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Infectious complications are a major cause of morbidity and mortality in both solid organ and hematopoietic stem cell transplant patients. The risk of infection by common opportunistic pathogens like cytomegalovirus can be mitigated with the optimal use of molecular diagnostics and antiviral prophylaxis. Novel and emerging bacterial, viral, fungal, and parasitic pathogens may be more successfully managed with early diagnosis and therapy. In the care of solid organ and hematopoietic stem cell...

Altered mental status is common in the solid organ transplant recipient. A variety of etiologies, including infections, metabolic abnormalities, medications, malignancies, and rejection, can lead to altered mental status in a transplant patient. Timeline after transplantation as well as organ transplanted have significant impact on etiology. Detailed physical examination, comprehensive laboratory evaluation, and in many cases imaging can help elucidate the etiology. Urgent treatment of underlying etiology can improve prognosis.

Human herpesviruses (HHV)-6, HHV-7, and HHV-8 were identified as causes of infection in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients nearly three decades ago. HHV-6 infection occurs early posttransplant and may cause fever of unknown origin, diarrhea, rash, pneumonitis, and encephalitis. Chromosomal integration of HHV-6 can complicate diagnostic testing for HHV-6, as these patients have markedly elevated HHV-6 DNA levels due to the presence of HHV-6...

Solid organ transplantation and hematopoietic cell transplantation are life-saving procedures, yet carry significant infection risk due to the significant and prolonged immunosuppression they entail. Infection prevention strategies using antibiotic prophylaxis can mitigate problems that arise through immunosuppression, especially if clinicians have a keen awareness for local epidemiology and patient-specific microbiological factors. Antifungal prophylaxis, especially in stem cell...

Influenza virus is a common respiratory virus in solid organ and stem cell transplant recipients. Influenza infection in immunocompromised hosts can result in severe disease, as compared to general population. Risk factors for severe influenza infection in transplant recipients include treatment with antilymphocyte globulin, presence of lower respiratory disease, and infection early after transplantation. Transplant programs should act to optimize prevention, early diagnosis, and treatment of...

Although a less common cause of gastrointestinal illness in transplant recipients than bacterial or viral etiologies, intestinal parasitic infections can result in severe and prolonged disease in this population. In the developed world, diagnostic delays stemming from low clinical suspicion for intestinal parasites (and the limitations of standard diagnostics) can worsen outcomes in these patients. As travel becomes more frequent among patients both before and after transplant, and with the...

In order to minimize a solid organ transplant (SOT) recipient’s risk for infection and injury, it is important to anticipate the risks post-transplantation inherent in routine and not so routine activities of daily living. The benefits of longevity by virtue of organ transplantation need to be closely protected by education before, during, and after transplantation about potential infectious risks and measures to mitigate such exposures. SOT recipients cannot stand alone in their efforts...

Transplant tourism and travel posttransplant, both solid organ and hematopoietic stem cell, are important and distinct topics, and each poses a risk of infection for transplant recipients. As solid organ transplant becomes a more common treatment option for end-stage organ disease, wait lists and wait times for these organs grow. Transplant tourism involves traveling abroad for the purposes of organ transplant and often involves commercial transactions. This process has been discouraged on...

Human herpesvirus 5, better known as cytomegalovirus (CMV), infects 50–90% of the adult population worldwide and is the most common opportunistic infection in allogeneic hematopoietic stem cell transplant (HSCT) recipients, causing significant morbidity and mortality [1–6]. Without prophylaxis, CMV reactivation occurs in up to 70–80% of CMV-seropositive individuals [6–9]. This chapter will review the current understanding of CMV infection in HSCT recipients focusing on emerging concepts and...

Cytomegalovirus (CMV) is among the most common of infections after transplant. In addition to causing viral infection, it increases the risk for a negative outcome for the organ or bone marrow graft, as well as for higher overall morbidity and mortality. Risk of CMV is especially high in transplant recipients previously nonimmune to the virus. Prevention is key for optimal outcomes, both for individuals and for transplant programs. Optimal disease recognition, diagnostics, prevention, and...

Hepatitis A (HAV) is vaccine-preventable disease with an ongoing burden of disease nationally and worldwide. It is caused by a non-enveloped RNA virus with predominantly fecal-oral spread. It does not cause chronic disease and symptomatic infection increases with age. Fulminant disease and death are more common in the elderly and comorbid, particularly those with underlying chronic liver disease. Immunity to HAV infection occurs after infection or vaccination, with antibody levels indicating...

While some biologicals have been routinely used in solid organ and hematopoietic stem cell transplant patients for years, a number of newer compounds have been added to the armamentarium for varying indications spanning from the underlying disease to complications of transplantation. This chapter aims at describing the infectious risk of a selection of compounds. The specific chapters list a number of recommendations to consider for infection prevention, in addition to the standard...

Fungal infections in recipients of solid organ and hematopoietic stem cell transplant recipients are significant causes of morbidity and mortality. Though relatively uncommon compared to other infectious complications, the difficulty in making a timely diagnosis and effectively treating patients presents a daunting challenge. Among the fungi responsible for these infections, there are many that are rarely encountered clinically yet are associated with high mortality in transplant patients....

This chapter reviews the epidemiology, clinical impact, diagnosis, prevention, and management of tuberculosis (TB) in solid organ and hematopoietic stem cell transplantation. Given the limitations of screening for latent TB using either the tuberculin skin test or interferon gamma release assays, it is important to also consider exposure history and chest imaging; promising new TB diagnostic strategies are currently under development. The clinical manifestations of active tuberculosis in...

Over the last half a century, there have been innumerable advances in our understanding of the human immune system. We now have a better understanding not only of the ways our innate and adaptive immune pathways interact to seek out and control infection and malignancy, but we are closer to understanding some of the control mechanisms behind tissue rejection. Organ allograft rejection, with consequent loss of graft function, remains one of the most challenging problems facing solid organ...

Herpes Simplex Virus (HSV) 1 and 2 and Varicella Zoster Virus (VZV) are ubiquitous alpha-herpes viruses that establish lifelong latency in nerve root ganglia. They are characterized by clinical and subclinical reactivation which can lead to significant morbidity in the transplant population. Primary infection after transplant can also be highly morbid, potentially fatal. Despite significant advances in screening, diagnosis, treatment and prevention, there are further gains to be made in...

Infectious and noninfectious pulmonary syndromes remain significant contributors to morbidity and mortality after solid organ and hematopoietic stem cell transplantation. Multiple factors increase the risk of pulmonary complications including the surgical trauma related to solid organ transplantation, chemotherapy and radiation prior to hematopoietic stem cell transplant, the degree of immunosuppression, and immune factors contributing to rejection and graft-versus-host disease. The first...

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms found in soil and water. The expansion of the transplant population combined with an increase in environmental exposures and improvements in mycobacterial diagnosis has contributed to a rise in the diagnosis of NTM infections among transplant recipients, who are at particular risk for infection as well as increased associated morbidity and mortality.

The hepatitis E virus (HEV) is one of the main causative agents of acute viral hepatitis worldwide. Over the past decade, HEV genotypes 3 and 4 have been responsible for chronic infections in immunocompromised patients, especially solid organ transplant recipients. A rapid progression of liver fibrosis and the development of HEV-related cirrhosis have been documented in this specific population. HEV infections have also been associated with extrahepatic manifestations such as neurological...

Cytopenias are a common occurrence in both hematopoietic stem cell and solid organ transplant recipients, particularly in the early post-transplant time period. The etiology is frequently multifactorial, reflecting the simultaneous interplay of infection, immunologic derangements, and medication effects in this patient population. These factors continually change over time, further adding to the complexity of diagnosis and management. Thorough evaluation of the individual’s medical history,...