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Transplant recipients are a population at high risk for various opportunistic infections, including toxoplasmosis. Toxoplasma infection is particularly lifethreatening in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients, primarily occurring through reactivation of latent infection or primary infection, respectively. Epidemiological, clinical features and levels of risk vary according to the transplanted organ, the pretransplant serologic status of both...

Solid organ and hematopoietic stem cell transplant recipients are at high risk of contracting infectious diseases, including vaccine-preventable illnesses, in the post-transplant period. Given the high degree of immunosuppression immediately post-transplant, infection in the transplant patient results in higher morbidity and mortality than in the general population. Thus, it is the responsibility of the care team to ensure appropriate vaccines are given in an attempt to mitigate this risk....

Hepatitis B virus (HBV) and hepatitis D virus (HDV) are hepatotropic viruses that can have a significant impact on patients undergoing solid organ and hematopoietic stem cell transplants. In the setting of transplant immunosuppression, patients with HBV or HDV coinfection can have acceleration in the natural history of their liver diseases with increased risk of developing cirrhosis, decompensation, and hepatocellular carcinoma. Immunosuppression can also reactivate HBV in patients with...

Antimicrobial stewardship is an essential component of transplant programs to improve patient outcomes, reduce the threat of antimicrobial resistance, and lower the risk of drug toxicity. A multidisciplinary approach that leverages the existing team-based infrastructure of transplant programs and encompasses partnership with pharmacy, infection prevention, and microbiology is important for successful implementation. This chapter outlines the importance of stewardship in transplantation,...

Infections due to adenoviruses confer significant morbidity and mortality in immunocompromised hosts. Manifestations of disease in the setting of hematopoietic stem cell and solid organ transplantation may range from asymptomatic shedding or viremia to localized infection and disseminated disease. In solid organ transplant recipients, adenoviral disease often involves the allograft and can lead to graft dysfunction and/or graft loss. Several diagnostic methods are available for adenovirus...

Respiratory syncytial virus (RSV) causes significant morbidity and mortality in immunocompromised hosts with particular burden among allogeneic hematopoietic stem cell transplant and lung transplant recipients. Affected patients have a substantial risk of secondary infection, ICU admission, or death. Improved diagnostic testing with better sensitivity has given new insights into the epidemiology of disease. In particular, it has highlighted the issue of nosocomial transmission and hospital...

Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients, but is rare among recipients of hematopoietic stem cell transplant (HSCT). Infection often occurs a year after transplantation; however early infections are common in HSCT. Among SOT patients, donorderived infections have been described within 3 months after transplant. The most common disease manifestations are meningitis and pneumonia. The fungi Cryptococcus neoformans and C. gattii are the main causes of cryptococcosis.

Polyomavirus-associated nephropathy (PyVAN) and hemorrhagic cystitis (PyVHC) occur almost exclusively after kidney transplantation (KT) and allogeneic hematopoietic stem cell transplantation (HSCT), respectively. In addition, PyV-associated urothelial cancer (PyVUC) is emerging after KT. These diseases are attributed to BK polyomavirus (BKPyV), a small non-enveloped, doublestranded DNA virus infecting >90% of the general population followed by renal persistence. PyVAN causes premature...

Coccidioidomycosis is an infection due to the fungal species Coccidioides, which is most heavily endemic in the desert southwestern USA. Although early studies of this infection among transplant recipients in the endemic region were complicated by high morbidity and mortality, solid organ and hematologic stem cell transplantation can be a successful undertaking within the Coccidioides-endemic region. Such success has been attributed to careful attention to screening for and treatment of...

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

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

Although a less common cause of gastrointestinal illness in transplant recipients than bacterial or viral etiologies, intestinal parasitic infections can result in severe and prolonged disease in this population. In the developed world, diagnostic delays stemming from low clinical suspicion for intestinal parasites (and the limitations of standard diagnostics) can worsen outcomes in these patients. As travel becomes more frequent among patients both before and after transplant, and with the...

Humanity is facing many challenges associated with population growth and shift in the setting of predicted climate change and global warming. These changes are expected to impose economic, political, and sociological challenges. Such changes will further introduce significant impediments to the functioning of global public health systems through the increasing risk of emerging infectious diseases. These issues are of utmost importance for investigation, in order to understand the future...

Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies...

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

Epstein-Barr virus (EBV) is an important potential cause of morbidity and mortality in children and adults undergoing solid organ (SOT) and hematopoietic stem cell transplantation (HSCT). The EBV virus is associated with a range of clinical symptoms and syndromes in both immunocompetent and immunocompromised patients based upon the virus’ ability to transform and immortalize B lymphocytes leading to viral-driven proliferation of infected B cells. In the immunocompetent host, this...

The endemic fungi are a group of thermally dimorphic fungi that occupy specific defined environmental ranges. They count Histoplasma, Blastomyces, Paracoccidioides, Coccidioides, Talaromyces, Emergomyces, and Sporothrix among their number. In the environment, they exist as molds, and at body temperature, they transform into their pathogenic yeast form (or, in the case of coccidioidomycosis, into a specialized structure called a spherule). Histoplasma, Blastomyces, and Paracoccidioides are...

Altered mental status is common in the solid organ transplant recipient. A variety of etiologies, including infections, metabolic abnormalities, medications, malignancies, and rejection, can lead to altered mental status in a transplant patient. Timeline after transplantation as well as organ transplanted have significant impact on etiology. Detailed physical examination, comprehensive laboratory evaluation, and in many cases imaging can help elucidate the etiology. Urgent treatment of underlying etiology can improve prognosis.

Solid organ transplantation and hematopoietic cell transplantation are life-saving procedures, yet carry significant infection risk due to the significant and prolonged immunosuppression they entail. Infection prevention strategies using antibiotic prophylaxis can mitigate problems that arise through immunosuppression, especially if clinicians have a keen awareness for local epidemiology and patient-specific microbiological factors. Antifungal prophylaxis, especially in stem cell...

The purpose of this review is to describe the characteristics of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) in transplant recipients. The majority of reported cases were transmitted by mosquito bite, but blood and graft transmission may occur. These arbovirus infections are clinically similar, resembling influenza-like illness or frequent transplant syndromes. Therefore, laboratory confirmation is necessary. In the acute phase, nucleic acid tests are preferred. DENV and ZIKV serology...