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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...
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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.
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Acinetobacter infections have emerged as an important pathogen in transplant recipients. It is a major cause of multidrug-resistant nosocomial infections, particularly pneumonia and bloodstream infections, and is associated with high morbidity and mortality. Given the organism’s propensity to develop resistance to multiple classes of antibiotics, treatment options can be limited but frequently include carbapenems, polymyxins, sulbactams, tetracyclines, and glycylcyclines. Infection...
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Multidrug-resistant organisms (MDROs) cause morbidity and mortality after organ transplantation. Infection from these organisms may arise from pre-transplant colonization/infectious events, and these organisms may be donor-derived. Here we review the epidemiology, clinical manifestations, disease diagnostics, and therapeutic modalities for six common MDRO bacterial pathogens in the context of solid organ and bone marrow transplantation.
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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...
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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...
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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...
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As one of the most formidable bacterial pathogens encountered in clinical practice, infections related to Pseudomonas aeruginosa (PsA) present a number of challenges to the infectious disease physician. In immunocompromised hosts in particular, PsA has the potential to manifest with unique, recurrent, and often severe clinical syndromes that warrant infectious disease consultation. A staggering array of virulence factors combined with a host of intrinsic and acquired genetic elements...
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Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective study of 1156 consecutive lung transplants performed from 2010-2019. We used log-binomial regression to identify risk factors for infection and analyzed clinical management and outcomes. In total, 27 (2.3%) recipients developed mollicute...
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