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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...

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

Infectious and noninfectious pulmonary syndromes remain significant contributors to morbidity and mortality after solid organ and hematopoietic stem cell transplantation. Multiple factors increase the risk of pulmonary complications including the surgical trauma related to solid organ transplantation, chemotherapy and radiation prior to hematopoietic stem cell transplant, the degree of immunosuppression, and immune factors contributing to rejection and graft-versus-host disease. The first...

Cytopenias are a common occurrence in both hematopoietic stem cell and solid organ transplant recipients, particularly in the early post-transplant time period. The etiology is frequently multifactorial, reflecting the simultaneous interplay of infection, immunologic derangements, and medication effects in this patient population. These factors continually change over time, further adding to the complexity of diagnosis and management. Thorough evaluation of the individual’s medical history,...

Transplantation in recent years has become a viable option to treat end stage organ failure in people living with HIV infection. Significant advances in the understanding of appropriate immunosuppression management and infection prevention have resulted in graft and patient survival comparable to HIV-negative recipients in many cases. Given the higher incidence of end stage organ disease in HIV positive patients, particularly liver cirrhosis and dialysis dependent renal failure, transplant...

Characteristics of transplant candidates can significantly impact risk for infection after transplantation and immunosuppression start. These characteristics include a wide variety of risk factors for potential infection ranging from country of origin and travel history to history of immunosuppression, to certain comorbid conditions, and to diet and occupation. Increased mobility and medical complexity of transplant patients, and the changing epidemiology of pathogen distribution, can...

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

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...

Following solid organ and hematopoietic stem cell transplantation, patients are at increased risk for community-acquired infections, opportunistic and uncommon pathogens, coinfections, and multidrug-resistant organisms. Given the increased predilection for serious infection in this population, diagnostics applicable to the practice of transplant infectious diseases are essential. In the last decade, diagnostic microbiology has witnessed a shift toward culture-independent methods such as...

Cases of malaria infection have been reported in solid organ and hematopoietic stem cell transplantation; malaria infections may occur as a consequence of a donor-derived infection (from organ or blood), as a relapse of previous P. vivax or P. ovale infection, or as newly acquired infections after transplantation in endemic areas. In donors or candidates with epidemiological risk of malaria infection, sensitive techniques in laboratory surveillance, including molecular tests, to rule out...

Advances in the field of hematopoietic stem cell transplantation (HSCT) provide the opportunity for cure of malignant and nonmalignant diseases. The kinetics of immune reconstitution posttransplant and the immunosuppressive therapies used place HSCT recipients at risk for bacterial, viral, fungal, and other opportunistic infections. Identification of new donor sources of hematopoietic cells has improved accessibility to transplant but may lead to significant deficits in shortand long-term immune...

Despite the availability of an efficacious vaccine, yellow fever continues to pose an emerging human health issue, with outbreaks in Africa and South America. Although the majority of cases are oligosymptomatic, severe cases present high mortality, reaching an overall lethality of 50%. The mainstay for yellow fever control remains adequate vaccine coverage. Because the yellow fever vaccine is composed of live, attenuated virus, it is contraindicated in solid organ transplant (SOT) and...

Acinetobacter infections have emerged as an important pathogen in transplant recipients. It is a major cause of multidrug-resistant nosocomial infections, particularly pneumonia and bloodstream infections, and is associated with high morbidity and mortality. Given the organism’s propensity to develop resistance to multiple classes of antibiotics, treatment options can be limited but frequently include carbapenems, polymyxins, sulbactams, tetracyclines, and glycylcyclines. Infection...

Candida remains a common infectious complication in the setting of solid organ transplantation. The rates of invasive Candida infection vary among organ transplant, with small bowel accounting for the majority of cases. In this chapter, we review the epidemiology of Candida infections following organ transplantation. While C. albicans continues to be the most common fungal species isolated, more recent data show that non-albicans Candida species are on the rise, specifically drug-resistant...

Infection of the anogenital tract with human papillomavirus (HPV) is very common. Approximately 15–20 anogenital HPV types are oncogenic or “high-risk” and are associated with 99.9% of cervical cancers, 90% of anal cancers, 70% of oropharyngeal cancers, and a high proportion of vaginal, penile, and vulvar cancers. Defects in cellular immunity make solid organ transplant (SOT) recipients particularly susceptible to persistent high-risk HPV infection, development of the cancer precursor...

This chapter is a review of rare yet clinically relevant viral encephalitides that have been transmitted from organ donors to recipients. We will discuss the potential pitfalls in diagnosing and managing these illnesses and also discuss the challenges and next steps to better outcomes from these infections.

Multidrug-resistant organisms (MDROs) cause morbidity and mortality after organ transplantation. Infection from these organisms may arise from pre-transplant colonization/infectious events, and these organisms may be donor-derived. Here we review the epidemiology, clinical manifestations, disease diagnostics, and therapeutic modalities for six common MDRO bacterial pathogens in the context of solid organ and bone marrow transplantation.

The incidence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) and carbapenem-resistant Enterobacterales (CRE) infections has been increasing worldwide, although the prevalence and mechanism of resistance vary by geographic region and institutional patterns of resistance. These multidrug-resistant infections are challenging to diagnose and treat and can cause significant morbidity and mortality in transplant patients. In this chapter we highlight recent trends in...

Infections are an important cause of morbidity and mortality after transplantation. Some of these infections are environmental and geographically or seasonally important. West Nile virus is one such infection, tied to the epidemiology of infected mosquitos which varies over time. It can cause disease for a transplant recipient either from direct inoculation from an infected mosquito or as a donorderived infection. This chapter reviews current data about the epidemiology of West Nile virus,...