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Transplant patients are uniquely predisposed to infections with multidrug-resistant organisms both in the early and late phases after transplantation. Similarly, recipients of stem cell or solid organ allograft show greater susceptibility for often difficult-to-treat infections acquired during the extensive healthcare environmental contact and multidrug-resistant bacteria in patients’ community. Infections are frequently encountered during pretransplant period due to the undergoing...

This chapter discusses recent developments in diagnostics for cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), community respiratory viruses (CRVs), parvovirus, hepatitis viruses, HIV, and other viral agents of importance in solid organ and hematopoietic stem cell transplantation.

Palliative care has been shown to improve quality of life and even prolong life in patients with certain types of malignancy and end-organ failure. Several studies have now demonstrated a beneficial impact of palliative care on the transplant patient. While hospice provides care for patients whose survival is expected to be less than 6 months, palliative care is the specialized care for the patient with serious illness and can be provided at any stage of the disease. All transplant...

The advanced technologies described in this chapter should allow for full inventories to be made of bacterial genes, their time- and place-dependent expression, and the resulting proteins as well as their outcome metabolites. The evolution of these molecular technologies will continue, not only in the microbial pathogens but also in the context of host-pathogen interactions targeting human genomics and transcriptomics. Their performance characteristics and limitations must be clearly...

Anemia, leukopenia, thrombocytopenia, as well as pancytopenias can be seen following solid organ transplant. Varying patterns of cytopenia can be seen based on the drugs used in the posttransplant period, infections encountered by the individual, as well as the individual’s immune response and bone marrow function. The chapter discusses the main causes of anemia, leukopenia/neutropenia, and thrombocytopenia. The differential diagnosis for anemia after solid organ transplant includes...

Toxoplasma gondii and Strongyloides stercoralis are important parasitic infections in transplant recipients. These helminths can lead to severe and often life-threatening disease in immunocompromised patients. Toxoplasma gondii can cause an undifferentiated febrile syndrome, encephalitis, pneumonitis, myocarditis, hepatitis, and retinochoroiditis, whereas S. stercoralis infestation, can lead to the hyperinfection syndrome, which carries a high mortality rate. Effective therapies are...

Both facial and upper extremity composite tissue allotransplants consist of heterogeneous tissues including skin, muscle, bone, fat, nerves, and lymph nodes. These tissues are extremely antigenic and necessitate an immunosuppressive regimen similar to that of solid organ transplants. Thus, the patient with a face or limb transplant has many of the same infection risks in individuals following kidney transplantation such as nosocomial and opportunistic bacterial, viral, fungal, and protozoan...

Antiviral therapy is required in the transplant setting for viral infections that arise from preexisting latent or persistent infection in the recipient and/or donor as well as from nosocomial or community sources. A preventive or prophylactic antiviral approach where feasible is preferable to the treatment of symptomatic viral disease. Acute infections need prompt diagnosis and antiviral treatment for the best outcome. Selection of antiviral therapy involves multiple considerations...

Dermatologists are often called upon to evaluate skin lesions in organ transplant patients, especially when an infectious etiology is suspected. This section will review some of the non-infectious skin eruptions that mimic cutaneous infections. This chapter is intended to help the clinician generate a differential diagnosis when evaluating cutaneous lesions in organ transplant patients. Using the morphology of the primary lesion as a starting point, we then list the non-infectious diagnosis...

Listeria monocytogenes, a small gram-positive bacterium, is a foodborne pathogen that can cause life-threatening bacteremia and central nervous system infections. Persons at risk for listeriosis are primarily those with impairments in cell-medicated immune function, including recipients of solid organ and bone marrow transplantation. Although infection with this microorganism is uncommon, it carries a high mortality. CNS infection may have a subacute course and may involve the brain...

Nocardia species are strictly aerobic, gram-positive, branching, filamentous rods which are beaded appearing and stained variably with the modified acid-fast Kinyoun stain. They can fragment into pleomorphic, rod-shaped, or coccoid pieces. Nocardia are sometimes difficult to recognize and identify in the laboratory, leading to delays in clinical diagnosis. Their relatively slow growth can result in the cultures being discarded before the colonies can be seen. Nocardia are found most often in...

Infection control and prevention strategies are of great importance to the healthcare system as a whole, but are even more critical in the immunocompromised host. While transplant recipients present unique challenges to clinicians and infection control practitioners alike, standard approaches to infection control are still of foremost importance in this population. The type of transplantation, degree of immune suppression, and duration of time following transplantation help determine the...

Vaccines are an essential component of protection against infection after solid organ transplantation for both children and adults. Unfortunately, many transplant recipients are undervaccinated. In general, vaccination before transplantation results in better immunologic response, and the period before transplant is a special opportunity to provide protection for this vulnerable population. Live vaccines, such as MMR, varicella/zoster, nasal influenza, yellow fever, oral polio, and others...

Over the last half-century, there has been a steady increase in opportunistic fungal infections due to the growth in population of patients with severe and mostly iatrogenically induced immune suppression. The explosive growth of this challenge in opportunistic fungal disease has been fueled in recent decades by advances in solid organ and hematopoietic stem cell transplantation. Furthermore, use of high-dose antineoplastic chemotherapy and biologic immunosuppressive regimens in oncology and...

Invasive fungal infections (IFIs) continue to pose a serious challenge in patients undergoing transplantation. An essential need for treatment with immunosuppressive drugs necessary for sustenance of solid organ allograft; preparatory conditioning regimens use to facilitate hematopoietic stem cell engraftment; drugs given to mitigate hosts’ adaptive cellular immune response for prevention and treatment of graft-versus-host disease (GVHD), and visceral allgraft rejection promote the risk for...

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in transplant recipients. The most common IFI are candidiasis, aspergillosis, pneumocystosis, cryptococcosis, mucormycosis, and endemic mycoses. Clinical presentations are generally non-specific, and fungal etiologies are often suspected when immunocompromised patients present with respiratory symptoms and/or undifferentiated fever that do not respond to empiric antibacterial therapy. Moreover, early treatment can...

Infections caused by Candida species range from local mucous membrane involvement to widely disseminated disease. In patients who have received a hematopoietic cell or solid organ transplant, candidiasis is one of the most common infections that is seen and is often life threatening. Candida species are part of the normal human microbiota and, as such, rarely cause infection in healthy hosts. Infections arise when the organisms are able to proliferate locally and gain access to the...

Epstein-Barr virus (EBV) is an oncogenic herpesvirus with a worldwide seroprevalence of >90%. Like all members of the herpesvirus family, EBV establishes infection that persists for the lifetime of the host. In most healthy patients, both primary EBV infection and lifelong latent infection are benign. However, in an immunocompromised host, such as a transplant recipient, either primary infection or reactivation of latent infection can lead to severe disease. The most significant...

Intestinal and multivisceral transplantation are associated with a significantly higher risk of infectious complications compared to other transplants. In this chapter we describe the approach to common infections after intestinal and multivisceral transplantation along with recent developments in the understanding of the gut microbiota and intestinal immune homeostasis.

Parvovirus B19 was discovered in 1975, and the first reports associating B19 with human disease came 6 years later, when B19 was linked to cases of aplastic crisis in patients with sickle cell disease. Since then, B19 infection has become a recognized infectious complication in the immunocompromised host, including persons infected with human immunodeficiency virus (HIV), as well as solid organ (SOT) and hematopoietic cell transplant (HCT) recipients. While typically a benign, self-limited...