European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL-4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN - Engelhard, D.; Mohty, B.; Camara, R. de la; Cordonnier, C.; Ljungman, P. (Transplant Infectious Disease, 2013)
Influenza may cause severe disease and mortality in leukemia patients and in hematopoietic stem cell transplantation recipients. The 4th European Conference of Infections in Leukemia (ECIL-4) has developed evidence-based guidelines for prevention and management of influenza infections in these patients. Real-time reverse-transcription polymerase chain reaction is the diagnostic test of choice, as it is the most sensitive and specific test for influenza. The risks for severe influenza and fatal outcome include lymphopenia, older age, influenza soon after transplantation or chemotherapy, steroid treatment, and lack of early antiviral therapy. Neuraminidase inhibitors (oral oseltamivir or inhalation of zanamivir) are currently the most effective therapeutic agents for influenza. Main preventive measures include annual vaccination of patients, household contacts, and hospital staff. This review summarizes ECIL-4's main recommendations.
Keywords: ECIL-4; HSCT; The European Conference on Infections in Leukemia; guidelines; hematopoietic stem cell transplantation; influenza; leukemia; recommendations

Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3) - Skiada, Anna; Lanternier, Fanny; Groll, Andreas H.; Pagano, Livio; Zimmerli, Stephan; Herbrecht, Raoul; Lortholary, Olivier; Petrikkos, George L. (Haematologica, 2013)
Mucormycosis is an emerging cause of infectious morbidity and mortality in patients with hematologic malignancies. However, there are no recommendations to guide diagnosis and management. The European Conference on Infections in Leukemia assigned experts in hematology and infectious diseases to develop evidence-based recommendations for the diagnosis and treatment of mucormycosis. The guidelines were developed using the evidence criteria set forth by the American Infectious Diseases Society and the key recommendations are summarized here. In the absence of validated biomarkers, the diagnosis of mucormycosis relies on histology and/or detection of the organism by culture from involved sites with identification of the isolate at the species level (no grading). Antifungal chemotherapy, control of the underlying predisposing condition, and surgery are the cornerstones of management (level A II). Options for first-line chemotherapy of mucormycosis include liposomal amphotericin B and amphotericin B lipid complex (level B II). Posaconazole and combination therapy of liposomal amphotericin B or amphotericin B lipid complex with caspofungin are the options for second line-treatment (level B II). Surgery is recommended for rhinocerebral and skin and soft tissue disease (level A II). Reversal of underlying risk factors (diabetes control, reversal of neutropenia, discontinuation/taper of glucocorticosteroids, reduction of immunosuppressants, discontinuation of deferroxamine) is important in the treatment of mucormycosis (level A II). The duration of antifungal chemotherapy is not defined but guided by the resolution of all associated symptoms and findings (no grading). Maintenance therapy/secondary prophylaxis must be considered in persistently immunocompromised patients (no grading).

Fungal Infections in Immunocompromised Travelers - Lortholary, O.; Charlier, C.; Lebeaux, D.; Lecuit, M.; Consigny, P. H. (Clinical Infectious Diseases, 2013)

Norovirus Gastroenteritis in Immunocompromised Patients - Bok, Karin; Green, Kim Y. (The New England journal of medicine, 2013)

Prospective, Multicenter Study of Ventricular Assist Device Infections - Gordon, R. J.; Weinberg, A. D.; Pagani, F. D.; Slaughter, M. S.; Pappas, P. S.; Naka, Y.; Goldstein, D. J.; Dembitsky, W. P.; Giacalone, J. C.; Ferrante, J.; Ascheim, D. D.; Moskowitz, A. J.; et al. (Circulation, 2013)

Diagnostic Bronchoscopy in Solid-Organ and Hematopoietic Stem Cell Transplantation - Harris, Bianca; Lowy, Franklin David; Stover, Diane Elizabeth; Arcasoy, Selim Mehmet (Annals of the American Thoracic Society, 2013)
Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes. This approach may be most critical when an underlying infectious etiology is suspected. In the absence of prompt diagnostic information on which to base effective treatment, the risks associated with empiric antimicrobial therapy, including medication side effects and the development of antibiotic resistance, compound the potential harm of delaying targeted management.

Evaluation of intravenous voriconazole in patients with compromised renal function - Lilly, Craig M.; Welch, Verna L.; Mayer, Thomas; Ranauro, Paul; Meisner, Joanne; Luke, David R. (BMC Infectious Diseases, 2013)
Incorporation of the solubilizing excipient, sulfobutylether-β-cyclodextrin (SBECD), in the intravenous (IV) formulation of voriconazole has resulted in the recommendation that this formulation be used with caution in patients with creatinine clearances (Clcr) < 50 mL/min. This study evaluated the safety of IV voriconazole compared with two other IV antifungals not containing SBECD in patients with compromised renal function.

Fourth European Conference on Infections in Leukaemia (ECIL-4): Guidelines for Diagnosis and Treatment of Human Respiratory Syncytial Virus, Parainfluenza Virus, Metapneumovirus, Rhinovirus, and Coronavirus - Hirsch, Hans H.; Martino, Rodrigo; Ward, Katherine N.; Boeckh, Michael; Einsele, Hermann; Ljungman, Per (Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 2013)
Respiratory viruses have been recognized as a significant cause of morbidity and mortality in patients with leukemia and those undergoing hematopoietic stem cell transplantation. The risk for lower respiratory tract infections and a fatal outcome appears to depend on the intrinsic virulence of the specific community-acquired respiratory virus as well as factors specific to the patient, the underlying disease, and its treatment., Community-acquired respiratory virus (CARV) infections have been recognized as a significant cause of morbidity and mortality in patients with leukemia and those undergoing hematopoietic stem cell transplantation (HSCT). Progression to lower respiratory tract infection with clinical and radiological signs of pneumonia and respiratory failure appears to depend on the intrinsic virulence of the specific CARV as well as factors specific to the patient, the underlying disease, and its treatment. To better define the current state of knowledge of CARVs in leukemia and HSCT patients, and to improve CARV diagnosis and management, a working group of the Fourth European Conference on Infections in Leukaemia (ECIL-4) 2011 reviewed the literature on CARVs, graded the available quality of evidence, and made recommendations according to the Infectious Diseases Society of America grading system. Owing to differences in screening, clinical presentation, and therapy for influenza and adenovirus, ECIL-4 recommendations are summarized for CARVs other than influenza and adenovirus.

Human Papillomavirus in Solid Organ Transplantation: Human Papillomavirus in Solid Organ Transplantation - Chin-Hong, P. V.; Kwak, E. J.; the AST Infectious Diseases Community of Practice (American Journal of Transplantation, 2013)

Perspectives on Liver and Kidney Transplantation in the Human Immunodeficiency Virus-Infected Patient - Chin-Hong, Peter; Beatty, George; Stock, Peter (Infectious Disease Clinics of North America, 2013)

Parasitic Infections in Solid Organ Transplant Recipients - Coster, Laura O’Bryan (Infectious Disease Clinics of North America, 2013)

Evaluation for Liver Transplantation in Adults: 2013 Practice Guideline by the AASLD and the American Society of Transplantation - Martin, Paul (2013)

Pharmacologic Issues of Antiretroviral Agents and Immunosuppressive Regimens in HIV-infected Solid Organ Transplant Recipients - Primeggia, Jennifer; Timpone, Joseph G.; Kumar, Princy N. (Infectious Disease Clinics of North America, 2013)

Travel Medicine and the Solid-Organ Transplant Recipient - Rosen, Jessica (Infectious Disease Clinics of North America, 2013)

Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012 - Runyon, Bruce A. (Hepatology, 2013)

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission Through Organ Transplantation - Seem, Debbie L.; Lee, Ingi; Umscheid, Craig A.; Kuehnert, Matthew J. (Public Health Reports, 2013)

European guidelines for diagnosis and treatment of adenovirus infection in leukemia and stem cell transplantation: summary of ECIL-4 (2011) - Matthes‐Martin, S.; Feuchtinger, T.; Shaw, P. J.; Engelhard, D.; Hirsch, H. H.; Cordonnier, C.; Ljungman, P. (Transplant Infectious Disease, 2012)
Human adenovirus (HAdV) infections are increasingly recognized as important pathogens in immunocompromised hosts, especially in patients with severely suppressed T-cell function. The 4th European Conference of Infections in Leukemia (ECIL-4) has developed evidence-based guidelines for diagnosis and management of HAdV infections. The risk for HAdV-associated disease is increased in children, and risk factors for HAdV disease are T-cell depletion, unrelated and cord blood hematopoietic stem cell transplantation, graft-versus-host disease grades III–IV, and lymphopenia. The recommended technique for monitoring of high-risk patients is quantitative polymerase chain reaction. Cidofovir is the most used antiviral therapy, although no controlled study has been performed. HAdV-specific T-cell therapy is in development.
Keywords: guidelines; human adenovirus; leukemia; stem cell

Oral doxycycline for non-systemic urinary tract infections (UTIs) due to P. aeruginosa and other Gram negative uropathogens - Cunha, B. A. (European Journal of Clinical Microbiology & Infectious Diseases, 2012)

Risk Factors for Cytomegalovirus Retinitis in Patients with Cytomegalovirus Viremia after Hematopoietic Stem Cell Transplantation - Jeon, Sohee; Lee, Won Ki; Lee, Yongeun; Lee, Dong Gun; Lee, Jong Wook (Ophthalmology, 2012)
Purpose To evaluate the risk factors for cytomegalovirus (CMV) retinitis in patients with CMV viremia after hematopoietic stem cell transplantation (HSCT). Design Retrospective cohort study. Participants We included all patients with CMV viremia detected by polymerase chain reaction after HSCT between April 2009 and August 2011. Risk factors for CMV retinitis were evaluated in the cohort of 270 patients with CMV viremia, who survived ≥12 weeks after HSCT and were screened for CMV retinitis. Methods Retrospective review of clinical records and laboratory results. Main Outcome Measures Survival analysis of patients in the cohort and frequency of CMV retinitis in relation to various factors. Variables analyzed were demographics, human leukocyte antigen (HLA) matched versus mismatched, related versus unrelated donor, preconditioning regimens, delayed engraftment of lymphocyte, presence of acute or chronic graft-versus-host disease, highest CMV DNA level in blood (copies/ml), cumulative period of CMV viremia (weeks), and CMV infection verified by culture or immunohistology in bronchoalveolar lavage or visceral biopsy specimens. Results Of the 708 patients who underwent HSCT during the study period, 363 (51%) developed CMV viremia after HSCT. Of the 363 patients with CMV viremia, 270 underwent retinal examination for CMV retinitis. We detected CMV retinitis in 15 of 270 patients with CMV viremia. In the univariate analysis, HLA-mismatched HSCT, HSCT from an unrelated donor, engraftment day, peak CMV DNA level, and duration of viremia were associated with the development of CMV retinitis. In the adjusted multivariate analysis, only peak CMV DNA blood levels predicted the development of CMV retinitis (hazard ratio, 25.0; 95% confidence interval, 3.0–210.8). An additional validity analysis by receiver operating characteristic area under curve suggested that a cutoff of 7.64×104 copies/mL best predicted the development of CMV retinitis by CMV DNA levels in blood. Conclusions The development of CMV retinitis should be carefully monitored in patients with a significant viral load, which is represented by a peak CMV DNA level >7.64×104 copies/ml and a long duration of CMV viremia, especially when patients received HSCT from an unrelated or HLA-mismatched donor and showed delayed lymphocyte engraftment. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

(1,3)- -D-Glucan as a Prognostic Marker of Treatment Response in Invasive Candidiasis - Jaijakul, S.; Vazquez, J. A.; Swanson, R. N.; Ostrosky-Zeichner, L. (Clinical Infectious Diseases, 2012)

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients - Marchetti, O.; Lamoth, F.; Mikulska, M.; Viscoli, C.; Verweij, P.; Bretagne, S. (Bone Marrow Transplantation, 2012)
As culture-based methods for the diagnosis of invasive fungal diseases (IFD) in leukemia and hematopoietic SCT patients have limited performance, non-culture methods are increasingly being used. The third European Conference on Infections in Leukemia (ECIL-3) meeting aimed at establishing evidence-based recommendations for the use of biological tests in adult patients, based on the grading system of the Infectious Diseases Society of America. The following biomarkers were investigated as screening tests: galactomannan (GM) for invasive aspergillosis (IA); β-glucan (BG) for invasive candidiasis (IC) and IA; Cryptococcus Ag for cryptococcosis; mannan (Mn) Ag/anti-mannan (A-Mn) Ab for IC, and PCR for IA. Testing for GM, Cryptococcus Ag and BG are included in the revised EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) consensus definitions for IFD. Strong evidence supports the use of GM in serum (A II), and Cryptococcus Ag in serum and cerebrospinal fluid (CSF) (A II). Evidence is moderate for BG detection in serum (B II), and the combined Mn/A-Mn testing in serum for hepatosplenic candidiasis (B III) and candidemia (C II). No recommendations were formulated for the use of PCR owing to a lack of standardization and clinical validation. Clinical utility of these markers for the early management of IFD should be further assessed in prospective randomized interventional studies.

New insights into hepatosplenic candidosis, a manifestation of chronic disseminated candidosis - Rammaert, B.; Desjardins, A.; Lortholary, O. (Mycoses, 2012)
Chronic disseminated candidosis, often referred to as hepatosplenic candidosis (HSC), is an infection due to Candida spp. that mainly involves the liver and spleen. HSC occurs mostly in patients after profound and prolonged neutropenia, which is more often seen in patients with acute haematological malignancies. The incidence of HSC ranges from 3% to 29% in patients suffering from Acute Leukaemia. However, it is now seen less frequently with the widespread use of antifungal agents as prophylaxis or as preemptive therapy. Early and adequate diagnosis and treatment of HSC are crucial, as treatment delays can negatively affect the prognosis of the underlying condition. The pathogenesis is not well understood, but it is believed that it may be due to an unbalanced adaptive immune response that leads to an exacerbated inflammatory reaction, resulting in an Immune Reconstitution Inflammatory Syndrome. In this context, new therapeutic approaches such as the use of adjuvant high-dose corticosteroids have been shown beneficial. This article will focus on the clinical, diagnostic and therapeutic aspects of HSC and provide an accurate review of recent pathophysiological data.
Keywords: Animals; Antifungal Agents; Candida; Candidiasis; Humans; Liver Diseases; Splenic Diseases

Identification of Kudoa septempunctata as the Causative Agent of Novel Food Poisoning Outbreaks in Japan by Consumption of Paralichthys olivaceus in Raw Fish - Kawai, Takao; Sekizuka, Tsuyoshi; Yahata, Yuichiro; Kuroda, Makoto; Kumeda, Yuko; Iijima, Yoshio; Kamata, Yoichi; Sugita-Konishi, Yoshiko; Ohnishi, Takahiro (Clinical Infectious Diseases, 2012)
Background. Outbreaks of an unidentified food-borne illness associated with the consumption of raw fish have increased in Japan since 2003. Those affected with this illness develop diarrhea and emesis within 2–20 hours after a meal including raw fish. No known causative agents such as bacteria, viruses, bacterial toxins, or toxic chemicals have been detected in the foods that were ingested. Fortunately, this illness is self-limiting with good prognosis in all cases.Methods. We conducted an epidemiological analysis of outbreaks that occurred during 2008 and 2010 and analysed a fish sample from one outbreak by metagenomic DNA sequencing, real-time polymerase chain reaction, and direct microscopic observations. The pathogenicity of a putative risk factor identified by these techniques was assessed using the suckling-mouse test and a house musk shrew emetic assay.Results. The epidemiological analysis of outbreaks in 24 municipalities involving >1300 subjects implicated an olive flounder (Paralichthys olivaceus) as the causative food source. The presence of Kudoa septempunctata, a recently-described myxosporean species in P. olivaceus, was prevalent in the causative foods. K. septempunctata induced watery stools and an elevated fluid accumulation ratio in suckling mice, as well as vomiting in house musk shrews.Conclusions. These results identify K. septempunctata as the etiological agent of this novel food-borne illness outbreak associated with consumption of raw P. olivaceus. This is the first report, to our knowledge, demonstrating the human pathogenicity of Kudoa spores.

Administration of voriconazole in patients with renal dysfunction - Neofytos, Dionissios; Lombardi, Lindsey R.; Shields, Ryan K.; Ostrander, Darin; Warren, Lindsay; Nguyen, M. Hong; Thompson, Carol B.; Marr, Kieren A. (Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 2012)
BACKGROUND: The intravenous use of voriconazole requires coadministration with sulphobutylether-β-cyclodextrin, which may accumulate in patients with impaired renal function. METHODS: All adult patients treated with the same formulation of voriconazole for a minimum of 3 consecutive days were included. Renal function was assessed based on the creatinine level and the calculated creatinine clearance (CrCl). Change in renal function was calculated on days 3, 7, and end of treatment (EOT) and was defined based on the RIFLE criteria. RESULTS: Among 166 patients in whom baseline renal function was assessed, 42 (25.3%) had a CrCl <50 mL/min and received intravenous voriconazole, 77 (46.4%) had a CrCl ≥50 mL/min and received intravenous voriconazole, and 47 (28.3%) had a CrCl <50 mL/min and were treated with oral voriconazole. Renal function changed on days 3, 7, and EOT in 19 (11.4%), 14 (8.4%), and 28 (16.9%) patients, respectively. Multivariate analyses identified significant predictors of renal dysfunction: (1) day 3, hematologic malignancy (odds ratio [OR], 5.09, P = .01), fluconazole use within 30 days prior to voriconazole (OR, 6.21; P = .008), coadministration of penicillins (OR, 6.12; P = .03), and immunosuppressants (OR, 7.00; P = .002); (2) day 7, baseline liver impairment (OR, 5.30; P value = .004); (3) EOT, administration of penicillins (OR, 2.39; P = .04). CONCLUSIONS: Voriconazole route of administration and baseline renal function were not predictors of worsening renal dysfunction on days 3, 7, and EOT. Underlying disease, baseline liver impairment, and concomitant administration of other drugs (eg, penicillins, fluoroquinolones, immunosuppressants) were the strongest predictors of renal dysfunction.
Keywords: Adult; Aged; Aged, 80 and over; Antifungal Agents; Creatinine; Female; Humans; Infusions, Intravenous; Kidney Diseases; Male; Metabolic Clearance Rate; Middle Aged; Mycoses; Pyrimidines; Renal Insufficiency; Retrospective Studies; Triazoles; Voriconazole; Young Adult

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients - Cornely, O. A.; Bassetti, M.; Calandra, T.; Garbino, J.; Kullberg, B. J.; Lortholary, O.; Meersseman, W.; Akova, M.; Arendrup, M. C.; Arikan-Akdagli, S.; Bille, J.; Castagnola, E.; et al. (Clinical Microbiology and Infection, 2012)
Clin Microbiol Infect 2012; 18 (Suppl. 7): 19–37 Abstract This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14 days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10 days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B +/− flucytosine. In ocular candidiasis, liposomal amphotericin B +/− flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects.
Keywords: Candidiasis; Guideline; non-neutropenic; prophylaxis; treatment

Polyomavirus-associated nephropathy - Costa, Cristina (World Journal of Transplantation, 2012)

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures - Cuenca-Estrella, M.; Verweij, P. E.; Arendrup, M. C.; Arikan-Akdagli, S.; Bille, J.; Donnelly, J. P.; Jensen, H. E.; Lass-Flörl, C.; Richardson, M. D.; Akova, M.; Bassetti, M.; Calandra, T.; et al. (Clinical Microbiology and Infection, 2012)
Clin Microbiol Infect 2012; 18 (Suppl. 7): 9–18 Abstract As the mortality associated with invasive Candida infections remains high, it is important to make optimal use of available diagnostic tools to initiate antifungal therapy as early as possible and to select the most appropriate antifungal drug. A panel of experts of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) undertook a data review and compiled guidelines for the clinical utility and accuracy of different diagnostic tests and procedures for detection of Candida infections. Recommendations about the microbiological investigation and detection of candidaemia, invasive candidiasis, chronic disseminated candidiasis, and oropharyngeal, oesophageal, and vaginal candidiasis were included. In addition, remarks about antifungal susceptibility testing and therapeutic drug monitoring were made.
Keywords: Biomarkers; Candida; diagnosis; guideline; noncultural

Human herpesvirus-6 infections in kidney, liver, lung, and heart transplantation: review: HHV-6 in kidney, liver, lung and heart transplantation - Lautenschlager, Irmeli; Razonable, Raymund R. (Transplant International, 2012)

Introduction to the revised American Association for the Study of Liver Diseases position paper on acute liver failure 2011 - Lee, William M.; Stravitz, R. Todd; Larson, Anne M. (Hepatology, 2012)

Infections after HSCT - Rovira, Montserrat; Mensa, Josep; Carreras, Enric (The ESH-EBMT handbook on haematopoietic stem cell transplantation, 2012)

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT) - Ullmann, A. J.; Akova, M.; Herbrecht, R.; Viscoli, C.; Arendrup, M. C.; Arikan-Akdagli, S.; Bassetti, M.; Bille, J.; Calandra, T.; Castagnola, E.; Cornely, O. A.; Donnelly, J. P.; et al. (Clinical Microbiology and Infection, 2012)
Clin Microbiol Infect 2012; 18 (Suppl. 7): 53–67 Abstract Fungal diseases still play a major role in morbidity and mortality in patients with haematological malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. Anti-Candida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation. The authors recognize that the recommendations would have most likely been different if the purpose would have been prevention of all fungal infections (e.g. aspergillosis). In targeted treatment of candidaemia, recommendations for treatment are available for all echinocandins, that is anidulafungin (AI), caspofungin (AI) and micafungin (AI), although a warning for resistance is expressed. Liposomal amphotericin B received a BI recommendation due to higher number of reported adverse events in the trials. Amphotericin B deoxycholate should not be used (DII); and fluconazole was rated CI because of a change in epidemiology in some areas in Europe. Removal of central venous catheters is recommended during candidaemia but if catheter retention is a clinical necessity, treatment with an echinocandin is an option (CIIt). In chronic disseminated candidiasis therapy, recommendations are liposomal amphotericin B for 8 weeks (AIII), fluconazole for >3 months or other azoles (BIII). Granulocyte transfusions are only an option in desperate cases of patients with Candida disease and neutropenia (CIII).
Keywords: Candida; European; guideline; haematopoietic stem cell transplantation; malignancies

First Report of Disseminated Mycobacterium Skin Infections in Two Liver Transplant Recipients and Rapid Diagnosis by hsp65 Gene Sequencing - Lau, Susanna K. P.; Curreem, Shirly O. T.; Ngan, Antonio H. Y.; Yeung, Chi-Keung; Yuen, Kwok-Yung; Woo, Patrick C. Y. (Journal of Clinical Microbiology, 2011)
We present here the first report of disseminated skin Mycobacterium infections in two liver transplant recipients, in which hsp65 gene sequencing was used for rapid species identification. Both patients had hepatitis B virus-related cirrhosis and diabetes mellitus and presented with progressive generalized, nodular skin lesions. In one patient, a 50-year-old woman who had frequent contact with marine fish, an acid-fast bacillus was isolated from skin biopsy tissue after 2 months of culture. While awaiting phenotypic identification results, hsp65 gene sequencing showed that it was most closely related to that of Mycobacterium marinum with 100% nucleotide identity. The patient was treated with oral rifampin, ethambutol, and moxifloxacin. In the other patient, a 59-year-old woman, direct PCR for Mycobacterium using hsp65 gene from skin biopsy tissue was positive, with the sequence most closely related to that of M. haemophilum with 100% nucleotide identity. Based on PCR results, the patient was treated with clarithromycin, ethambutol, moxifloxacin, and amikacin. A strain of M. haemophilum was only isolated after 3 months. Skin lesions of both patients resolved after 1 year of antimycobacterial therapy. Nontuberculous Mycobacterium infections should be considered in liver transplant recipients presenting with chronic, nodular skin lesions. This report highlights the crucial role of hsp65 gene PCR and sequencing on both cultured isolates and direct clinical specimens for rapid diagnosis of slow-growing Mycobacterium infection.

Vibrio parahemolyticus septicaemia in a liver transplant patient: a case report - Fernando, Rajeev R.; Krishnan, Sujatha; Fairweather, Morgan G.; Ericsson, Charles D. (Journal of Medical Case Reports, 2011)
Vibrio parahemolyticus is the leading cause of vibrio-associated gastroenteritis in the United States of America, usually related to poor food handling; only rarely has it been reported to cause serious infections including sepsis and soft tissue infections. In contrast, Vibrio vulnificus is a well-known cause of septicaemia, especially in patients with cirrhosis. We present a patient with V. parahemolyticus sepsis who had an orthotic liver transplant in 2007 and was on immunosuppression for chronic rejection. Clinical suspicion driven by patient presentation, travel to Gulf of Mexico and soft tissue infection resulted in early diagnosis and institution of appropriate antibiotic therapy.
Keywords: Chronic Kidney Disease; Chronic Rejection; Fishing Trip; Necrotizing Fasciitis; Soft Tissue Infection

European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3—2009 Update - Maertens, J.; Marchetti, O.; Herbrecht, R.; Cornely, O. A.; Flückiger, U.; Frêre, P.; Gachot, B.; Heinz, W. J.; Lass-Flörl, C.; Ribaud, P.; Thiebaut, A.; Cordonnier, C. (Bone Marrow Transplantation, 2011)
In 2005, several groups, including the European Group for Blood and Marrow Transplantation, the European Organization for Treatment and Research of Cancer, the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia (ECIL). The main goal of ECIL is to elaborate guidelines, or recommendations, for the management of infections in leukemia and stem cell transplant patients. The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007. The third meeting of the group (ECIL 3) was held in September 2009 and the group updated its previous recommendations. The goal of this paper is to summarize the new proposals from ECIL 3, based on the results of studies published after the ECIL 2 meeting: (1) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently, by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole; (2) micafungin was introduced as an alternative drug for empirical antifungal therapy; (3) although several studies were published on preemptive antifungal approaches in neutropenic patients, the group decided not to propose any recommendation, as the only randomized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group.

A 2010 working formulation for the standardization of definitions of infections in cardiothoracic transplant recipients - Husain, Shahid; Mooney, Martha L.; Danziger-Isakov, Lara; Mattner, Frauke; Singh, Nina; Avery, Robin; Ison, Michael; Humar, Atul; Padera, Robert F.; Lawler, Leo P.; Fisher, Andy; Drew, Richard J.; et al. (The Journal of Heart and Lung Transplantation, 2011)

Histopathologic Diagnosis of Fungal Infections in the 21st Century - Guarner, Jeannette; Brandt, Mary E. (Clinical Microbiology Reviews, 2011)
Summary: Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases - Gupta, Kalpana; Hooton, Thomas M.; Naber, Kurt G.; Wullt, Björn; Colgan, Richard; Miller, Loren G.; Moran, Gregory J.; Nicolle, Lindsay E.; Raz, Raul; Schaeffer, Anthony J.; Soper, David E. (Clinical Infectious Diseases, 2011)
Abstract. A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Mic

Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America - Freifeld, Alison G.; Bow, Eric J.; Sepkowitz, Kent A.; Boeckh, Michael J.; Ito, James I.; Mullen, Craig A.; Raad, Issam I.; Rolston, Kenneth V.; Young, Jo-Anne H.; Wingard, John R. (Clinical Infectious Diseases, 2011)
Abstract. This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 199

Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children - Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; Rybak, Michael J.; Talan, David A.; et al. (Clinical Infectious Diseases, 2011)

Medical Marijuana and Organ Transplantation: Drug of Abuse, or Medical Necessity? - Baumrucker, Steven; Mingle, Paige; Harrington, Dianne; Stolick, Matt; Carter, Gregory T.; Oertli, Karrie A. (American Journal of Hospice and Palliative Medicine®, 2011)
Keywords: Adult; Attitude of Health Personnel; Humans; Male; Marijuana Abuse; Marijuana Smoking; Organ Transplantation

Pneumocystis jirovecii pneumonia in kidney transplantation - Goto, N.; Oka, S. (Transplant Infectious Disease, 2011)

Working formulation for the standardization of definitions of infections in patients using ventricular assist devices - Hannan, Margaret M.; Husain, Shahid; Mattner, Frauke; Danziger-Isakov, Lara; Drew, Richard J.; Corey, G. Ralph; Schueler, Stephan; Holman, William L.; Lawler, Leo P.; Gordon, Steve M.; Mahon, Niall G.; Herre, John M.; et al. (The Journal of Heart and Lung Transplantation, 2011)

Posttransplant Lymphoproliferative Disease in Liver Transplant Patients - Hartmann, Christina; Schuchmann, Marcus; Zimmermann, Tim (Current Infectious Disease Reports, 2011)

Primer on transplantation - Hricik, Donald E. (Wiley-Blackwell, 2011)
"This editition of the Textbook of Transplantation represents just one of the American Society for Transplantation (AST's) many educational initiatives targeted to the next generation of transplant professionals. In addition to organ-specific chapters (kidney, pancreas, heart, lung and liver), this book includes generic chapters that should be of interest to all readers, irrespective of their organ-specific speciality. These include chapters on immunibiology, pharmacology, donor management, infectious complications, pediatric transplantation, and general principles of patient management. New features of this edition include clinical vignettes, "key point" boxes to emphasize major teaching points, and self-assesment multiple choice questions for each chapter"--
Keywords: MEDICAL / Public Health; Transplantation of organs, tissues, etc

AASLD Position Paper: The Management of Acute Liver Failure: Update 201 - Lee, William M; Larson, Anne M; Stravitz, R Todd (2011)

European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3–2009 update - Maertens, Johan; Marchetti, O.; Herbrecht, R.; Cornely, O. A.; Flückiger, U.; Frere, P.; Gachot, B.; Heinz, W. J.; Lass-Flörl, C.; Ribaud, P.; others (Bone marrow transplantation, 2011)

Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation - Wingard, John R.; Carter, Shelly L.; Walsh, Thomas J.; Kurtzberg, Joanne; Small, Trudy N.; Baden, Lindsey R.; Gersten, Iris D.; Mendizabal, Adam M.; Leather, Helen L.; Confer, Dennis L.; Maziarz, Richard T.; Stadtmauer, Edward A.; et al. (Blood, 2010)
Invasive fungal infection (IFI) is a serious threat after allogeneic hematopoietic cell transplant (HCT). This multicenter, randomized, double-blind trial compared fluconazole (N = 295) versus voriconazole (N = 305) for the prevention of IFI in the context of a structured fungal screening program. Patients undergoing myeloablative allogeneic HCT were randomized before HCT to receive study drugs for 100 days, or for 180 days in higher-risk patients. Serum galactomannan was assayed twice weekly for 60 days, then at least weekly until day 100. Positive galactomannan or suggestive signs triggered mandatory evaluation for IFI. The primary endpoint was freedom from IFI or death (fungal-free survival; FFS) at 180 days. Despite trends to fewer IFIs (7.3% vs 11.2%; P = .12), Aspergillus infections (9 vs 17; P = .09), and less frequent empiric antifungal therapy (24.1% vs 30.2%, P = .11) with voriconazole, FFS rates (75% vs 78%; P = .49) at 180 days were similar with fluconazole and voriconazole, respectively. Relapse-free and overall survival and the incidence of severe adverse events were also similar. This study demonstrates that in the context of intensive monitoring and structured empiric antifungal therapy, 6-month FFS and overall survival did not differ in allogeneic HCT recipients given prophylactic fluconazole or voriconazole. This trial was registered at www.clinicaltrials.gov as NCT00075803.

Melanized Fungi in Human Disease - Revankar, Sanjay G.; Sutton, Deanna A. (Clinical Microbiology Reviews, 2010)
Summary: Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

Leukocyte SPECT/CT for Detecting Infection of Left-Ventricular-Assist Devices: Preliminary Results - Litzler, Pierre-Yves; Manrique, Alain; Etienne, Manuel; Salles, Alice; Edet-Sanson, Agathe; Vera, Pierre; Bessou, Jean-Paul; Hitzel, Anne (Journal of Nuclear Medicine, 2010)
We report our experience with using integrated molecular and anatomic hybrid imaging to assess infection in patients who have a left-ventricular-assist device (LVAD). Methods: Thirteen 99mTc-exametazime-leukocyte planar and SPECT/CT scans were obtained for 8 consecutive patients who had an implanted LVAD. SPECT/CT was used to assess suspected device-related infections (n = 8) and to evaluate the efficiency of current antibiotic therapy (n = 5). Results: Device-related infection was seen on 8 of the 13 scans. SPECT/CT was positive for infection in all 8 patients, whereas planar scans were positive in 6 of 8. SPECT/CT provided relevant information on the extent of infection and its exact location in all patients. Additional distant infectious foci were demonstrated in 3 of 13 patients. Conclusion: SPECT/CT led to an accurate diagnosis of LVAD-related infection, revealing both anatomic location and extent. This noninvasive approach could lead to improved therapeutic strategies.
Keywords: SPECT/CT; infection; infectious disease; radionuclide imaging; scintigraphy; ventricular-assist device

Update on Cardiovascular Implantable Electronic Device Infections and Their Management: A Scientific Statement From the American Heart Association - Baddour, L. M.; Epstein, A. E.; Erickson, C. C.; Knight, B. P.; Levison, M. E.; Lockhart, P. B.; Masoudi, F. A.; Okum, E. J.; Wilson, W. R.; Beerman, L. B.; Bolger, A. F.; Estes, N. A. M.; et al. (Circulation, 2010)

Identifying Predictors of Central Nervous System Disease in Solid Organ Transplant Recipients with Cryptococcosis - Osawa, Ryosuke; Alexander, Barbara D.; Lortholary, Olivier; Dromer, Françoise; Forrest, Graeme N.; Lyon, G. Marshall; Somani, Jyoti; Gupta, Krishan L.; Busto, Ramon del; Pruett, Timothy L.; Sifri, Costi D.; Limaye, Ajit P.; et al. (Transplantation, 2010)
Background CSF analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine if a subset of SOT recipients with high likelihood of CNS disease could be identified in whom CSF analysis must be performed. Methods Patients comprised a multicenter cohort of SOT recipients with cryptococcosis. Results Of 129 of 146 (88%) SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62%) had CNS disease. In the overall study population, abnormal mental status, time to onset of cryptococcosis >24 months post-transplantation (late-onset disease), serum cryptococcal antigen titer >1:64, and fungemia were independently associated with an increased risk of CNS disease. Of patients with abnormal mental status, 95% had CNS cryptococcosis. When only patients with normal mental status were considered, three predictors (serum antigen titer >1:64, fungemia, and late-onset disease) independently identified patients with CNS cryptococcosis; the risk of CNS disease was 14% if none, 39% if one, and 94% if two of the aforementioned predictors existed (χ2 for trend p<0.001). Conclusions CSF analysis should be strongly considered in SOT recipients with cryptococcosis who have late-onset disease, fungemia, or serum cryptococcal antigen titer >1:64 even in the presence of normal mental status.

Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America - Solomkin, Joseph S.; Mazuski, John E.; Bradley, John S.; Rodvold, Keith A.; Goldstein, Ellie J. C.; Baron, Ellen J.; O'Neill, Patrick J.; Chow, Anthony W.; Dellinger, E. Patchen; Eachempati, Soumitra R.; Gorbach, Sherwood; Hilfiker, Mary; et al. (Clinical Infectious Diseases, 2010)
Abstract. Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and

Recommended curriculum for subspecialty training in transplant infectious disease on behalf of the American Society of Transplantation Infectious Diseases Community of Practice Educational Initiatives Working Group - Avery, R.; Clauss, H.; Danziger-Isakov, L.; Davis, J.; Doucette, K.; Van Duin, D.; Fishman, J.; Gunseren, F.; Humar, A.; Husain, S.; Isada, C.; Julian, K.; et al. (Transplant Infectious Disease, 2010)
This curriculum serves to provide comprehensive guidelines for training fellows in transplant ID.These guidelines will no doubt need to be modi¢ed for the unique environment of each transplant center. Moreover, as the ¢eld changes and new paradigms in transplantation emerge, updates will be required as well.
Keywords: curriculum; subspecialty; training; transplant infectious disease

Transplantation immunology: Solid organ and bone marrow - Chinen, Javier; Buckley, Rebecca H. (Journal of Allergy and Clinical Immunology, 2010)

Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) - Cohen, Stuart H.; Gerding, Dale N.; Johnson, Stuart; Kelly, Ciaran P.; Loo, Vivian G.; McDonald, L. Clifford; Pepin, Jacques; Wilcox, Mark H. (Infection Control and Hospital Epidemiology, 2010)

Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America - Perfect, John R.; Dismukes, William E.; Dromer, Francoise; Goldman, David L.; Graybill, John R.; Hamill, Richard J.; Harrison, Thomas S.; Larsen, Robert A.; Lortholary, Olivier; Nguyen, Minh‐Hong; Pappas, Peter G.; Powderly, William G.; et al. (Clinical Infectious Diseases, 2010)

Clinical management of continuous-flow left ventricular assist devices in advanced heart failure - Slaughter, Mark S.; Pagani, Francis D.; Rogers, Joseph G.; Miller, Leslie W.; Sun, Benjamin; Russell, Stuart D.; Starling, Randall C.; Chen, Leway; Boyle, Andrew J.; Chillcott, Suzanne; Adamson, Robert M.; Blood, Margaret S.; et al. (The Journal of Heart and Lung Transplantation, 2010)

How I treat EBV lymphoproliferation - Heslop, H. E. (Blood, 2009)

Dosing charts for prevention or preemptive treatment of specific infections in HCT patients (Bone Marrow Transplantation, 2009)
Appendices

Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America - Mermel, Leonard A.; Allon, Michael; Bouza, Emilio; Craven, Donald E.; Flynn, Patricia; O'Grady, Naomi P.; Raad, Issam I.; Rijnders, Bart J. A.; Sherertz, Robert J.; Warren, David K. (Clinical Infectious Diseases, 2009)
Abstract. These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers w

Rigorous Vibrio vulnificus Soft Tissue Infection of the Lower Leg in a Renal Transplant Patient Managed by Vacuum Therapy and Autologous Growth Factors - Thodis, Elias; Kriki, Pelagia; Kakagia, Despoina; Passadakis, Ploumis; Theodoridis, Marios; Mourvati, Euthymia; Vargemezis, Vassilios (Journal of Cutaneous Medicine and Surgery, 2009)
Background:Vibrio vulnificus is a gram-negative marine bacterium that grows well in coastal waters. It is an opportunistic pathogen that can cause serious life-threatening infections in patients with certain health conditions. Vibrio-induced wound infections in immunosuppressed patients are difficult to treat because the healing process may be significantly delayed. Reconstructive surgery may not be successful in early treatment as skin grafts are likely to fail, and there may be increased morbidity of donor sites of grafts or flaps.Objective:Herein a case of septicemia and wound necrosis owing to V. vulnificus wound infection in a renal transplant patient is reported.Method:To conservatively yet adequately débride the wound bed, stimulate angiogenesis, and accelerate granulation, vacuum-assisted closure was employed. Granulation was further enhanced by autologous platelet concentrate spray, which has also been reported to increase the epithelialization rate.Result:Complete epithelialization of the wound was achieved 4 weeks after completion of treatment.Conclusion:Noninvasive advanced modalities may be employed to successfully treat infectious soft tissue deficits in immunocompromised patients.

Approach to the Diagnosis of Invasive Aspergillosis and Candidiasis - Wheat, L. Joseph (Clinics in Chest Medicine, 2009)
Keywords: Antigen detection; Aspergillosis; Candidiasis; Diagnosis; Mucormycosis; Mycosis; Serology; Zygomycosis

Graft-versus-Host Disease - Ferrara, James L.M.; Levine, John E.; Reddy, Pavan; Holler, Ernst (Lancet, 2009)

Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists - Rybak, M.; Lomaestro, B.; Rotschafer, J. C.; Moellering, R.; Craig, W.; Billeter, M.; Dalovisio, J. R.; Levine, D. P. (American Journal of Health-System Pharmacy, 2009)

Diagnostic Performance of the (1→3)‐β‐ d ‐Glucan Assay for Invasive Fungal Disease - Koo, Sophia; Bryar, Julie M.; Page, John H.; Baden, Lindsey R.; Marty, Francisco M. (Clinical Infectious Diseases, 2009)

Pancreas transplantation - White, Steve A; Shaw, James A; Sutherland, David ER (2009)

Occupation, Lifestyle, Diet, and Invasive Fungal Infections - Sipsas, N. V.; Kontoyiannis, D. P. (Infection, 2008)
Although the risk factors for invasive fungal infections (IFIs) in immunocompromised hosts are well described and associated with the net state of immunosuppression, much less is written on the effects of lifestyle on the risk of IFIs in the general population.
Keywords: Aspergillosis; Cryptococcosis; Histoplasmosis; Invasive Fungal Infection; Invasive Pulmonary Aspergillosis

Adenoviruses in Immunocompromised Hosts - Echavarría, Marcela (Clinical Microbiology Reviews, 2008)
Summary: The number of patients with acquired immunodeficiency has grown steadily as a result of both a larger number of patients receiving solid organ and hematopoietic stem cell transplants and their longer survival times. The use of newer, more potent immunosuppressive regimens has increased the frequency of severe adenovirus infections. Human adenoviruses are a large group of viruses, represented by at least 52 serotypes with various genotypes divided into genomic clusters, and these may cause a broad variety of clinical manifestations. The development of molecular methods has increased the sensitivity and rapidity of adenovirus infection diagnosis. The implementation of PCR assays has significantly contributed to the identification of patients with disseminated adenovirus disease. More recently, the development of real-time PCR assays has permitted virus quantification and patient follow-up. There is no treatment for adenovirus with demonstrated efficacy, although cidofovir is widely used. Sensitive diagnostic tests for adenovirus can contribute to the early diagnosis and successful treatment of life-threatening adenovirus infections, especially in complex immunocompromised patients. The development of improved adenovirus therapy still remains a challenge. Adenovirus genetic diversity should be considered for diagnosis, typing, and therapeutic interventions.

Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis - Aiello, Allison E.; Coulborn, Rebecca M.; Perez, Vanessa; Larson, Elaine L. (American Journal of Public Health, 2008)
To quantify the effect of hand-hygiene interventions on rates of gastrointestinal and respiratory illnesses and to identify interventions that provide the greatest efficacy, we searched 4 electronic databases for hand-hygiene trials published from January 1960 through May 2007 and conducted meta-analyses to generate pooled rate ratios across interventions (N=30 studies)., Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap., Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed.

Clinical Practice Guidelines for the Management of Blastomycosis: 2008 Update by the Infectious Diseases Society of America - Chapman, Stanley W.; Dismukes, William E.; Proia, Laurie A.; Bradsher, Robert W.; Pappas, Peter G.; Threlkeld, Michael G.; Kauffman, Carol A. (Clinical Infectious Diseases, 2008)

Hepatic Sinusoidal Obstruction Syndrome Following Hematopoietic Stem Cell Transplantation - Krimmel, Tracy; Williams, Loretta A. (Oncology Nursing Forum, 2008)

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation - Martín-Dávila, P.; Fortún, J.; López-Vélez, R.; Norman, F.; Oca, M. Montes de; Zamarrón, P.; González, M. I.; Moreno, A.; Pumarola, T.; Garrido, G.; Candela, A.; Moreno, S. (Clinical Microbiology Reviews, 2008)
In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially ...

Mycobacterium marinum infections in transplant recipients: case report and review of the literature - Pandian, T.k.; Deziel, P.j.; Otley, C.c.; Eid, A.j.; Razonable, R.r. (Transplant Infectious Disease, 2008)
Abstract: Infections due to Mycobacterium marinum are rarely encountered following organ and tissue transplantation. Herein, we report a case of M. marinum infection in a kidney and pancreas transplant recipient who manifested clinically with multiple locally spreading sporotrichoid-like cutaneous nodules in his left forearm. In order to provide a general overview of post-transplant M. marinum infections, we reviewed and summarized all previously reported cases of this infection that occurred after transplantation. Including our index case, all 6 cases presented with multiple cutaneous and subcutaneous nodules that had spread locally in the involved extremity. One patient had lesions located in non-contiguous body sites suggesting either systemic dissemination or multiple sites of inoculation. In all but 1 patient, the cutaneous nodules appeared in an ascending pattern and following exposure to fish tanks or after contact with the marine environment. The diagnosis of M. marinum infection was suspected on clinical grounds and confirmed by mycobacterial culture. Treatment consisted of at least 2 active antibiotics (such as rifamycins, ethambutol, tetracyclines, or macrolides) for 4–9 months, resulting in clinical cure or improvement. Relapse was observed in 1 patient despite completing 6 months of antibiotic therapy. One patient had surgical excision of the lesions. In conclusion, M. marinum should be considered as the cause of cutaneous and subcutaneous nodules in transplant recipients, particularly in the context of fish tank or marine exposure. Compared with the immunocompetent hosts, M. marinum infection may have a more aggressive clinical course after transplantation, and may require a longer duration of antibiotic treatment. Early diagnosis and treatment may prevent local spread and potential systemic dissemination.
Keywords: Mycobacterium marinum; fish tank granuloma; transplant; ulcerative nodule

Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America - Walsh, Thomas J.; Anaissie, Elias J.; Denning, David W.; Herbrecht, Raoul; Kontoyiannis, Dimitrios P.; Marr, Kieren A.; Morrison, Vicki A.; Segal, Brahm H; Steinbach, William J.; Stevens, David A.; Burik, Jo‐Anne van; Wingard, John R.; et al. (Clinical Infectious Diseases, 2008)

Syphilis-related hepatitis in a liver transplant patient - Camara, Boubou; Kamar, Nassim; Bonafe, Jean-Louis; Danjoux, Marie; Suc, Bertrand; Rostaing, Lionel (Experimental and Clinical Transplantation: Official Journal of the Middle East Society for Organ Transplantation, 2007)
We herein describe a case of secondary syphilis hepatitis in a liver transplant patient. This homosexual man presented 15 years after an orthotopic liver transplant with nonsquamous papillomacular rash, mild cytolysis, and anicteric cholestasis. Laboratory tests showed syphilis seroconversionwith a VDRL test titer of 1/256, a Treponema pallidum hemagglutination assay of 1/5120, and a positive immunoglobulin M fluorescent Treponemal antibody absorbance. A liver biopsy performed 13 months after the diagnosis showed low-grade hepatitis with a METAVIR score of A1F1; it also showed moderate, nonspecific portal inflammation consisting primarily of neutrophils, with no evidence of cholestasis. The patient was given benzathine-penicillin (2400000 IU) with a transient increase in prednisolone dosages. Cytolysis rapidly, and cholestasis progressively, disappeared. Results of an immunoglobulin M fluorescent Treponemal antibody absorbance test became negative, whereas the VDRL test and the Treponema pallidum hemagglutination assay titers decreased slightly over time.
Keywords: Hepatitis, Viral, Human; Humans; Liver Transplantation; Male; Middle Aged; Syphilis; Treponema pallidum

Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America - Kauffman, Carol A.; Bustamante, Beatriz; Chapman, Stanley W.; Pappas, Peter G. (Clinical Infectious Diseases, 2007)
Guidelines for the management of patients with sporotrichosis were prepared by an Expert Panel of the Infectious Diseases Society of America and replace the guidelines published in 2000. The guidelines are intended for use by internists, pediatricians, family practitioners, and dermatologists. They include evidence-based recommendations for the management of patients with lymphocutaneous, cutaneous, pulmonary, osteoarticular, meningeal, and disseminated sporotrichosis. Recommendations are also provided for the treatment of sporotrichosis in pregnant women and in children.

Prevention of Infective Endocarditis - Wilson, Walter; Taubert, Kathryn A.; Gewitz, Michael; Lockhart, Peter B.; Baddour, Larry M.; Levison, Matthew; Bolger, Ann; Cabell, Christopher H.; Takahashi, Masato; Baltimore, Robert S.; Newburger, Jane W.; Strom, Brian L.; et al. (Circulation, 2007)
Background— The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. Methods and Results— A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. Conclusions— The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
Keywords: AHA Scientific Statements; antibiotic prophylaxis; cardiovascular diseases; endocarditis; prevention

Clinical Practice Guidelines for the Management of Patients with Histoplasmosis: 2007 Update by the Infectious Diseases Society of America - Wheat, L. Joseph; Freifeld, Alison G.; Kleiman, Martin B.; Baddley, John W.; McKinsey, David S.; Loyd, James E.; Kauffman, Carol A. (Clinical Infectious Diseases, 2007)

An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases - Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; et al. (American Journal of Respiratory and Critical Care Medicine, 2007)

Posaconazole vs. Fluconazole or Itraconazole Prophylaxis in Patients with Neutropenia - Cornely, Oliver A.; Maertens, Johan; Winston, Drew J.; Perfect, John; Ullmann, Andrew J.; Walsh, Thomas J.; Helfgott, David; Holowiecki, Jerzy; Stockelberg, Dick; Goh, Yeow-Tee; Petrini, Mario; Hardalo, Cathy; et al. (New England Journal of Medicine, 2007)
In this randomized trial of patients undergoing treatment for acute myelogenous leukemia or the myelodysplastic syndrome, prophylaxis with posaconazole resulted in fewer fungal infections and longer survival than did prophylaxis with fluconazole or itraconazole. The difference was primarily due to a lower rate of invasive aspergillosis in the posaconazole group.

Posaconazole or Fluconazole for Prophylaxis in Severe Graft-versus-Host Disease - Ullmann, Andrew J.; Lipton, Jeffrey H.; Vesole, David H.; Chandrasekar, Pranatharthi; Langston, Amelia; Tarantolo, Stefano R.; Greinix, Hildegard; Morais de Azevedo, Wellington; Reddy, Vijay; Boparai, Navdeep; Pedicone, Lisa; Patino, Hernando; et al. (New England Journal of Medicine, 2007)
This randomized, double-blind trial of prophylaxis to prevent invasive fungal infections was conducted in 600 patients with severe graft-versus-host disease after hematopoietic stem-cell transplantation. Posaconazole, an extended-spectrum triazole, was as effective as fluconazole in preventing invasive fungal infections (incidence, 5.3% and 9.0%, respectively). With posaconazole, there were fewer cases of invasive aspergillosis infections.

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis - Garcia-Tsao, Guadalupe; Sanyal, Arun J.; Grace, Norman D.; Carey, William; Practice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology (Hepatology, 2007)

Hematopoietic Stem-Cell Transplantation - Copelan, Edward A. (New England Journal of Medicine, 2006)
Hematopoietic stem-cell transplantation, which is used to treat both malignant and nonmalignant conditions, was first conceived more than 50 years ago, but problems associated with transplanting a nonsolid organ and modulating the immune response had to be solved before the procedure could be used clinically. This review summarizes background information about hematopoietic stem-cell transplantation and discusses the current role of the procedure.

Late Syphilis in a Cardiac Transplant Patient - Farr, Maryjane; Rubin, Adam I.; Mangurian, Christina; Scully, Brian; Silvers, David N.; Husain, Sameera; Grossman, Marc E.; Mancini, Donna (The Journal of Heart and Lung Transplantation, 2006)

Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study - Singh, Nina; Limaye, Ajit P.; Forrest, Graeme; Safdar, Nasia; Muñoz, Patricia; Pursell, Kenneth; Houston, Sally; Rosso, Fernando; Montoya, Jose G.; Patton, Pamela; Del Busto, Ramon; Aguado, Jose M.; et al. (Transplantation, 2006)
BACKGROUND: : The efficacy of the combination of voriconazole and caspofungin when used as primary therapy for invasive aspergillosis in organ transplant recipients has not been defined. METHODS: : Transplant recipients who received voriconazole and caspofungin (n=40) as primary therapy for invasive aspergillosis (proven or probable) in a prospective multicenter study between 2003 and 2005 were compared to a control group comprising a cohort of consecutive transplant recipients between 1999 and 2002 who had received a lipid formulation of AmB as primary therapy (n=47). In vitro antifungal testing of Aspergillus isolates to combination therapy was correlated with clinical outcome. RESULTS: : Survival at 90 days was 67.5% (27/40) in the cases, and 51% (24/47) in the control group (HR 0.58, 95% CI, 0.30-1.14, P=0.117). However, in transplant recipients with renal failure (adjusted HR 0.32, 95% CI: 0.12-0.85, P=0.022), and in those with A. fumigatus infection (adjusted HR 0.37, 95% CI: 0.16-0.84, P=0.019), combination therapy was independently associated with an improved 90-day survival in multivariate analysis. No correlation was found between in vitro antifungal interactions of the Aspergillus isolates to the combination of voriconazole and caspofungin and clinical outcome. CONCLUSIONS: : Combination of voriconazole and caspofungin might be considered preferable therapy for subsets of organ transplant recipients with invasive aspergillosis, such as those with renal failure or A. fumigatus infection.
Keywords: Adult; Aged; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Caspofungin; Drug Therapy, Combination; Echinocandins; Female; Humans; Lipopeptides; Male; Middle Aged; Organ Transplantation; Peptides, Cyclic; Pyrimidines; Renal Insufficiency; Treatment Outcome; Triazoles; Voriconazole

Lung Transplant Recipients Holding Companion Animals: Impact on Physical Health and Quality of Life - Irani, S.; Mahler, C.; Goetzmann, L.; Russi, E.w.; Boehler, A. (American Journal of Transplantation, 2006)
Since lung transplant recipients are susceptible to infections and inhaled pollution, many centers warn against pets. However, data supporting this recommendation are lacking. Our program is less restrictive regarding pets. This study, for the first time, investigates the association of pets with physiological and psychological parameters in these patients. A questionnaire concerning pets was sent to 104 lung transplant recipients. Lung function tests, levels of exhaled nitric oxide (FENO), need for antibiotic treatments and hospitalizations, creatinine clearance, body mass index (BMI) and demographic data were assessed. Additionally, the questionnaire of life satisfaction (FLZ), a question on summarized life satisfaction (LS), the life orientation test (LOT), the hospital anxiety depression scale (HADS) and the social support questionnaire (F-SozU) were assessed. Response rate was 86%. Fifty-two percent defined themselves as pet owners, whereas 48% did not. The two groups did not differ in demographic or physiological data. Significant differences in FLZ (79/65, p = 0.04), in LS (4.3/3.9, p = 0.01), LOT (32/29, p = 0.006) and F-SozU (4.5/4.2, p = 0.04) were found in favor of pet owners. In lung transplant recipients keeping pets the frequency of somatic complications is not higher compared to lung transplant recipients without pets. After lung transplantation, pets are associated with a better quality of life.
Keywords: Companion animal; Lung transplantation; Physical health; Quality of life

Antigen detection, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host - Wheat, L. J. (Transplant infectious disease, 2006)

Sushi Delights and Parasites: The Risk of Fishborne and Foodborne Parasitic Zoonoses in Asia - Nawa, Yukifumi; Hatz, Christoph; Blum, Johannes (Clinical Infectious Diseases, 2005)
Because of the worldwide popularization of Japanese cuisine, the traditional Japanese fish dishes sushi and sashimi that are served in Japanese restaurants and sushi bars have been suspected of causing fishborne parasitic zoonoses, especially anisakiasis. In addition, an array of freshwater and brackish-water fish and wild animal meats, which are important sources of infection with zoonotic parasites, are served as sushi and sashimi in rural areas of Japan. Such fishborne and foodborne parasitic zoonoses are also endemic in many Asian countries that have related traditional cooking styles. Despite the recent increase in the number of travelers to areas where these zoonoses are endemic, travelers and even infectious disease specialists are unaware of the risk of infection associated with eating exotic ethnic dishes. The aim of this review is to provide practical background information regarding representative fishborne and foodborne parasitic zoonoses endemic in Asian countries.

Levofloxacin to Prevent Bacterial Infection in Patients with Cancer and Neutropenia - Bucaneve, Giampaolo; Micozzi, Alessandra; Menichetti, Francesco; Martino, Pietro; Dionisi, M. Stella; Martinelli, Giovanni; Allione, Bernardino; D'Antonio, Domenico; Buelli, Maurizio; Nosari, A. Maria; Cilloni, Daniela; Zuffa, Eliana; et al. (New England Journal of Medicine, 2005)
In 760 patients with cancer in whom chemotherapy-induced neutropenia was expected to last more than seven days, those assigned to levofloxacin (500 mg daily) had a lower incidence of fever (65 percent vs. 85 percent) and clinically documented bacteremias than those assigned to placebo. The benefits of prophylaxis were similar in patients with acute leukemia and those with solid tumors or lymphoma. These data support the prophylactic use of levofloxacin in this high-risk population.

Antibacterial Prophylaxis after Chemotherapy for Solid Tumors and Lymphomas - Cullen, Michael; Steven, Neil; Billingham, Lucinda; Gaunt, Claire; Hastings, Mark; Simmonds, Peter; Stuart, Nicholas; Rea, Daniel; Bower, Mark; Fernando, Indrajit; Huddart, Robert; Gollins, Simon; et al. (New England Journal of Medicine, 2005)
In this trial, 1565 patients who were receiving cyclic chemotherapy for solid tumors or lymphoma and who were at risk for temporary, severe neutropenia received either 500 mg of levofloxacin once daily or placebo for seven days. At least one febrile episode occurred in 15.2 percent of the placebo group and 10.8 percent of the levofloxacin group (P=0.01). Hospitalization was required for the treatment of infection in 21.6 percent of the placebo group and 15.7 percent of the levofloxacin group (P=0.004). Antimicrobial resistance was not systematically evaluated.

Identification of an infected left ventricular assist device after cardiac transplant by indium-111 WBC scintigraphy - Roman, Christopher D.; Habibian, M. Reza; Martin, William H. (Clinical Nuclear Medicine, 2005)
PURPOSE: The purpose of this case report is to demonstrate the utility of multimodality imaging in the diagnosis of infection within a retained prosthetic device in the posttransplant setting. MATERIAL AND METHODS: Autologous leukocytes were labeled in vitro with indium-111 oxine and were reinjected. Whole-body and SPECT images were acquired at 24 hours and correlated with contemporary CT images. RESULTS: Through the use of combined indium-labeled WBC scintigraphy and CT we were able to identify infection within retained left ventricular assist device tubing status postcardiac transplantation in a patient with a diagnosis of fever of unknown origin. CONCLUSION: Localization of possible infectious etiologies within the transplant population is of utmost concern. Multimodality imaging, often utilizing scintigraphic techniques, is recommended.
Keywords: Heart Ventricles; Heart-Assist Devices; Humans; Image Enhancement; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Myocarditis; Prosthesis-Related Infections; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Subtraction Technique

Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation - Taylor, Anna L.; Marcus, Robert; Bradley, J. Andrew (Critical Reviews in Oncology/Hematology, 2005)

Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation - Zerr, Danielle M.; Corey, Lawrence; Kim, Hyung W.; Huang, Meei-Li; Nguy, Long; Boeckh, Michael (Clinical infectious diseases, 2005)

Immunosuppressive Drugs for Kidney Transplantation - Halloran, Philip F. (New England Journal of Medicine, 2004)
The central issue in organ transplantation remains suppression of allograft rejection. Thus, development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction (intense immunosuppression in the initial days after transplantation), maintenance, and reversal of established rejection. This review focuses on agents that are either approved or in phase 2 or phase 3 trials in kidney transplantation, but many issues covered here are applicable to all organ transplantation. I begin with a model of the alloimmune response to illustrate how these medications act. Three-Signal Model of Alloimmune Responses Alloimmune responses involve both naive and . . .

Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients - Rodriguez, M.; Fishman, J. A. (Clinical Microbiology Reviews, 2004)

Chronic Diarrhea and Weight Loss Due to Vibrio parahaemolyticus Infection in a Renal Transplant Recipient - Shankar, Venugopal K.; Zilvetti, Miguel; Handa, Ashok; Bowler, Ian C. J. W.; Gray, Derek W. R. (Transplantation, 2004)
An abstract is unavailable.

Combination Antifungal Therapy - Johnson, Melissa D.; MacDougall, Conan; Ostrosky-Zeichner, Luis; Perfect, John R.; Rex, John H. (Antimicrobial Agents and Chemotherapy, 2004)
The availability of new antifungal agents with novel mechanisms of action has stimulated renewed interest in combination antifungal therapies. In particular, and despite the limited clinical data, the high mortality of mold infections and the relatively limited efficacy of current agents have

Travel Patterns and Risk Behavior in Solid Organ Transplant Recipients - Boggild, Andrea K.; Sano, Marie; Humar, Atul; Gilman, Matt; Salit, Irving; Kain, Kevin C. (Journal of Travel Medicine, 2004)
International travel is associated with an increased risk of enteric, vector-borne and bloodborne infections. The risk of acquiring travel-related illness is higher in those who are immunocompromised. However, little is known about travel practices and risk behaviors in transplant recipients who travel. We herein profile transplant recipients who travel, and characterize their pretravel precautions, travel activities, burden of illness, and exposure history.With the use of a standardized and validated questionnaire, patients attending a transplant clinic were surveyed regarding recent travel and risk behaviors.Of 267 transplant recipients who participated, 95 (36%) indicated that they had recently traveled outside Canada and the USA. Their mean age was 49.9 years, 54% were male, and 54% were born outside Canada. Eighty-six percent of travelers were receiving at least two immunosuppressive drugs at the time of their trip. Sixty-six percent of travelers sought pretravel advice, primarily from their transplant physician. Sixty-three percent traveled to areas where hepatitis A is endemic, but only 5% had received hepatitis A immunization. Fifty percent traveled to dengue- and malaria-endemic areas, but <25% adhered to mosquito prevention measures. Ten percent reported behaviors that exposed them to blood or body fluids, including injections, body piercing, and casual sexual activity.Solid organ transplant recipients represent a unique group of compromised travelers; however, few were adequately protected against travel-associated enteric, vector-borne and bloodborne pathogens.
Keywords: Adolescent; Adult; Aged; Dengue; Female; Hepatitis A; Humans; Immunocompromised Host; Malaria; Male; Middle Aged; Ontario; Organ Transplantation; Patient Acceptance of Health Care; Risk-Taking; Surveys and Questionnaires; Travel

Antifungal Drug Interactions

Clinical Decision Support Tool for Resistant/Refractory CMV in Transplantation

Doctor Fungus - Histoplasmosis due to Histoplasma capsulatum (Doctor Fungus)
Synonyms North American histoplasmosis. Contrast with African histoplasmosis due to Histoplasma duboisii Definition Histoplasmosis refers to the condition caused by the infection with the dimorphic endemic fungi N/A(L):Histoplasma capsulatum var. capsulatum. This anamorphic fungus has a known sexual teleomorph that carries the name Ajellomyces capsulatus. The majority of acute cases of infection with this fungus follow a subclinical and benign course in normal hosts [2412]. However, a disseminated and potentially fatal picture is seen among immunosuppressed individuals, children less than 2 years old, elderly persons, and people exposed to very large inoculum [872]. Since the advent of the HIV epidemic, […]

Doctor Fungus - Histoplasmosis due to Histoplasma duboisii (Doctor Fungus)
Synonyms African histoplasmosis. Contrast with North American histoplasmosis due to Histoplasma capsulatum Definition and forms of the disease Histoplasmosis due to N/A(L):Histoplasma duboisii is a mycotic infection primarily involving cutaneous, liver, lung, lymphatic, subcutaneous, and bony tissues. Skin and bone are the most frequently invaded sites [454]. The etiologic agent grows as a large yeast within giant cells. It may also present with small cells that are typical of those seen in histoplasmosis due to Histoplasma capsulatum. Nodular and ulcerative cutaneous and osteolytic lesions of bone that disseminate or remain localized are the primary clinical characteristics of histoplasmosis duboisii [11, […]

Doctor Fungus - Mycoses in Patients Receiving Tumor Necrosis Factor-α Inhibitor (Doctor Fungus)
John W. Baddley, MD, MSPH Introduction The number of patients receiving immunosuppressive agents has increased over the past decade and is expected to increase substantially in the near future. Therapeutic antibodies have become an important class of drugs, with annual sales that exceeded $27 billion in 2007[(A):1].  Important new therapeutic biologics include the TNF-a inhibitors (TNFi) infliximab, etanercept, adalimumab, certolizumab pegol and golimumab. These drugs are approved for the treatment of one or more of a number of diseases including rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, Crohn’s disease, juvenile idiopathic arthritis and ankylosing spondylitis.  Although these drugs have revolutionized the […]

Doctor Fungus - Oropharyngeal Candidiasis (Doctor Fungus)
Overview Oropharyngeal candidiasis (OPC) is the general term given to the oral infection caused by the yeast Candida. This condition is also often referred to informally as “thrush”. As we will discuss in detail in this section, OPC meets all the criteria to be considered an opportunistic infection. Whereas asymptomatic oral colonization may also occur, OPC implies the presence of signs and symptoms of infection. Epidemiology Candida spp. are part of the normal mouth flora in 25-50{64e6c1a1710838655cc965f0e1ea13052e867597ac43370498029d1bc5831201} of healthy individuals [1672]. Such carriage is referred to as asymptomatic colonization. Candida albicans is the most frequent colonizer (70-80{64e6c1a1710838655cc965f0e1ea13052e867597ac43370498029d1bc5831201}) but any of […]

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fungal diagnostic test menu | fungal diagnostic test form (MiraVista Diagnostics)
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Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection
The 2024 hepatitis B guidelines provide updated evidence-informed recommendations on key priority topics. They prioritize simplified treatment criteria for adults and adolescents and expanded eligibility for antiviral prophylaxis for pregnant women to prevent mother-to-child transmission of HBV.

LIFE Worldwide | Fungal Education (Life Worldwide)
LIFE Worldwide provide, free educational resources and materials on global fungal infections.

Phaeohyphomycosis (Doctor Fungus)
Synonyms Cerebral chromomycosis, chromoblastomycosis (in part), chromomycosis (in part), cladosporiosis, phaeomycotic cyst, phaeosporotrichosis, subcutaneous mycotic cyst.   Definition Phaeohyphomycosis consists of a group of mycotic infections characterized by the presence of dematiaceous (dark-walled) septate hyphae and sometimes yeast or a combination of both in tissue. The hyphae may be short to elongate, distorted or swollen (toruloid hyphae), regularly shaped, or any combination of the above. The yeast when present will be variable in size and most of the time will show budding. The yeast should not be confused with the sclerotic Medler cells seen with the agents of chromoblastomycosis in […]

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Sporotrichosis (Doctor Fungus)
Synonyms None Definition Sporotrichosis refers to the infection caused by the dimorphic fungus N/A(L):Sporothrix schenckii. The disease has been described worldwide, however it is more common in tropical and subtropical America [1898, 2251]. Sporotrichosis is acquired through direct inoculation into the skin and rarely via inhalation of conidia. As a consequence, the majority of cases are localized lesions affecting the skin and subcutaneous tissues with minimal if any systemic manifestation. Skin lesions characteristically follow lymphatic pathways, but the lymph nodes themselves are not usually involved. The initial erythematous papulonodular lesions evolve into either smooth or verrucose painless nodules of about […]

The Aspergillus Website (Aspergillus and Aspergillosis)
Living with itWorking with itTreating it The Aspergillus website is a comprehensive resource providing detailed information about the fungus Aspergillus and the diseases it can cause, these are usually called aspergillosis. 25 years of service to the clinical and research communities across the world. This site is free to use and provides an encyclopaedia of ... Read more

TransplantID.Net - American Society of Transplantation (@transplantidnet.bsky.social) (Bluesky Social)
The official Bluesky account for http://transplantid.net, the AST @astinfo.bsky.social ID COP @ast-idcop.bsky.social Transplant Infectious Diseases Library Posts made by this account are not endorsed and may not reflect the views of AST.

Visiting Friends & Relatives: VFR Travel - Chapter 9 - 2020 Yellow Book | Travelers' Health | CDC

Histoplasmosis beyond HIV: Clinical characteristics and T outcomes in non-HIV population - Ac, Tello-Mercado

Investigation of donor-derived Strongyloides stercoralis infection in multiple solid organ transplant recipients—California, Michigan, Ohio, 2022 - Adeyemo, AdeSubomi; Montgomery, Susan; Chancey, Rebecca J.; Annambhotla, Pallavi; Barba, Lilly; Clarke, Tyan; Williams, Jonathan; Malilay, Anne; Coyle, Joseph (Transplant Infectious Disease)
Background The Centers for Disease Control and Prevention led an investigation to determine if Strongyloides infection in a right kidney recipient was an existing chronic infection, or if the infection was transmitted from an infected organ donor. Methods Evidence regarding the organ donor and organ recipients Strongyloides testing, treatment, and risk factors were gathered and evaluated. The case classification algorithm created by the Disease Transmission Advisory Committee was utilized. Results The organ donor had risk factors for Strongyloides infection; the banked donor specimen, submitted for serology testing 112 days post-donor death, was positive. The right kidney recipient was negative for Strongyloides infection pretransplant. Strongyloides infection was diagnosed via small bowel and stomach biopsies. The left kidney recipient had risk factors for Strongyloides infection. Two posttransplant Strongyloides antibody tests were negative at 59 and 116 days posttransplant; repeat antibody tests returned positive at 158 and 190 days posttransplant. Examination of bronchial alveolar lavage fluid collected 110 days posttransplant from the heart recipient showed a parasite morphologically consistent with Strongyloides species. She subsequently developed complications from Strongyloides infection, including hyperinfection syndrome and disseminated strongyloidiasis. Based on the evidence from our investigation, donor-derived strongyloidiasis was suspected in one recipient and proven in two recipients. Conclusion The results of this investigation support the importance of preventing donor-derived Strongyloides infections by laboratory-based serology testing of solid organ donors. Donor positive testing results would direct the monitoring and treatment of recipients to avoid severe complications.
Keywords: Strongyloides stercoralis; donor-derived; parasitic infection; transplant

Comprehensive Trainee Curriculum - AST

COVID-19 Information - AST

Timely Topics in Transplantation - AST

Transplant in 10 (Tx10) Videos - AST

Executive Summary 7_14_25 - Attipoe, Senam

2024 Clinical Practice Guideline Update by the Infectious T Diseases Society of America on Complicated Intra- IP abdominal Infections: Risk Assessment in Adults and R Children - Bonomo, Robert A; Chow, Anthony W; Abrahamian, Fredrick M; Bessesen, Mary; Dellinger, Patchen; Edwards, Morven S; Goldstein, Ellie; Hayden, Mary K; Kaye, Keith; Potoski, Brian A; Baño, Jesús Rodríguez; Sawyer, Robert; et al.

Systematic fungal biomarker or polymerase chain reaction testing in lung transplant recipients: Retrospective analysis to optimize their use - Boutin, Catherine-Audrey; Ison, Michael G (Transplant Infectious Disease)
Background Among lung transplant recipients, serial bronchoscopies are performed frequently. Often, serial galactomannan (GM), 1,3-β-d-glucan (BDG), and Pneumocystis jirovecii (PJ) testing is performed with these broncho-alveolar lavages (BALs) as standard of care with limited data to support their routine use. Methods After Institutional Review Board approval, we retrospectively collected all blood and BAL GM, BDG, and PJ test results from January 2015 to July 20, 2022. Primary data collection from the Northwestern Medicine EDW was supplemented by manual chart review. Results During the study period, 236 lung transplant recipients were cared for by our center. Of these patients, 217 (91.9%) had 1418 GM tests performed; 61 (4.3%) were positive (index ≥1). Fungal cultures were requested for most BAL-GM (90.7%). Out of duplicates in same BAL, results discrepancy was minimal (3.4%). 172 (72.9%) had BDG tests were performed; 25.6% were positive. Thirteen patients had multiple BDG during one hospitalization (mean 2.3 tests); none of the negative test repeated became positive. Eleven negative BDG were seen in patients with invasive aspergillosis (IA). Note that, 577 PJ testing were performed (direct fluorescent antibody [n = 494] or polymerase chain reaction [PCR] [n = 80], or both [n = 3]) in 174 different patients. None were positive. Conclusion Despite supplemental GM, BDG, and Pneumocystis jirovecii pneumonia PCR being performed routinely on lung transplant recipients undergoing BAL at our center, the data suggests a more tailored approach may be appropriate. There is no role for routine serial testing with these assays during a single hospitalization. BDG confers no added-value over GM with cultures for IA diagnosis.
Keywords: B-D-glucan; Pneumocystis jirovecii; diagnostic stewardship; galactomannan; transplantation

CDC Patient Information: Isoniazid - CDC

CDC Patient Information: Isoniazid (Espanol) - CDC

CDC Patient Information: Isoniazid-Rifapentine - CDC

CDC Patient Information: Isoniazid-Rifapentine (Espanol) - CDC

CDC Patient Information: Rifampin - CDC

CDC Patient Information: Rifampin (Espanol) - CDC

CDC Patient Information: The 12-Dose Regimen for Latent Tuberculosis (TB) Infection - CDC

CDC Patient Information: The 12-Dose Regimen for Latent Tuberculosis (TB) Infection (Espanol) - CDC

CDC: The Difference Between Latent TB Infection and TB Disease - CDC

CDC: The Difference Between Latent TB Infection and TB Disease (Espanol) - CDC

Destinations | Travelers' Health | CDC - CDC

Measles Clinical Diagnosis Fact Sheet - CDC
Learn about measles disease course and what to do if you have a suspected case.

Test Types Typically Available to Clinicians and Descriptions for Measles, Mumps, Rubella, and Varicella - CDC

Travelers' Health | CDC - CDC

Development of an Interferon-Gamma Release Assay (IGRA) to Aid Diagnosis of Histoplasmosis - Datta, Kausik; LaRue, Richard; Permpalung, Nitipong; Das, Sukanya; Zhang, Sean; Mehta Steinke, Seema; Bushkin, Yuri; Nosanchuk, Joshua D.; Marr, Kieren A. (Journal of Clinical Microbiology)
Establishing diagnosis of latent and active histoplasmosis is challenging. Interferon gamma-release assays (IGRAs) may provide evidence of latent and active infection. An enzyme-linked immunospot (ELISpot) assay was developed using yeast cell lysate (YCL) antigen prepared from a representative North American Histoplasma capsulatum strain. Assay parameters were optimized by measuring responses in healthy volunteers with and without Histoplasma infection. Assay performance as an aid for diagnosing histoplasmosis was assessed in a prospective cohort of 88 people with suspected or confirmed infection, and 44 healthy controls enrolled in two centers in North America (2013 to 2018). Antigen specificity of IFN-γ release was demonstrated using ELISpot and enzyme-linked immunosorbent assay (ELISA). Antigen-evoked, single-cell mRNA expression by memory T cells was shown using flow cytometry. The area under the receiver operating characteristic curve (AUC) was estimated at 0.89 (95% confidence interval [CI]: 78.5% to 99.9%). At optimal cutoff, sensitivity was 77.2% (95% CI: 54.6% to 92.2%) and specificity was 100% (95% CI: 89.7% to 100%). Sixteen of 44 healthy volunteers (36.4%) from a region of hyperendemicity had positive responses, suggesting detection of previously unrecognized (latent) infection. The ELISpot assay is sensitive and specific as an aid to diagnose H. capsulatum infection and disease, supporting proof of concept and further development.

Clinical utility of a cytomegalovirus-specific T cell assay in assessing the risk of post-prophylaxis cytomegalovirus infection and post-treatment relapse - Dioverti, Maria Veronica; Bhaimia, Eric; Yetmar, Zachary A.; Melendez, Dante P.; Misner, Lori; Beito, Elaine; Deziel, Paul J.; Theel, Elitza S.; Razonable, Raymund R. (Clinical Transplantation)
Introduction Cytomegalovirus (CMV) causes significant morbidity in solid organ transplant recipients (SOTR). Measuring cell-mediated immunity (CMI) may inform the risk of CMV infection after antiviral prophylaxis and predict relapse after CMV treatment. Methods We serially assessed CMV CMI using the QuantiFERON-CMV assay (QF-CMV; Qiagen, Germantown, MD) in two cohorts of SOTRs: during valganciclovir prophylaxis and during treatment of CMV viremia. Results of CMI were correlated with post-prophylaxis CMV infection and post-treatment relapse, respectively. Results Only one (4.2%) of 24 CMV D+/R- patients demonstrated positive QF-CMV by the end of valganciclovir prophylaxis. Four (16.6%) patients developed post-prophylaxis CMV infection; all four had undetectable QF-CMV at end of prophylaxis. Among 20 patients treated for CMV infection, 18 (90%) developed QF-CMV levels >.2 IU/mL by end of antiviral treatment and none developed CMV relapse. In contrast, the single patient who relapsed after completing treatment had a CMV CMI <.2 IU/ml (p = .0036). Conclusion Since CMV D+/R- SOTRs are unlikely to develop adequate CMV CMI while receiving valganciclovir prophylaxis, the utility of CMV CMI monitoring for risk stratification during time of prophylaxis had limited value. Conversely, CMV CMI testing may be a useful marker of the risk of CMV relapse after antiviral treatment.
Keywords: CMV; T-cell assay; cell-mediated immunity

Antfungal Therapeutic Drug Monitoring (TDM): Infographic Resources - Fungus Education Hub (Fungus Education Hub)

Incidence and severity of cytomegalovirus infection in seropositive heart transplant recipients - Gardiner, Bradley J.; Bailey, Jessica P.; Percival, Mia A.; Morgan, Beth A.; Warner, Victoria M.; Lee, Sue J.; Morrissey, C. Orla; Kaye, David M.; Peleg, Anton Y.; Taylor, Andrew J. (Clinical Transplantation)
Background The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. Methods R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one-year post-transplant; secondary outcomes included other herpesvirus infections and mortality. Results CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p = .01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p = .005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p < .001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p < .001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR .07, .01–.72, p = .025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p = .005). Conclusions CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients.
Keywords: cytomegalovirus; heart transplant; recipient positive

“They paged me what?”: A transplant infectious disease guide to donor calls - Gorsline, Chelsea A.; Tyler, Robert Sean; Sigler, Rachel K.; Wolfe, Cameron R.; Harris, Courtney E.; Kumar, Rebecca N. (Transplant Infectious Disease)
Donor-derived infections in solid organ transplantation can be prevented by risk stratification of donors based on available information, and inquiries surrounding possible or diagnosed infection are common questions posed to transplant infectious disease subspecialists. This article outlines the five key steps in addressing a donor call from a transplant team in a systematic approach, focusing on donor and recipient-specific factors, transmissibility and treatment of possible infections, and the likelihood of a patient's future organ offers and mortality remaining on the waitlist. These principles are then applied to five donor call cases, in which we review the key takeaway points and supporting literature. These cases can be used as a resource for teaching with trainees.
Keywords: donor calls; donor-derived infection; early career; transplant program development

Pharmacokinetics, Safety, and Efficacy of Letermovir for Cytomegalovirus Prophylaxis in Adolescent Hematopoietic Cell Transplantation Recipients - Groll, Andreas H.; Schulte, Johannes H.; Antmen, Ali Bülent; Fraser, Christopher J.; Teal, Valerie L.; Haber, Barbara; Caro, Luzelena; McCrea, Jacqueline B.; Fancourt, Craig; Patel, Mayankbhai; Menzel, Karsten; Badshah, Cyrus (The Pediatric Infectious Disease Journal)
Introduction: Letermovir is a cytomegalovirus (CMV) terminase complex inhibitor approved for prophylaxis of CMV infection and disease in adult CMV-seropositive allogeneic hematopoietic cell transplantation (allo-HCT) recipients (R+). We report pharmacokinetics (PK), safety, and efficacy of letermovir in adolescent (12–18 years) allogeneic HCT recipients from an ongoing clinical study. Methods: In this phase 2b, multicenter, open-label study (NCT03940586), 28 adolescents received 480 mg letermovir [240 mg with cyclosporin A (CsA)] once daily orally or intravenously. Blood was collected for intensive (n = 14) plasma concentrations of letermovir. Intensive PK data were used for dose confirmation. Target exposure range 34,400–100,000 h × ng/mL for pediatric median exposures was based on model-predicted phase 3 population PK simulations in adult HCT recipients. Results: All participants were CMV-seropositive (body weight 28.7–95.0 kg). Of 12 PK-evaluable participants, 8 receiving 480 mg letermovir without CsA and 4 receiving 240 mg letermovir with CsA achieved exposures comparable to the adult exposure range. Exposure above the target but below the adult clinical program maximum was observed in 1 patient. Safety was consistent with previously described safety in adults. The proportion of participants with clinically significant CMV infection through week 24 post-HCT was comparable (24%) to that in the pivotal phase 3 study in adults (37.5%). Conclusions: Administration of adult letermovir doses in this adolescent cohort resulted in exposures within adult clinical program margins and was associated with safety and efficacy similar to adults. Results support a letermovir dose of 480 mg (240 mg with CsA) in adolescent allo-HCT recipients.

IDSA COVID-19 Guideline, Part 5: Antigen Testing - Hanson KE, Altayar O, Caliendo AM, Arias CA, Englund JA, Hayden MK, Lee MJ, Loeb M, Patel R, El Alayli A, Sultan S, Falck-Ytter Y, Lavergne V, Mansour R, Morgan RL, Murad MH, Patel P, Bhimraj A, Mustafa RA.
IDSA Guidelines on Antigen Testing for the Diagnosis of COVID-19 now available. These evidence-based rapid guidelines will address pressing clinical questions related to optimal use of SARS-CoV-2 Antigen tests in both medical and non-medical settings.

Donor blood cultures and outcomes after lung transplantation: a single-center report - Hashim, Mahmoud; Saleh, Rana Ahmed; Abdulqawi, Rayid; Albachir, Chams Alkhalaf; Aldakhil, Haifa; AlKattan, Khaled Manae; Almaghrabi, Reem Saad; Hamad, Alaa; Saleh, Waleed; Al-Mutairy, Eid Abdullah (Transplant Infectious Disease)
Background Transplanting lungs from donors with positive blood cultures has not been shown to adversely affect survival. There is limited evidence for potential effects on other outcomes, such as hospital course, graft function, and transmission of infection. Methods This retrospective cohort study included adult patients who underwent lung-only transplantation for the first time between March 2010 and December 2022. Outcomes of patients whose donors had positive blood cultures within 72 h of transplant were compared to patients whose donors had negative blood cultures. Results Twenty-five (10.8%) of 232 donors had positive blood cultures, including a single, unexpected case with candidemia. The most commonly isolated bacteria were Enterobacter cloacae (n = 5), Klebsiella pneumoniae (n = 5), Acinetobacter baumannii (n = 3), Pseudomonas aeruginosa (n = 3), and Staphylococcus aureus (n = 3). Eleven donors had identical bacteria in their respiratory cultures. All patients who were transplanted from donors with positive blood cultures survived beyond 90 days. Positive donor blood cultures were not associated with longer hospital stay, in-hospital complications, acute cellular rejection, or the achievement of 80% predicted forced expiratory volume in the first second. Probable transmission of donor bacteremia occurred in only two cases (both with S. aureus). These two donors had positive respiratory cultures with the same organism. Conclusion The study did not find an increased risk of adverse events when transplanting lungs from donors with positive blood cultures. Allograft cultures may be more predictive of the risk of transmitting infections.
Keywords: bacteremia; fungemia; lung transplantation

Safety of Inhaled Amphotericin B Lipid Complex as Antifungal Prophylaxis in Lung Transplant Recipients - Huggins, Jonathan P.; Pease, Robert; Stanly, Kelly; Workman, Adrienne; Reynolds, John; Alexander, Barbara D. (Antimicrobial Agents and Chemotherapy)
Inhaled formulations of amphotericin B are the most widely used antifungal prophylactic agents in lung transplant recipients, yet there are limited data on their safety. We performed a single-center retrospective cohort study of 603 consecutive patients who underwent lung transplantation between 2012 and 2017 and received antifungal prophylaxis with inhaled amphotericin B lipid complex (iABLC) from the day of transplantation until hospital discharge. Of 603 patients, 600 (99.5%) received ≥1 dose of iABLC, and 544 (90.2%) completed the recommended prophylactic course. In total, 4,128 iABLC doses (median, 5; range, 1 to 48 per patient) were administered; 24 patients received >3 months of therapy. Only one (0.2%) patient discontinued therapy due to a drug-attributable adverse event. During the first posttransplant year, 80 (13.3%) patients died (median time to death, 171 days; interquartile range [IQR], 80 to 272 days), and 3,352 (median, 6 per patient) lung biopsies were performed; 414 (68.7%) patients developed biopsy-proven acute cellular rejection. One-year adverse events in our cohort of lung transplant recipients treated with iABLC during transplant hospitalization matched national outcomes for rejection, graft loss, and death. iABLC is a safe and well-tolerated antifungal prophylactic agent in lung transplant recipients.

Management of Drug Interactions With Nirmatrelvir/Ritonavir (Paxlovid®) - IDSA

ISHLT/TTS-ID Measles Guidance for the Transplant Community - ISHLT (Default)
The ISHLT Infectious Diseases Professional Community, in collaboration with the Transplant Infectious Diseases Section of The Transplantation Society, have developed a document to provide guidance to all of the transplant community.

IDSA COVID-19 Guideline, Part 2: Infection Prevention - John B. Lynch*, Perica Davitkov**, Deverick J. Anderson, Adarsh Bhimraj, Vincent Chi-Chung Cheng, Judith Guzman-Cottrill, Jasmine Dhindsa, Abhijit Duggal, Mamta K. Jain, Grace M. Lee, Stephen Y. Liang, Allison McGeer, Valéry Lavergne**, M. Hassan Murad**,
SARS-CoV-2 is a highly transmissible virus that can infect health care personnel and patients in health care settings. Specific care activities, in particular aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in health care facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect health care personnel (HCP). Summarized here are the recommendations for infection prevention among health care personnel caring for suspected or known patients with COVID-19.

HHV-8-associated diseases in transplantation: A case report and narrative review focused on diagnosis and prevention - Kates, Olivia S.; McDade, Heather; Tinney Jr, Francis J.; Weeks-Groh, Sharon R.; Lurain, Kathryn (Transplant Infectious Disease)
Background Human herpes virus 8 (HHV-8) or Kaposi sarcoma herpesvirus (KSHV) is an opportunistic oncovirus that causes multiple pathologic entities. Methods We present a case of fatal HHV-8-associated multisystem illness with disseminated Kaposi sarcoma and HHV8-associated lymphoproliferative disorder with systemic inflammation. We conducted a narrative review of the literature on HHV-8 in transplantation with a goal of illuminating the spectrum of HHV-8-associated diseases in this vulnerable population, modes of disease transmission, and the potential role for donor and recipient screening. Results HHV-8-associated KS, primary effusion lymphoma (PEL), multicentric Castleman disease (MCD), and KSHV inflammatory cytokine disorder (KICS) may affect transplant recipients; with the exception of KS, these conditions are rare but carry high morbidity and mortality. Conclusion HHV-8-associated diseases have diverse and protean manifestations in transplant recipients, with potentially fatal outcomes. HHV-8 seroprevalence among organ donors and the magnitude of risk for donor-derived HHV-8 infection or clinically significant disease remain unknown and require further study.
Keywords: Kaposi sarcoma; donor-derived infections; human herpesvirus 8; liver transplant; lymphoma

IDSA COVID-19 Guideline, Part 4: Serologic Testing - Kimberly E. Hanson*, Angela M. Caliendo, Cesar A. Arias, Janet A. Englund, Mary K. Hayden, Mark J. Lee, Mark Loeb, Robin Patel, Osama Altayar**, Abdallah El Alayli**, Shahnaz Sultan**, Yngve Falck-Ytter**, Valéry Lavergne**, Rebecca L. Morgan**, M. Hassan
Serologic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are now widely available. IDSA has developed recommendations related to the use of SARS-CoV-2 serologic testing in clinical practice and public health.

IDSA COVID-19 Guideline, Part 3: Molecular Diagnostics - Kimberly E. Hanson et al.
Direct detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acids in respiratory tract specimens informs patient, healthcare institution, and public health level decision-making. IDSA has developed an evidence-based diagnostic guideline to assists clinicians, clinical laboratorians, patients and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests.

Successful clinical and virological outcomes of liver transplantation for HDV/HBV-related disease after long-term discontinuation of hepatitis B immunoglobulins - Lenci, Ilaria; Tariciotti, Laura; Angelico, Roberta; Milana, Martina; Signorello, Alessandro; Manzia, Tommaso Maria; Toti, Luca; Tisone, Giuseppe; Angelico, Mario; Baiocchi, Leonardo (Clinical Transplantation)
Background Indefinite, long-term administration of hepatitis B immunoglobulins (HBIg), together with a third generation nucleos(t)ide analog (NA), is the currently recommended prophylactic strategy to prevent viral recurrence after liver transplantation (LT) for Hepatitis Delta virus (HDV)/Hepatitis B virus (HBV)-related disease. Methods We retrospectively analyzed the safety and long-term clinical and virological outcomes of a consecutive cohort of 16 patients (10 males, median age 64.5, range 41–75) transplanted for HDV/HBV-related cirrhosis at our Institution, who discontinued HBIg after a median of 24.5 months (range 15–116) after transplant. All patients continued prophylaxis with same NA used before LT. Recurrence of HDV/HBV infection was defined as reappearance of serum HDV-RNA with detectable serum HBsAg and/or HBV-DNA. Results The median follow-up after LT was 138 months (range 73–316) and 110 months (range 52–200) after HBIg withdrawal. All patients were HBsAg-positive, HBV-DNA negative, and anti-HDV positive at the time of LT and without coinfections with HCV or HIV. Patients were followed with biochemical and virological tests every 3–6 months after HBIg withdrawal. No recurrences of HDV/HBV infection or disease were observed during monoprophylaxis with NA. In addition, eight patients (50%) spontaneously developed anti-HBs titers above 10 IU/L at a median of 74 months (range 58–140) following HBIG discontinuation. Conclusions HBIg withdrawal after LT is a safe and efficacious strategy in patients transplanted for HDV/HBV disease and is frequently associated with the spontaneous development of serological immunity against HBV. These data call for a revision of current prophylactic recommendations in this setting.
Keywords: hepatitis B virus; hepatitis D virus; immunoglobulins; liver transplantation; withdrawal

Perioperative daptomycin for prophylaxis of vancomycin-resistant Enterococcus infection in colonized liver transplant recipients - Mak, Jordan T.; Ha, Seung; Perloff, Sarah; Knorr, John P. (Transplant Infectious Disease)
Background Infection with vancomycin-resistant Enterococcus (VRE) in liver transplant recipients (LTR) has been associated with extended hospital stays, increased readmission rates, graft failure, and death. A tailored perioperative surgical prophylaxis regimen targeting VRE may reduce postoperative infections in VRE-colonized patients. This study investigated the outcomes of perioperative daptomycin in this patient population. Methods This retrospective, single-center cohort study included LTR ≥ 18 years old who were VRE-colonized from June 2018 to November 2022. VRE colonization was identified by a VRE rectal swab screen or a positive VRE culture prior to transplant. Two groups were analyzed: daptomycin versus no daptomycin. All LTR received perioperative piperacillin-tazobactam for 24 h. If VRE-colonized, one dose of daptomycin (6 mg/kg) was given pre- and postoperatively. Demographics, clinical characteristics, risk factors for VRE infection, and daptomycin dose were collected. The primary outcome was VRE infection at 14 days and 90 days post-transplant. Results There were 36 VRE-colonized LTR; 19 received daptomycin and 17 did not. Baseline characteristics and risk factors for VRE infection were similar between groups. More VRE infections occurred in the no daptomycin group within 14 days post-transplant (24% vs. 0%, p = .04), but at 90 days posttransplant there was no significant difference (29% vs. 16%, p = .43). The average daptomycin dose was 7.1 mg/kg. Conclusion Perioperative daptomycin reduced the rate of VRE infections in VRE-colonized LTR within 14 days posttransplant but not at 90 days. Future studies should evaluate if higher doses and/or longer duration of perioperative daptomycin can reduce VRE infections beyond 14 days post-transplant.
Keywords: daptomycin; liver transplant; perioperative prophylaxis; vancomycin-resistant Enterococcus

Invasive aspergillosis in liver transplant recipients - Melenotte, Cléa; Aimanianda, Vishukumar; Slavin, Monica; Aguado, José María; Armstrong-James, Darius; Chen, Yee-Chun; Husain, Shahid; Van Delden, Christian; Saliba, Faouzi; Lefort, Agnès; Botterel, Francoise; Lortholary, Olivier (Transplant Infectious Disease)
Background Liver transplantation is increasing worldwide with underlying pathologies dominated by metabolic and alcoholic diseases in developed countries. Methods We provide a narrative review of invasive aspergillosis (IA) in liver transplant (LT) recipients. We searched PubMed and Google Scholar for references without language and time restrictions. Results The incidence of IA in LT recipients is low (1.8%), while mortality is high (∼50%). It occurs mainly early (<3 months) after LT. Some risk factors have been identified before (corticosteroid, renal, and liver failure), during (massive transfusion and duration of surgical procedure), and after transplantation (intensive care unit stay, re-transplantation, re-operation). Diagnosis can be difficult and therefore requires full radiological and clinicobiological collaboration. Accurate identification of Aspergillus species is recommended due to the cryptic species, and susceptibility testing is crucial given the increasing resistance of Aspergillus fumigatus to azoles. It is recommended to reduce the dose of tacrolimus (50%) and to closely monitor the trough level when introducing voriconazole, isavuconazole, and posaconazole. Surgery should be discussed on a case-by-case basis. Antifungal prophylaxis is recommended in high-risk patients. Environmental preventative measures should be implemented to prevent outbreaks of nosocomial aspergillosis in LT recipient units. Conclusion IA remains a very serious disease in LT patients and should be promptly sought and, if possible, prevented by clinicians when risk factors are identified.
Keywords: Aspergillus; Aspergillus fumigatus; aspergillosis; azoles; children; drug interaction; immune reconstitution syndrome; immunosuppression; invasive fungal infection; liver transplant; prophylaxis; solid organ transplant; transplantation; treatment; voriconazole

Safety and efficacy of weight-based ganciclovir dosing strategies in overweight/obese patients - Miller, William; January, Spenser; Klaus, Jeff; Neuner, Elizabeth; Pande, Anupam; Krekel, Tamara (Transplant Infectious Disease)
Background The management of cytomegalovirus (CMV) is particularly challenging as both CMV and its usual first-line treatment, ganciclovir, are associated with neutropenia. Ganciclovir dosing is weight-based, most commonly utilizing total body weight (TBW). The subsequent high doses of ganciclovir in overweight/obese patients may increase the risk of toxicity. Utilizing adjusted body weight (AdjBW) dosing may help mitigate this risk. Therefore, the objective of this study was to evaluate the difference in toxicity and efficacy between TBW and AdjBW ganciclovir dosing strategies in overweight/obese patients. Methods This retrospective study conducted safety and efficacy analyses of ganciclovir courses (≥72 h) used as CMV treatment. The primary safety outcome was the incidence of neutropenia (absolute neutrophil count <1000 cells/μL), and the primary efficacy outcome was a 2-log decrease in CMV polymerase chain reaction within 4 weeks following ganciclovir initiation. In both analyses, courses were excluded in which ganciclovir was dosed outside of specified renal dosing parameters for >20% of the course. Results Among the 253 courses in the safety cohort, there was no difference in the incidence of neutropenia (17.4% vs. 13.5%, p = .50) in AdjBW compared to TBW dosing. In the 62 courses evaluating efficacy, there was no statistical difference between AdjBW and TBW dosing (60.0% vs. 45.2%, p = .28). No subgroups were identified in which AdjBW dosing was advantageous. Conclusion Utilization of AdjBW ganciclovir dosing did not result in decreased neutropenia or treatment efficacy as compared to TBW dosing. Further studies with larger patient populations would be beneficial to confirm these findings.
Keywords: cytomegalovirus; ganciclovir; neutropenia; obesity

Fungus Education Hub – A central hub for high-quality education about invasive fungal infections - MSGERC

NIH COVID-19 Treatment Guidelines: Table of Contents - NIH (COVID-19 Treatment Guidelines)
Read this summary to learn about the key changes and additions to the guidelines, including the latest recommendations on managing COVID-19.

Criptococosis: MedlinePlus enciclopedia médica - NLM
Es una infección con los hongos Cryptococcus neoformans o Cryptococcus gattii.

Cryptococcosis: MedlinePlus Medical Encyclopedia - NLM
Cryptococcosis is infection with the fungi Cryptococcus neoformans or Cryptococcus gattii.

Estrongiloidiasis: MedlinePlus enciclopedia médica - NLM
Es una infección causada por el ascáride Strongyloides stercoralis (S stercoralis).

Neumonía por Pneumocystis jiroveci: MedlinePlus enciclopedia médica - NLM
Es una infección micótica de los pulmones. La enfermedad se solía llamar Pneumocystis carinii o neumonía por PC.

Pneumocystis jiroveci pneumonia: MedlinePlus Medical Encyclopedia - NLM
Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The disease used to be called Pneumocystis carini or PCP pneumonia.

Strongyloidiasis: MedlinePlus Medical Encyclopedia - NLM
Strongyloidiasis is an infection with the roundworm Strongyloides stercoralis (S stercoralis).

Hepatitis C and heart transplantation: An update - Nunez, Marina; Kelkar, Anita A. (Clinical Transplantation)
There are limited data regarding heart transplantation in the setting of hepatitis C virus (HCV) infection in either recipients or donors, as the practice was infrequent, given concerns of worse post-transplant outcomes. This changed dramatically after the development of highly effective HCV therapies, namely direct-acting antivirals (DAAs). Additionally, nucleic acid testing currently in use establishes more precisely the risk of HCV transmission from donors. As a result, chronic HCV infection in itself is no longer a barrier for heart transplant candidates, and the use of HCV-positive organs for HCV-infected and non-infected transplant candidates has increased dramatically. A review of the literature revealed that in the pre-DAA era, HCV seropositive heart transplant patients had a higher mortality than their seronegative counterparts. However, short-term data suggest that the differences in survival have been erased in the DAA era. Heart transplantation from HCV-viremic donors to HCV-uninfected recipients has become increasingly common as the number of deceased donors with HCV viremia has increased over the past years. Preliminary outcome reports are very encouraging, although further data are needed with regard to long-term safety. New information continues to be incorporated to optimize protocols that guide this practice.
Keywords: DAAs; HCV; HCV mismatch transplant; heart transplantation; outcomes

Invasive Fungal Infections in Inpatient Solid Organ Transplant Recipients With COVID-19: A Multicenter Retrospective Cohort - Permpalung, Nitipong; Chiang, Teresa Po-Yu; Manothummetha, Kasama; Ostrander, Darin; Datta, Kausik; Segev, Dorry L.; Durand, Christine M.; Mostafa, Heba H.; Zhang, Sean X.; Massie, Allan B.; Marr, Kieren A.; Avery, Robin K. (Transplantation)
Background. The prevalence and outcomes of COVID-19-associated invasive fungal infections (CAIFIs) in solid organ transplant recipients (SOTRs) remain poorly understood. Methods. A retrospective cohort study of SOTRs with COVID-19 admitted to 5 hospitals within Johns Hopkins Medicine was performed between March 2020 and March 2022. Cox regression multilevel mixed-effects ordinal logistic regression was used. Results. In the cohort of 276 SOTRs, 22 (8%) developed IFIs. The prevalence of CAIFIs was highest in lung transplant recipients (20%), followed by recipients of heart (2/28; 7.1%), liver (3/46; 6.5%), and kidney (7/149; 4.7%) transplants. In the overall cohort, only 42 of 276 SOTRs (15.2%) required mechanical ventilation; these included 11 of 22 SOTRs (50%) of the CAIFI group and 31 of 254 SOTRs (12.2%) of the no-CAIFI group. Compared with those without IFIs, SOTs with IFIs had worse outcomes and required more advanced life support (high-flow oxygen, vasopressor, and dialysis). SOTRs with CAIFIs had higher 1-y death-censored allograft failure (hazard ratio 1.65.116.4, P = 0.006) and 1-y mortality adjusting for oxygen requirement (adjusted hazard ratio 1.12.45.1, P < 0.001), compared with SOTRs without CAIFIs. Conclusions. The prevalence of CAIFIs in inpatient SOTRs with COVID-19 is substantial. Clinicians should be alert to the possibility of CAIFIs in SOTRs with COVID-19, particularly those requiring supplemental oxygen, regardless of their intubation status.

Lung Transplantation for People Living With HIV: Promising Mid-term Outcomes - Ralphs, Asher S.; Anderson, Scott T.; Langlais, Blake T.; D’Cunha, Jonathan; Reck dos Santos, Pedro A. (Transplantation)
Background. With increasing life expectancy, patients with HIV are more commonly acquiring other chronic diseases, such as end-stage lung disease, for which transplant may be the only effective solution. Until recently, HIV infection was considered a contraindication to lung transplant (LTx). As LTx in people living with HIV (PLWH) becomes more common, there remain limited data on outcomes in this population. Methods. Using the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research file, we identified LTx recipients with HIV by either serostatus or nucleic acid testing. A control group of confirmed HIV-negative LTx recipients was propensity score matched on age, body mass index, primary diagnosis, and year of transplant. Patient characteristics, transplant parameters, survival, and postoperative outcomes were compared. Results. Fifty-nine LTx recipients with HIV were identified and compared with 236 HIV-negative controls. Among PLWH, cytomegalovirus status was more frequently positive (76.3% versus 58.9%, P = 0.014), and the median Lung Allocation Score at match was higher (44 versus 39, P = 0.004). PLWH were more likely to undergo dialysis postoperatively (18.6% versus 8.9%, P = 0.033), although other complication rates were similar. Fifty-three percent of LTx for PLWH occurred since 2020. One-year survival for PLWH was 91.2% versus 88.6% for controls (P = 0.620). Three-year survival for a smaller subset was also not statistically significant (HIV versus control: 82.6% versus 77.8%, respectively, P = 0.687). Conclusions. There was no difference in 1-y survival for LTx recipients living with HIV compared with a matched control group, supporting this group of patients as viable candidates for LTx.

Risk factors for positive follow-up blood cultures in Gram-negative bacteremia among immunocompromised patients with neutropenia - Ranganath, Nischal; Yetmar, Zachary A.; Saleh, Omar Abu; Tande, Aaron J.; Shah, Aditya S. (Transplant Infectious Disease)
Introduction Gram-negative bacillary bloodstream infection (GN-BSI) is a frequent clinical challenge among immunocompromised hosts and is associated with a high mortality. The utility of follow-up blood cultures (FUBCs) for GN-BSI in this population, particularly in the setting of neutropenia, is poorly defined. Methods We conducted a single-center, retrospective cohort study between the period of July 2018 and April 2022 to investigate the utility of FUBCs and delineate risk factors for positive cultures among neutropenic patients with monomicrobial GN-BSI. Univariate logistic regression was performed to assess risk factors associated with positive FUBCs. Results Of 206 patients, 98% had FUBCs performed, and 9% were positive. Risk factors for positive FUBCs included multidrug-resistant GN infection (OR 3.26; 95% confidence interval [CI] 1.22–8.72) and vascular catheter source (OR 4.82; CI 1.76–13.17). Among patients lacking these risk factors, the prevalence of positive FUBCs was low (2.8%) and the negative predictive value was 92%. Those with positive and negative FUBCs had similar rates of all-cause mortality (16.7% vs. 16.6%; p = .942) and microbiologic relapse (11.1% vs. 6.0%; p = .401) within 90-days of treatment completion. However, positive FUBCs were associated with prolonged hospitalization and longer duration of antimicrobial therapy. Conclusion Positive FUBCs were infrequent in neutropenic patients with GN-BSI, and their occurrence did not significantly impact mortality or microbiologic relapse. Risk factors for positive FUBCs included multidrug resistant Gram-negative infection and vascular catheter source. Prospective studies will be necessary to elucidate the benefits and risks of FUBCs when managing GN-BSI in patients with underlying immune compromise.
Keywords: Gram-negative; bacteremia; follow-up blood cultures; immunocompromised; neutropenia

Vaccine schedule recommendations and updates for patients with hematologic malignancy post-hematopoietic cell transplant or CAR T-cell therapy - Reynolds, Gemma; Hall, Victoria G.; Teh, Benjamin W. (Transplant Infectious Disease)
Revaccination after receipt of a hematopoietic cell transplant (HCT) or cellular therapies is a pillar of patient supportive care, with the potential to reduce morbidity and mortality linked to vaccine-preventable infections. This review synthesizes national, international, and expert consensus vaccination schedules post-HCT and presents evidence regarding the efficacy of newer vaccine formulations for pneumococcus, recombinant zoster vaccine, and coronavirus disease 2019 in patients with hematological malignancy. Revaccination post-cellular therapies are less well defined. This review highlights important considerations around poor vaccine response, seroprevalence preservation after cellular therapies, and the optimal timing of revaccination. Future research should assess the immunogenicity and real-world effectiveness of new vaccine formulations and/or vaccine schedules in patients post-HCT and cellular therapy, including analysis of vaccine response that relates to the target of cellular therapies.
Keywords: CAR-T cell; bispecific; cellular therapy; hematologic malignancy; stem cell transplant; vaccination

Clinical and immune features of human parvovirus B19 infection in allogeneic stem cell transplantation recipients: A retrospective monocentric study - Sammut, Rinzine; Feghoul, Linda; Xhaard, Alienor; Dhedin, Nathalie; Robin, Marie; Michonneau, David; Loschi, Michael; Legoff, Jerome; de Peffault de Latour, Regis; de Sicre de Fontbrune, Flore (Transplant Infectious Disease)
Background Human parvovirus B19 (B19V) infection is associated with pure red cell aplasia (PRCA) in immunocompromised patients; however, the spectrum of manifestations associated with B19V in allogeneic hematopoietic stem cell transplantation recipients (alloHSCT) has rarely been reported. Methods In this study, we aimed to report clinical and immune features of B19V infection after alloHSCT. We retrospectively collected and analyzed clinical and microbiological data of all transplanted patients with B19V DNAmia or tissue infection detected by polymerase chain reaction (PCR) in our center from 2010 to 2021. Results We report 35 cases of B19V infections in 33 patients. Median time from transplant to B19V first PCR positivity was 6.9 months (interquartile range (IQR) [1.6–18.9]). No preferential immune profile, type of transplantation or conditioning was identified. Hematological impairment was the most frequent sign, followed by rash and fever. Unconventional clinical forms were also detected, such as acute myelitis and myositis. For some cases, the direct relationship between symptoms and B19V infection was difficult to prove but was suggested by targeted tissue PCR positivity. When hematological impairment was not at the forefront, reticulocytopenia helped to diagnose B19V infections. Treatment was mainly based on high dose intravenous immunoglobulin. Conclusion Although hematological impairment was the most frequent sign, B19V can affect multiple targets and lead to atypical manifestations. Because of its heterogeneous clinical presentation, B19V infection is likely under-diagnosed. Diagnosis of unusual B19V organ involvement needs combination of arguments which can include targeted tissue PCR.
Keywords: allogeneic stem cell transplantation; immune reconstitution; parvovirus B19

Cowpox to COVID: History of vaccination in the immunocompromised host - Schaenman, Joanna; Avery, Robin (Transplant Infectious Disease)
Background The use of vaccination to prevent infection has a long history, starting in the 1700s with Jenner. New innovations have led to improvements in the safety and efficacy of vaccines, from live attenuated viruses to subunit vaccines, to RNA-based vaccination for SARS-CoV-2. Despite this progress, however, solid organ transplant (SOT) recipients on immunosuppression demonstrate an impaired vaccine response compared with healthy controls. This issue is important given the increased vulnerability to infection in immunocompromised patients, especially in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic. Methods We reviewed the literature on key topics in vaccination with significant clinical impact on SOT patients. Results Prior to COVID-19, a large amount of data has been published demonstrating impaired humoral and T-cell responses to multiple vaccinations targeting influenza, hepatitis B, VZV, and Pneumococcus. Poor immunogenicity can be addressed through the use of adjuvants to boost the immune response, even in the setting of senescence related to age or immunosuppression. New vaccines provide hope for preventing infection due to hepatitis C and Cytomegalovirus, and to the emerging infection, monkeypox. The data on the impact of the COVID-19 vaccine in SOT patients is reviewed, with a focus on seroconversion, antibody titer, and antigen-specific T cells. Factors associated with impaired response, including mycophenolate, are described. Conclusion The history of vaccination demonstrates how scientific breakthroughs can be applied to clinical challenges. New approaches using adjuvants, strategic antigen selection, and RNA-based vaccines offer the potential to improve immune response in SOT recipients. Future innovations are needed to better protect the vulnerable immunocompromised host.
Keywords: COVID; T cell; immunology; immunosuppression; solid organ transplantation; vaccination

Safety of Once-Weekly Dapsone for Pneumocystis jirovecii Pneumonia Prophylaxis in Kidney Transplant Recipients - Schumacher, Lauren; Philippart, Olivia; Carr, Abbey; Sadler, Catherine J (CJ); Paluri, Sravanthi (Transplant Infectious Disease)
Background Sulfamethoxazole-trimethoprim (SMX-TMP) is recommended first-line for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in kidney transplant recipients. In cases of sulfa allergy or intolerance, our center utilizes dapsone 100 mg once weekly as alternative prophylaxis. As both agents have the potential to cause hematologic abnormalities, we sought to compare hematologic effect profiles of weekly dapsone versus SMX-TMP in kidney transplant recipients. Methods This retrospective, single-center, cohort study included kidney transplant recipients who received SMX-TMP or dapsone for PJP prophylaxis. The primary endpoint was the change in hemoglobin from baseline to nadir. Secondary endpoints included hemoglobin and white blood cell (WBC) count at 1, 3, and 6 months posttransplant, time to hemoglobin nadir, neutropenia incidence, and ANC nadir. In addition, we evaluated the incidence of hospital readmission, bacteremia, and PJP. Results A total of 509 kidney transplant recipients were included (334 SMX-TMP vs. 175 dapsone). Median decrease in hemoglobin (g/dL) from baseline to nadir was greater in the dapsone group (0 SMX-TMP vs. −0.20 dapsone; p = 0.046). Mean absolute hemoglobin count was lower in the dapsone group at all time points. There was no difference in WBC, ANC nadir, or incidence of neutropenia at any time point between groups. Greater frequencies in readmissions (30.7% vs. 55.7%; p < 0.001) and bacteremia (3.6% vs. 10.8%; p < 0.001) were observed in the dapsone arm. Conclusions Once-weekly dapsone is associated with statistically significant decreases in hemoglobin when compared to SMX-TMP in a kidney transplant cohort, which may be clinically relevant in select patients. Dapsone use may also increase infection risk.
Keywords: PJP prophylaxis; anemia; dapsone; neutropenia; sulfamethoxazole-trimethoprim

Evaluation of pulmonary abnormalities in recipients of hematopoietic cell transplants and cellular therapies - Thomas, Lora; Boatman, Julie (Transplant Infectious Disease)
Hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy recipients are susceptible to multiple pulmonary complications that are caused by infectious and noninfectious processes. Numerous variables can be associated with specific pulmonary diseases including time from transplantation, presence of graft versus host disease (GVHD), underlying disease, and prolonged neutropenia and lymphocytopenia. Most pulmonary complications are infectious in origin, with bacterial pneumonia remaining the most common pulmonary infection, particularly before neutrophil engraftment. Invasive fungal infections continue to affect this patient population even when antifungal prophylaxis is used. Noninfectious pulmonary complications include a wide differential of pathologies in this population, and as clinical presentations of these various pulmonary disorders often overlap, clinicians frequently will use a multidisciplinary approach in diagnosing these abnormalities. Radiography, particularly with chest computed tomography (CT) imaging, is an essential tool in identifying pulmonary pathology and potential sources. While standard microbiological cultures of respiratory specimens are still utilized, their role is limited by low sensitivity and diagnostic yield. The likelihood of obtaining a diagnosis can be improved by using other microbiological assays, including fungal antigen tests and molecular diagnostic methods, particularly if specimens are collected via bronchoscopy. This review will highlight the more common causes of pulmonary diseases encountered after HCT and CAR-T and will examine the different methods in their diagnosis.
Keywords: CAR-T; HCT; Pulmonary; and; complications; in

Liverpool COVID-19 Interactions - University of Liverpool
Comprehensive, up-to-date, evidence-based COVID19 drug-drug interaction resource, freely available to healthcare workers, patients and researchers.

Fatal Invasive Mold Infections after Transplantation of Organs Recovered from Drowned Donors, United States, 2011–2021 - Volume 29, Number 7—July 2023 - Emerging Infectious Diseases journal - CDC - Wu, Karen; Annambhotla, Pallavi; Free, Rebecca J.; Ritter, Jana M.; Leitgeb, Brooke; Jackson, Brendan R.; Toda, Mitsuru; Basavaraju, Sridhar V.; Gold, Jeremy A. W.
Fatal Mold Infections after Transplantation

When you need to dive in the deep end—Transplanting SARS-CoV-2 PCR+ recipients - Zavala, Sofia; DeLaurentis, Clare; Aaron, Justin G.; Miko, Benjamin A.; Fox, Alyson N.; Bergelson, Michael; DeVore, Adam; Segovia, Maria Cristina; Wolfe, Cameron R.; Pereira, Marcus R. (Transplant Infectious Disease)
There is an ongoing need to understand whether transplantation during acute Coronavirus disease 2019 (COVID-19) can be performed safely, especially when urgent transplant is required. We collected retrospective data of all consecutive non-lung transplant recipients who had a positive SARS-CoV-2 polymerase chain reaction (PCR) on the day of planned deceased donor organ implantation. Data were collected from two large transplant centers from 01/01/2022 to 02/01/2023. Demographics, details regarding COVID-19 infection, waitlist priority, and details regarding transplantation were obtained. A descriptive analysis was performed. A total of 12 patients were identified: 7 renal, 4 liver, and 1 heart transplant recipient. All 12 patients were vaccinated for COVID-19. Ten were asymptomatic outpatients found positive on admission and transplanted immediately. Two were in-patients with mild COVID-19 symptoms and were reactivated on the waitlist following 3 days of remdesivir when no progression to severe COVID-19 occurred. Most patients (10/12) received remdesivir posttransplant. No complications attributed to COVID-19 were noted nor were any secondary family or healthcare worker infections observed. All recipients were managed with special isolation precautions befitting their potentially infectious state. Standard induction therapy was used in all recipients. After a median follow up period of 143 days (interquartile range: 96–201 days), 3 episodes of rejection were documented, 2/7 renal recipients experienced delayed graft function, and 2/4 liver recipients required renal replacement therapy. Graft and patient survival were 100%. Transplantation can safely proceed in select, minimally symptomatic, non-lung recipients with a positive SARS-CoV-2 PCR at the time of transplant.
Keywords: COVID-19; SARS-CoV-2; organ transplantation