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Both solid organ and hematopoietic stem cell transplant candidates and recipients are at high risk for healthcare-associated infections due to their underlying diseases, comorbid conditions, as well as the receipt of augmented immunosuppression to prevent rejection. Partnership between transplant physicians, institutional leaders, and infection preventionists allows for the accommodation of this growing vulnerable patient population into institutional risk assessments and hazard analyses. In...

Invasive aspergillosis is a major cause of morbidity and mortality in hematopoietic stem cell transplant and solid organ transplant recipients. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has decreased the mortality rates associated with invasive aspergillosis.

Respiratory viruses are among the most common causes of infection among solid organ and hematopoietic stem cell transplant recipients. Respiratory viruses, such as influenza and respiratory syncytial virus, can cause a range of disease from asymptomatic shedding, upper respiratory infections, to life threatening pneumonia. In addition, respiratory viruses may be associated with chronic sequelae, including devasting late complications such as chronic rejection in lung transplant recipients and...

Chagas disease is a vector-borne infection caused by the protozoan Trypanosoma cruzi that is endemic in Latin America. More recently, the geographic distribution of the disease has changed due to immigration of asymptomatic infected individuals from endemic to non-endemic regions. Therefore, Chagas disease involving acute infection among negative recipients receiving a transplant graft from positive donors and reactivation episodes among positive recipients due to posttransplant...

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...

Chronic hepatitis C virus (HCV) infection related liver diseases are a leading indication for liver transplantation (LT) worldwide, responsible for about 20% of all LT performed in Europe and the United States. In the context of liver transplantation, treatment of HCV infection has been classically challenging because of therapies’ low efficacy and safety concerns associated with interferon-based regimens, so that patients with decompensated cirrhosis and liver graft recipients have been...

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...

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....

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...

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...

Pneumocystis pneumonia (PJP) is caused by Pneumocystis jiroveci and is an important infection of chronically immunocompromised patients, especially those receiving higher doses of corticosteroids and those with abnormalities in cell-mediated immunity. Until recently, the vast majority of cases were in HIV patients. This has changed with an increasing proportion occurring in non-HIV patients, including in solid organ and hematopoietic stem cell transplant recipients. The risk factors,...

Burkholderia species are found in soil and water and have the ability to cause serious human disease. Infections from these organisms are particularly challenging to manage in the immunocompromised host. Speciation, and identification to strain level, has relevance to virulence, prognosis, and therapeutic strategy – particularly in the case of cystic fibrosis – indicated in lung transplantation. B. pseudomallei complex causes melioidosis and needs to be considered in endemic area travelers or...

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...

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...

We review different types of mechanical circulatory support devices available as a bridge to heart transplantation and then discuss infectious complications in these devices, with a particular focus on ventricular assist devices. We also discuss infection prevention and management strategies, in particular as relevent to transplantation.

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...

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...