The American Society of Transplantation Online Transplant Infectious Diseases Library

Background Multidrug-resistant (MDR) and extensively drug-resistant (XDR) gram-negative bacteria may be transmitted from organ donors to solid organ transplant recipients and are associated with poor outcomes post-transplant. Methods We reported the prevalence of MDR/XDR gram-negative respiratory colonization among 702 deceased organ donors in the New York City area from 2011 to 2014 and performed chart reviews for a subset of recipients to determine whether donor respiratory culture results...

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...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the management of transplantation in HIV-infected individuals. Transplantation has become the standard of care for patients with HIV and end-stage kidney or liver disease. Although less data exist for thoracic organ and pancreas transplantation, it is likely that transplantation is also safe and effective for these recipients as well. Despite what is typically a...

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...

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to...

Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics,...

These guidelines from the American Society of Transplantation Infectious Diseases Community of Practice update the epidemiology and management of human papillomavirus (HPV) infections in organ transplant recipients. HPV is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region. Increasing evidence suggests an association with head and neck cancers as well. Solid organ transplant recipients have a higher risk of HPV infection than the...

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...

These updated guidelines of the AST IDCOP review vaccination of solid organ transplant candidates and recipients. General principles of vaccination as well as the use of specific vaccines in this population are discussed. Vaccination should be reviewed in the pre-transplant setting and appropriate vaccines updated. Both inactivated and live vaccines can be given pre-transplant. The timing of vaccination post-transplant should be taken into account. In the post-transplant setting, inactivated...

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...

These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation,...

Clinical manifestations of human parvovirus B19 infection can vary widely and may be atypical in solid organ transplant (SOT) recipients. However, disease is apparent when there is destruction of erythrocyte progenitor cells leading to severe acute or chronic anemia with lack of an appropriate reticulocyte response in the setting of active parvovirus B19 infection. Serology may not reliably establish the diagnosis. High-level viremia is more likely to be associated with symptomatic disease....