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The spectrum of nontuberculous mycobacterial (NTM) infections has become an increasingly recognized cause of clinical concern in transplant recipients. While episodic isolation of NTM is often common among certain solid organ transplants such as lung recipients, there is sufficient evidence to support that serious infections can result in all transplant groups. As NTM are ubiquitous in the environment, and exposure to such bacteria is universally unavoidable, clinicians providing care for...

Hematopoietic stem cell transplantation (HSCT) refers to the process of intravenous infusion of self-renewing hematopoietic stem cells to restore normal hematopoiesis and is a rapidly developing and highly effective modality of treatment for a wide range of immunologic, metabolic, hematologic, as well as malignant diseases. Patients undergoing HSCT are at high risk of infectious complications in the peri-transplant period while awaiting immune reconstitution. There has been significant...

This chapter will review the basic biology of Mycobacterium tuberculosis and then focus on the epidemiology, clinical manifestations, and diagnosis in transplant patients. Prevention and treatment will be considered elsewhere. Tuberculosis (TB) remains a leading cause of human mortality in resource-limited settings, in part because it is still a diagnostic and treatment challenge. These challenges are compounded in immunocompromised hosts such as transplant patients because the performance...

Human herpes viruses are a family of double-stranded DNA viruses that cause opportunistic infections in solid organ and hematopoietic stem cell transplant recipients. Alpha-herpesviruses cause localized ulcerative mucosal and vesicular cutaneous lesions, with the tendency to disseminate if not treated early and aggressively. Beta-herpes viruses, discussed in this chapter such as human herpes viruses 6 and 7, may rarely cause a febrile illness and a skin rash; however, HHV6 in recipients of...

Cryptococcosis is the third most common invasive fungal infection among solid organ transplant recipients but has been reported very rarely in hematopoietic stem cell transplant recipients. Pulmonary cryptococcal disease is the most common clinical presentation, and the central nervous system involvement is the most common extrapulmonary site. Diagnosis is confirmed by isolation of the fungus from culture samples and measuring cryptococcal antigen in various body fluids including serum and...

Despite the overall decline in the frequency of documented gram-negative infections in transplant recipients receiving antimicrobial prophylaxis, the proportion of these infections caused by nonfermentative gram-negative bacilli (NFGNB) is increasing. Pseudomonas aeruginosa is the most common species of NFGNB isolated from such patients, from both monomicrobial and polymicrobial infections. The spectrum of infection caused by P. aeruginosa is wide, and involvement of multiple organ systems...

Over the last 70 years, a steady growth in population of patients with severe and mostly iatrogenically induced immune suppression while undergoing myeloablative antineoplastic therapy and blood- and marrow-derived stem cell or solid organ transplantation has resulted in a near-explosive growth of opportunistic infections. Furthermore, the advent and now common use of biologic immunosuppressive drugs are given to an increasing number of patients prior to transplantation or for treatment of...

In the general population, cytomegalovirus (CMV) is a common infection that is frequently acquired at a young age; one in three children in the United States are infected with CMV. In patients undergoing transplantation, CMV most frequently presents as reactivation of a remotely acquired infection, whereas primary CMV infection in seronegative (−) recipients transmitted via allografts harvested from CMV-seropositive (+) donors poses the greatest threat of infection and viral end-organ...

Gram-positive bacteria (GPB) are an important cause of systemic disease in immunocompromised patients, especially those undergoing transplantation. A rise in infections due to GPB in the last two decades has been attributed to a variety of reasons that prominently include antimicrobial prophylaxis with a focus on prevention of Gram-negative bacterial infections. The near-universal use of indwelling intravascular access devices that are usually retained for an extended duration also...

The use of intravascular devices for administration of drugs, fluids, blood products, and nutritional support is essential in patients undergoing transplantation procedures. These intravascular devices have a significant potential to produce iatrogenic disease, such as bloodstream infection originating from colonization of the indwelling intravascular devices. Over two-thirds of all healthcare-associated bacteremia originate from devices used for vascular access. Patients undergoing...

Surgical site infections (SSIs) following transplantation have been linked to increased mortality, graft rejection, increased length of stay, and increased resource utilization ). Rates of SSI vary and can reach as high as 37% for some transplant procedures . The risk of infection depends greatly on type of surgery and patient-specific factors. Postoperative wound infections following transplant generally occur within 30 days of surgery and can range from superficial to organ/space...

Aspergillus species are ubiquitous fungi that infect humans after their asexual spores are inhaled and deposited in the respiratory tract. Neutrophils and cell-mediated immunity are crucial components of host defenses that prevent invasion of Aspergillus, and these elements are often lacking or impaired in transplant recipients. Aspergillosis is the most common invasive fungal infection in hematopoietic stem cell transplant recipients and the second most common in solid organ transplant...

There are numerous fungal pathogens which merit consideration in the hematopoietic cell and solid organ transplant recipients including yeasts, filamentous molds, and endemic fungi. Important differences in the incidence, types, and timeline of infections exist among the differing transplant groups. The overall risk of invasive fungal infection is affected by a multitude of factors including the transplant donor and recipient as well as transplant type. These considerations guide the...

The Enteroviridae are single-stranded RNA viruses in the Picornaviridae family notable for their ability to cause a wide range of diseases, with more severe disease manifestations in the immunocompromised host. Humans are the reservoir for Enteroviridae, and person-to-person transmission occurs via the fecal-oral or respiratory route. Intact innate immune response including NK cells and macrophages plays an important role during the initial phase of infection followed by T- and B-cell...

Transplant infectious diseases are among the most challenging sectors of present-day medicine. Solid organ and hematopoietic stem cell transplants are being performed with increasing frequency, and the threat of infection is ever-present due to a degree of dependence upon potent immunosuppressive agents that ensure sustained engraftment. Accordingly, antibacterial agents will be employed as well. The responses of these patients to bacterial infection can be very different when compared to...

Viral infections are a global public health problem and can contribute significantly to patient morbidity and mortality. It is estimated that there are 350 million people worldwide who are infected with hepatitis B virus and 17,000 new cases per year of hepatitis C are identified (Wasley et al., MMWR Morb Mortal Wkly Rep 57(SS-2):1–24, 2008). Herpes viruses are common, with an estimated seroprevalence of 50% for herpes simplex virus type-1 and 20% herpes simplex virus type-2 seroprevalence...

Caring for immunocompromised patients is challenging. Despite significant advances, infection remains a major cause of morbidity and mortality, and as such, these patients are frequently exposed to antimicrobial agents. Antimicrobial stewardship programs (ASPs) can assist transplant centers in optimizing antibiotic usage, particularly in this age of growing microbial resistance and the scarcity of new anti-infective agents in development. The collaborative approach of antimicrobial...

The first line and the most effective form of antifungal host defense are comprised by phagocytes, particularly neutrophils and monocytes/macrophages that play a central role in local containment of infection and prevent systemic dissemination. These immune cells are also exposed to antifungal drugs while patients undergo systemic antifungal therapy. In the phagocyte-fungus-antifungal drug interplay, drugs including amphotericin B formulations, azoles, and echinocandins may directly interact...

Mucormycosis (formerly known as zygomycosis) is a life-threatening infection caused by fungi of the order Mucorales. Mucormycosis is an infectious emergency that typically occurs in patients with defects in host defense and/or with increased available serum iron, but can also occur after traumatic implantation of the etiologic fungi through skin. Recent years have witnessed some dramatic changes in the fungal taxonomy, etiology, epidemiology, and therapy of and outcomes from such infections, including in the transplant setting.

Viral infections account for a large proportion of emerging infectious diseases, and the agents included in this group consist of recently identified viruses as well as previously identified viruses with an apparent increase in disease incidence. In transplant recipients, this group can include viruses with no recognized pathogenicity in immunocompetent patients and those that result in atypical or more severe disease presentations in the immunocompromised host. In this chapter, we begin by...