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Over the last 70 years, a steady growth in population of patients with severe and mostly iatrogenically induced immune suppression while undergoing myeloablative antineoplastic therapy and blood- and marrow-derived stem cell or solid organ transplantation has resulted in a near-explosive growth of opportunistic infections. Furthermore, the advent and now common use of biologic immunosuppressive drugs are given to an increasing number of patients prior to transplantation or for treatment of...

Gram-positive bacteria (GPB) are an important cause of systemic disease in immunocompromised patients, especially those undergoing transplantation. A rise in infections due to GPB in the last two decades has been attributed to a variety of reasons that prominently include antimicrobial prophylaxis with a focus on prevention of Gram-negative bacterial infections. The near-universal use of indwelling intravascular access devices that are usually retained for an extended duration also...

In the general population, cytomegalovirus (CMV) is a common infection that is frequently acquired at a young age; one in three children in the United States are infected with CMV. In patients undergoing transplantation, CMV most frequently presents as reactivation of a remotely acquired infection, whereas primary CMV infection in seronegative (−) recipients transmitted via allografts harvested from CMV-seropositive (+) donors poses the greatest threat of infection and viral end-organ...

Despite the overall decline in the frequency of documented gram-negative infections in transplant recipients receiving antimicrobial prophylaxis, the proportion of these infections caused by nonfermentative gram-negative bacilli (NFGNB) is increasing. Pseudomonas aeruginosa is the most common species of NFGNB isolated from such patients, from both monomicrobial and polymicrobial infections. The spectrum of infection caused by P. aeruginosa is wide, and involvement of multiple organ systems...

Hematopoietic stem cell transplantation (HSCT) has the potential to provide long-term survival and potential cure in patients with hematological malignancies and nonmalignant hematologic and autoimmune disorders. Conditioning regimens are designed to make room for the stem cell allograft by ablation of hosts’ immune system with the objective of sustained foreign immune cell engraftment. However, a number of short-term and long-term complications are associated with regimens used for...

Solid organ and hematopoietic stem cell transplant recipients are at increased risk of upper and lower respiratory tract infections. While these infections are frequently encountered in the general population, the spectrum of their clinical presentation including morbidity and mortality is increased in patients undergoing transplantation procedures. Impaired innate and adaptive immunity, potential anatomical abnormalities resulting from extensive surgical procedures, presences of indwelling...

The spectrum of nontuberculous mycobacterial (NTM) infections has become an increasingly recognized cause of clinical concern in transplant recipients. While episodic isolation of NTM is often common among certain solid organ transplants such as lung recipients, there is sufficient evidence to support that serious infections can result in all transplant groups. As NTM are ubiquitous in the environment, and exposure to such bacteria is universally unavoidable, clinicians providing care for...

Prevention of infection is important in the susceptible patients undergoing transplantation. Accurate diagnosis continues to be a challenge, and response to treatment is often suboptimal, mainly due to immune defects that cannot be corrected during the course of an infection episode. Antimicrobial drugs are the cornerstone for prevention of opportunistic and other routinely encountered infections in patients undergoing solid organ and hematopoietic stem cell allograft transplantation....

Invasive fungal infections (IFIs) continue to pose a serious challenge in patients undergoing transplantation. An essential need for treatment with immunosuppressive drugs necessary for sustenance of solid organ allograft; preparatory conditioning regimens use to facilitate hematopoietic stem cell engraftment; drugs given to mitigate hosts’ adaptive cellular immune response for prevention and treatment of graft-versus-host disease (GVHD), and visceral allgraft rejection promote the risk for...

The Enteroviridae are single-stranded RNA viruses in the Picornaviridae family notable for their ability to cause a wide range of diseases, with more severe disease manifestations in the immunocompromised host. Humans are the reservoir for Enteroviridae, and person-to-person transmission occurs via the fecal-oral or respiratory route. Intact innate immune response including NK cells and macrophages plays an important role during the initial phase of infection followed by T- and B-cell...

Transplant patients are uniquely predisposed to infections with multidrug-resistant organisms both in the early and late phases after transplantation. Similarly, recipients of stem cell or solid organ allograft show greater susceptibility for often difficult-to-treat infections acquired during the extensive healthcare environmental contact and multidrug-resistant bacteria in patients’ community. Infections are frequently encountered during pretransplant period due to the undergoing...

Infections involving the hepatobiliary tract contribute to significant morbidity and mortality in solid-organ transplant recipients, particularly recipients of a hepatic allograft. Bacteria within the gastrointestinal tract may colonize a dysfunctional biliary system, thereby increasing the risk for ascending cholangitis. Additionally, infections such as cytomegalovirus or Epstein-Barr virus may trigger life-threatening acute illness and foster risk for other opportunistic infections and...

Human herpes viruses are a family of double-stranded DNA viruses that cause opportunistic infections in solid organ and hematopoietic stem cell transplant recipients. Alpha-herpesviruses cause localized ulcerative mucosal and vesicular cutaneous lesions, with the tendency to disseminate if not treated early and aggressively. Beta-herpes viruses, discussed in this chapter such as human herpes viruses 6 and 7, may rarely cause a febrile illness and a skin rash; however, HHV6 in recipients of...

Over the last half-century, there has been a steady increase in opportunistic fungal infections due to the growth in population of patients with severe and mostly iatrogenically induced immune suppression. The explosive growth of this challenge in opportunistic fungal disease has been fueled in recent decades by advances in solid organ and hematopoietic stem cell transplantation. Furthermore, use of high-dose antineoplastic chemotherapy and biologic immunosuppressive regimens in oncology and...

Acute bloodstream infection (BSI) is one of the most severe forms of infection. BSI may be primary or secondary and community-acquired or healthcare-associated. BSI is frequently observed among immunocompromised and critically ill patients, but is rarely asymptomatic and may be associated with multiple organ failure (Pittet et al. JAMA. 1994;271(20):1598–601; Edmond et al. Clin Infect Dis. 1999;29(2):239–44; Marshall et al. Crit Care Med. 2003;31(5):1560–7). Infective endocarditis (IE) is...

Dermatologists are often called upon to evaluate skin lesions in organ transplant patients, especially when an infectious etiology is suspected. This section will review some of the non-infectious skin eruptions that mimic cutaneous infections. This chapter is intended to help the clinician generate a differential diagnosis when evaluating cutaneous lesions in organ transplant patients. Using the morphology of the primary lesion as a starting point, we then list the non-infectious diagnosis...

Mucormycosis (formerly known as zygomycosis) is a life-threatening infection caused by fungi of the order Mucorales. Mucormycosis is an infectious emergency that typically occurs in patients with defects in host defense and/or with increased available serum iron, but can also occur after traumatic implantation of the etiologic fungi through skin. Recent years have witnessed some dramatic changes in the fungal taxonomy, etiology, epidemiology, and therapy of and outcomes from such infections, including in the transplant setting.

Parvovirus B19 was discovered in 1975, and the first reports associating B19 with human disease came 6 years later, when B19 was linked to cases of aplastic crisis in patients with sickle cell disease. Since then, B19 infection has become a recognized infectious complication in the immunocompromised host, including persons infected with human immunodeficiency virus (HIV), as well as solid organ (SOT) and hematopoietic cell transplant (HCT) recipients. While typically a benign, self-limited...

The first line and the most effective form of antifungal host defense are comprised by phagocytes, particularly neutrophils and monocytes/macrophages that play a central role in local containment of infection and prevent systemic dissemination. These immune cells are also exposed to antifungal drugs while patients undergo systemic antifungal therapy. In the phagocyte-fungus-antifungal drug interplay, drugs including amphotericin B formulations, azoles, and echinocandins may directly interact...

The use of intravascular devices for administration of drugs, fluids, blood products, and nutritional support is essential in patients undergoing transplantation procedures. These intravascular devices have a significant potential to produce iatrogenic disease, such as bloodstream infection originating from colonization of the indwelling intravascular devices. Over two-thirds of all healthcare-associated bacteremia originate from devices used for vascular access. Patients undergoing...