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The purpose of this review is to describe the characteristics of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) in transplant recipients. The majority of reported cases were transmitted by mosquito bite, but blood and graft transmission may occur. These arbovirus infections are clinically similar, resembling influenza-like illness or frequent transplant syndromes. Therefore, laboratory confirmation is necessary. In the acute phase, nucleic acid tests are preferred. DENV and ZIKV serology...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tissue and blood protozoal infections in the pre- and post-transplant period. Significant new developments in the field have made it necessary to divide the previous single guideline published in 2013 into two sections, with the intestinal parasites separated from this guideline devoted to tissue and blood protozoa. The...

Free-living amoebae (FLA) are ubiquitous in the environment. Although they rarely cause infection in humans, when they do so, the infection is often severe and diagnosed late. The three most clinically relevant genera of FLA are Acanthamoeba spp., Naegleria fowleri, and Balamuthia mandrillaris. An increasing body of literature points to these organisms as potential diseasecausing agents in immunocompromised and transplant patients, particularly with regard to donor-derived infections. This...

Following solid organ and hematopoietic stem cell transplantation, patients are at increased risk for community-acquired infections, opportunistic and uncommon pathogens, coinfections, and multidrug-resistant organisms. Given the increased predilection for serious infection in this population, diagnostics applicable to the practice of transplant infectious diseases are essential. In the last decade, diagnostic microbiology has witnessed a shift toward culture-independent methods such as...

Cases of malaria infection have been reported in solid organ and hematopoietic stem cell transplantation; malaria infections may occur as a consequence of a donor-derived infection (from organ or blood), as a relapse of previous P. vivax or P. ovale infection, or as newly acquired infections after transplantation in endemic areas. In donors or candidates with epidemiological risk of malaria infection, sensitive techniques in laboratory surveillance, including molecular tests, to rule out...

Advances in the field of hematopoietic stem cell transplantation (HSCT) provide the opportunity for cure of malignant and nonmalignant diseases. The kinetics of immune reconstitution posttransplant and the immunosuppressive therapies used place HSCT recipients at risk for bacterial, viral, fungal, and other opportunistic infections. Identification of new donor sources of hematopoietic cells has improved accessibility to transplant but may lead to significant deficits in shortand long-term immune...

Practitioners caring for pediatric transplant patients face unique issues compared with adult transplant providers. Distinct challenges to pediatric providers include incomplete or missed primary immunizations, lack of primary immunity to common illnesses, inability to definitively determine infectious serostatus in infants, and recognition of pediatric-specific disease states. Further, the lack of pediatric indications and dosing data for antimicrobials as well as variations in pediatric...

Despite the availability of an efficacious vaccine, yellow fever continues to pose an emerging human health issue, with outbreaks in Africa and South America. Although the majority of cases are oligosymptomatic, severe cases present high mortality, reaching an overall lethality of 50%. The mainstay for yellow fever control remains adequate vaccine coverage. Because the yellow fever vaccine is composed of live, attenuated virus, it is contraindicated in solid organ transplant (SOT) and...

Vascularized composite allografts, or VCA transplants, are allotransplants that incorporate multiple tissues transplanted as a single functional unit, most commonly hands or face. They are, by definition, transplants aimed at improving quality of life rather than life sparing. Yet they may also be life-giving in the case of temporary uterine transplants, where the goal is to carry a healthy pregnancy through to term and delivery. Because of the multiple tissue layers involved and the systemic...

Background The optimal number of doses as well as the role for measurement of postvaccination titers after measles, mumps, rubella (MMR) vaccination in adult hematopoietic cell transplantation (HCT) recipients remains unknown. Methods In the present study, we assessed humoral immunity against measles, mumps and rubella before and after MMR vaccination in 187 adults who received at least one dose of the MMR vaccine after HCT. Results Among those with baseline titers, posttransplant...

Background: Adenovirus (AdV) is a serious infection following hematopoietic cell transplantation (HCT). Little is known about AdV viral kinetics and optimal threshold for initiation of pre-emptive therapy. Methods: Single-center retrospective study of 16 consecutive adult HCT recipients with detectable AdV identified over a 5-year period. Results: Median time to AdV reactivation after HCT was 176 days (IQR 86–408). Nine patients received cidofovir, although 14/16 had no tissue-invasive...

Mycobacterium abscessus is increasingly recognized as a human pathogen causing life-threatening infections in immunocompromised patients. There is a paucity of data around this topic in solid organ transplant (SOT) recipients.This work was a single-center retrospective cohort study of all SOT recipients with a positive culture for M abscessus between 2013 and 2018.A total of 20 patients (55% female) met inclusion criteria, including 1 kidney recipient (5.0%), 2 liver recipients (10.0%), 12...

Abstract Background Isavuconazole (ISA) is a newer antifungal used in patients with history of hematologic malignancies and hematopoietic transplant and cellular therapies (HM/TCT). Although it has a more favorable side‐effect profile, breakthrough invasive fungal infections (bIFIs) while on ISA have been reported. Methods In this single‐center retrospective study evaluating HM/TCT patients...

Authors determined variables that pose a risk for immune reconstitution syndrome (IRS) and have shown that discontinuation of calcineurin inhibitors was independently associated with 5-fold increased risk of IRS in transplant recipients with cryptococcosis., Background. Risk factors including how changes in immunosuppression influence the occurrence of immune reconstitution syndrome (IRS) in solid organ transplant (SOT) recipients with cryptococcosis have not been fully defined.,...

The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both...

The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both...

Background CSF analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine if a subset of SOT recipients with high likelihood of CNS disease could be identified in whom CSF analysis must be performed. Methods Patients comprised a multicenter cohort of SOT recipients with cryptococcosis. Results Of 129 of 146 (88%) SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62%) had CNS disease. In...

Background. Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. Methods. ...