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CHAPTER 117 INFECTIONS IN -lymphopriliferative disease (LPD) - 1-

TRANSPLANT RECEPIENTS 3 months after engrfment


A. BONE MARROW TRANSPLANT - tx: ? EBV specific T cells; Rituximab ,
INFECTIONS: 1st month of bone marrow ganciclovir; zidovudine
transplant HHV -8 - Kaposi' s Sarcoma, primary effusion
LEVOFLOXACIN: decreases bacteremia sarcoma, castle man
maong bone marrow transplant px RSV and Parainfluena- fatal pneumonia on
1st few days: common org: aerobic( E coli, BMT
klebsiella, Pseudomonas and thru skin or - tx: aerosolized Ribavirirn, RSV Ig
catheter ( Staph coag -/+) ,Palivizumab
beyond 1st few days; Filamentous bacteria Influenza- Oseltamivir and Zanamivir
( Nocardia/ Actininomyctes) Rotavirus- gastoenteritis
Late posttransplant: encapsualted org (>6 Polyomavirus BK- hemorrhagic cystitis
months after BM reconstitution) B. SOLID ORGAN TRANSPLANT
beyond 1st week: fungal (candida) Early period( <1 month)- extracellular
TMP-SMX- prophylactic for Pneumocystis; 1 ( Staph, strep, e coli,)
month after engrafment and continiung for at - origin : surgical wound or
least 1 year anostomotic sites
- prophylactic also for Toxoplasma, CMV- 1st 6 months; sever systemic disease
Listeria, Nocardia, Strep and haemophilus HHV 6 reactivation- w/in 1st 2 to 4 wks; fever
ACYCLOVIR: prophylactic for seropositve and granulocytopenia
BMT/SCT; reduce mucositis and prevent HSV CMV rejection related syndromes:
pneumonia - glomerulopathy- kidney
: 2 wks after BMT excretion of virus of -bronchilitis obliterans- lung
seropositve HSV 1 transplant
_ also good for Varicella- Zoster virus -vanishing bile duct syndrome- liver
(low dose for the entire year) transplant
CMV: 30- 90 days after transplant: great Beyond 6 months: defects on CMI ( listeria ,
concern on the 2nd month nocardia, fungi other intracellular org)
-assoc w/ used of alpha CD52 EBV_LPD- 2 months to many years after
antibody among GVHD px transplant; heart and lung transplants
-Ganciclovir- delay the devt of normal 1) KIDNEY TRANSPLANTS
immune rsponse to CMV, not really protective -Early: due ti skin and wound
- IVIg and Ganciclovir: tx for CMV infections; Tx: Cephalosporins
pneumonia -UTI- due to anatomical alterations
HHV-6 / Roseola- 2-4 wks after surgery: ? from surgery (pyelonephritis)-longer duration
foscarnet of tx
EBV- fatal to transplant recepients appear after 6 mos: shorter duration
of tx
-Prophylaxis: TMP-SMX - operation >12 hrs - inc incidence of
-Middle period- lung infections w/ T- infection
celldef( ICbacteria, nocardia, fungi, virus, -PERITONITIS and Intraabdominal
parasite) Abscess- Common complication
-Legionella pnuemophilia- high -Peritonitis- from biliary leak and
mortality primary or 2ndary infx,polymicrobil
- CMV- 1 to 4 months -fever, -Abscess- w/in 1st month, spleen,
glomerulopathy; tx: administer Ig w/ liver, pericolic and pelvis,Tx: antibiotic and
antibodies w/ CMV drainage
-EBV reactivation- extranodal prolif of -middle: Cholangitis- devt postsurgical
B cells; invade CNS, nasopharynx, liver, small stricture on biliary- fever abdominla paina nd
bowel heart and transplanted kidney jaundice
-PAPOVAVIRUS:BK-nepropathy; JC -Viral hepatitis- lamiduvine and
virus- progressive multifocal adefovir for hepa B
leukoencephalopathy 5) Pancreas
- L. monocytogenes- most common -infection prevented by draining
cause of bacteremia >= 1 month after renal pancreas to urinary tract or bladder
transplantation INdwelling cathter- S. aureus- bloodstream
-NOCARDIA- skin, bones, lungs and infxn w/in a week
CNS, multiple abscess Tuberculosis- w/in 12 months
-Late infection (>6 months) - CMV VACCINATION:
retinitis, transplant ebow?, invasive fungal For autologous and allogenic BMT recepients-
2) HEART TRANSPLANTS (1 year and 2 years after)
-early: sternal wound infxn and 1) pneumococcal
mediastinitis -repeated every 5 years for px on
-dx: sternal instability and failure to immunosuppresants
heal -every 3 years w/ significant exposure
-middle: toxoplasmosis, CMV ,CNS risk
infxn 2) H. Influenza type b conjugate vaccines
- late: EBV-lymphoma like Add: (12-14and 16 months after)
3) LUNG TRANSPLANTS 3) N. meningitides polysaccharide disease
-eearly: ischemia and mucosal 4) diphtheia vaccines
damage, denervtion and lack of lymph 5) tetanus vaccine
drainage 6) inactivated polio vaccine
- prophylactic broad spectrum 1st 3 OTHERS:
to 4 days antibiotics 7) Live virus MMR- BMT recepients 24 mos
4) LIVER TRANSPLANTS after transplant
- infection on early; systemic broad
spectrum antibiotic for the 1st 5 days