cystitis (PyVHC) occur almost exclusively after kidney transplantation (KT) and allogeneic hematopoietic stem cell transplantation (HSCT), respectively. In addition, PyV-associated urothelial cancer (PyVUC) is emerging after KT. These diseases are attributed to BK polyomavirus (BKPyV), a small non-enveloped, doublestranded DNA virus infecting >90% of the general population followed by renal persistence. PyVAN causes premature...

The incidence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) and carbapenem-resistant Enterobacterales (CRE) infections has been increasing worldwide, although the prevalence and mechanism of resistance vary by geographic region and institutional patterns of resistance. These multidrug-resistant infections are challenging to diagnose and treat and can cause significant morbidity and mortality in transplant patients. In this chapter we highlight recent trends in...

Infections are an important cause of morbidity and mortality after transplantation. Some of these infections are environmental and geographically or seasonally important. West Nile virus is one such infection, tied to the epidemiology of infected mosquitos which varies over time. It can cause disease for a transplant recipient either from direct inoculation from an infected mosquito or as a donorderived infection. This chapter reviews current data about the epidemiology of West Nile virus,...

Cystic fibrosis is an autosomal recessive inherited disorder of salt transport. The natural history of the disease is determined by the development of chronic bronchiectasis and ensuing chronic colonization with multidrug-resistant bacteria and fungi. End-stage lung disease commonly necessitates lung transplant, and occasionally even combined lung/liver or lung/kidney transplant may be the only way forward for affected patients. Due to the common organisms colonizing the lungs of patients...

Coccidioidomycosis is an infection due to the fungal species Coccidioides, which is most heavily endemic in the desert southwestern USA. Although early studies of this infection among transplant recipients in the endemic region were complicated by high morbidity and mortality, solid organ and hematologic stem cell transplantation can be a successful undertaking within the Coccidioides-endemic region. Such success has been attributed to careful attention to screening for and treatment of...

Invasive aspergillosis is a major cause of morbidity and mortality in hematopoietic stem cell transplant and solid organ transplant recipients. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has decreased the mortality rates associated with invasive aspergillosis.

Respiratory viruses are among the most common causes of infection among solid organ and hematopoietic stem cell transplant recipients. Respiratory viruses, such as influenza and respiratory syncytial virus, can cause a range of disease from asymptomatic shedding, upper respiratory infections, to life threatening pneumonia. In addition, respiratory viruses may be associated with chronic sequelae, including devasting late complications such as chronic rejection in lung transplant recipients and...

Chagas disease is a vector-borne infection caused by the protozoan Trypanosoma cruzi that is endemic in Latin America. More recently, the geographic distribution of the disease has changed due to immigration of asymptomatic infected individuals from endemic to non-endemic regions. Therefore, Chagas disease involving acute infection among negative recipients receiving a transplant graft from positive donors and reactivation episodes among positive recipients due to posttransplant...

Infectious and noninfectious diarrheas are important complications in immunocompromised host (ICH) populations including hematologic stem cell (HSCT) and solid organ transplant (SOT) recipients. Adverse consequences of diarrhea, including fluid and electrolyte imbalances with resultant malabsorption of nutrition and medications, can lead to prolonged hospital stays or rehospitalizations. Clostridioides (formerly Clostridium) difficile is the most common infectious etiology of infectious...

Pneumocystis pneumonia (PJP) is caused by Pneumocystis jiroveci and is an important infection of chronically immunocompromised patients, especially those receiving higher doses of corticosteroids and those with abnormalities in cell-mediated immunity. Until recently, the vast majority of cases were in HIV patients. This has changed with an increasing proportion occurring in non-HIV patients, including in solid organ and hematopoietic stem cell transplant recipients. The risk factors,...

Rapidly growing mycobacteria (RGM) are environmental microorganisms that thrive in water-associated biofilms and grow more quickly in the laboratory than slow-growing nontuberculous mycobacteria. Prevalence of RGM infection appears to be increasing, and patients with structural lung disease and immunocompromised hosts, especially patients with cystic fibrosis or lung transplant recipients, are at increased risk. Transplant recipients can acquire RGM from the community or from healthcare...

Humanity is facing many challenges associated with population growth and shift in the setting of predicted climate change and global warming. These changes are expected to impose economic, political, and sociological challenges. Such changes will further introduce significant impediments to the functioning of global public health systems through the increasing risk of emerging infectious diseases. These issues are of utmost importance for investigation, in order to understand the future...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a...

Infections due to Mucorales fungi in hematopoietic stem cell transplantation (HSCT) and solid organ transplant (SOT) recipients may be increasing. Disease is severe and rapidly progressive and carries high mortality. Both the prevalence and species epidemiology vary with geography. Rhizopus species is the most common pathogen followed by Mucor species. Risk factors in SOT patients include renal failure, diabetes mellitus, and immunosuppression to prevent rejection. Additional risks in HSCT...

Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies...

Burkholderia species are found in soil and water and have the ability to cause serious human disease. Infections from these organisms are particularly challenging to manage in the immunocompromised host. Speciation, and identification to strain level, has relevance to virulence, prognosis, and therapeutic strategy – particularly in the case of cystic fibrosis – indicated in lung transplantation. B. pseudomallei complex causes melioidosis and needs to be considered in endemic area travelers or...

Epstein-Barr virus (EBV) is an important potential cause of morbidity and mortality in children and adults undergoing solid organ (SOT) and hematopoietic stem cell transplantation (HSCT). The EBV virus is associated with a range of clinical symptoms and syndromes in both immunocompetent and immunocompromised patients based upon the virus’ ability to transform and immortalize B lymphocytes leading to viral-driven proliferation of infected B cells. In the immunocompetent host, this...

The endemic fungi are a group of thermally dimorphic fungi that occupy specific defined environmental ranges. They count Histoplasma, Blastomyces, Paracoccidioides, Coccidioides, Talaromyces, Emergomyces, and Sporothrix among their number. In the environment, they exist as molds, and at body temperature, they transform into their pathogenic yeast form (or, in the case of coccidioidomycosis, into a specialized structure called a spherule). Histoplasma, Blastomyces, and Paracoccidioides are...