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Surgical site infections (SSIs) following transplantation have been linked to increased mortality, graft rejection, increased length of stay, and increased resource utilization ). Rates of SSI vary and can reach as high as 37% for some transplant procedures . The risk of infection depends greatly on type of surgery and patient-specific factors. Postoperative wound infections following transplant generally occur within 30 days of surgery and can range from superficial to organ/space...

In recent years, extensive research and newer therapeutic strategies have remarkably reduced the number of acute and chronic rejections and graft-versus-host disease (GVHD) and have significantly improved the survival of transplant recipients. On the other hand, transplant recipients are more vulnerable to a wide range of infections as immunosuppressive therapies not only suppress host T-cell response but also destroy other rapidly dividing cells resulting in neutropenia and...

Nocardia species are strictly aerobic, gram-positive, branching, filamentous rods which are beaded appearing and stained variably with the modified acid-fast Kinyoun stain. They can fragment into pleomorphic, rod-shaped, or coccoid pieces. Nocardia are sometimes difficult to recognize and identify in the laboratory, leading to delays in clinical diagnosis. Their relatively slow growth can result in the cultures being discarded before the colonies can be seen. Nocardia are found most often in...

Listeria monocytogenes, a small gram-positive bacterium, is a foodborne pathogen that can cause life-threatening bacteremia and central nervous system infections. Persons at risk for listeriosis are primarily those with impairments in cell-medicated immune function, including recipients of solid organ and bone marrow transplantation. Although infection with this microorganism is uncommon, it carries a high mortality. CNS infection may have a subacute course and may involve the brain...

Antiviral therapy is required in the transplant setting for viral infections that arise from preexisting latent or persistent infection in the recipient and/or donor as well as from nosocomial or community sources. A preventive or prophylactic antiviral approach where feasible is preferable to the treatment of symptomatic viral disease. Acute infections need prompt diagnosis and antiviral treatment for the best outcome. Selection of antiviral therapy involves multiple considerations...

Viral infections are a global public health problem and can contribute significantly to patient morbidity and mortality. It is estimated that there are 350 million people worldwide who are infected with hepatitis B virus and 17,000 new cases per year of hepatitis C are identified (Wasley et al., MMWR Morb Mortal Wkly Rep 57(SS-2):1–24, 2008). Herpes viruses are common, with an estimated seroprevalence of 50% for herpes simplex virus type-1 and 20% herpes simplex virus type-2 seroprevalence...

Palliative care has been shown to improve quality of life and even prolong life in patients with certain types of malignancy and end-organ failure. Several studies have now demonstrated a beneficial impact of palliative care on the transplant patient. While hospice provides care for patients whose survival is expected to be less than 6 months, palliative care is the specialized care for the patient with serious illness and can be provided at any stage of the disease. All transplant...

Invasive fungal infections are an important problem in the management of both solid organ and hematopoietic stem cell transplant recipients. This chapter summarizes the evidence and recommendations for preventing invasive fungal infections in transplant recipients. A summary of recommendations are presented in Table 64.1.

Both facial and upper extremity composite tissue allotransplants consist of heterogeneous tissues including skin, muscle, bone, fat, nerves, and lymph nodes. These tissues are extremely antigenic and necessitate an immunosuppressive regimen similar to that of solid organ transplants. Thus, the patient with a face or limb transplant has many of the same infection risks in individuals following kidney transplantation such as nosocomial and opportunistic bacterial, viral, fungal, and protozoan...

Febrile neutropenic patients are at increased risk of developing infections. During the initial stages of neutropenia, most of these infections are bacterial. The spectrum of bacterial infections depends to some extent on whether or not patients receive antimicrobial prophylaxis when neutropenic. Since most transplant recipients do, Gram-positive organisms predominate, due to the fact prophylaxis is directed primarily against Gram-negative organisms. Staphylococcus species (often...

Transplant-related immunosuppression is an important risk factor for the development of infectious diseases. The skin, as barrier to the outside world and the body’s largest organ, is particularly susceptible to both primary and disseminated infection. For the astute and thorough clinician, the skin is a useful marker of the health of the patient. It may provide clues to systemic disease and offers a chance at early diagnosis and prompt intervention.

This chapter will review the basic biology of Mycobacterium tuberculosis and then focus on the epidemiology, clinical manifestations, and diagnosis in transplant patients. Prevention and treatment will be considered elsewhere. Tuberculosis (TB) remains a leading cause of human mortality in resource-limited settings, in part because it is still a diagnostic and treatment challenge. These challenges are compounded in immunocompromised hosts such as transplant patients because the performance...

Infections caused by Candida species range from local mucous membrane involvement to widely disseminated disease. In patients who have received a hematopoietic cell or solid organ transplant, candidiasis is one of the most common infections that is seen and is often life threatening. Candida species are part of the normal human microbiota and, as such, rarely cause infection in healthy hosts. Infections arise when the organisms are able to proliferate locally and gain access to the...

Cryptococcosis is the third most common invasive fungal infection among solid organ transplant recipients but has been reported very rarely in hematopoietic stem cell transplant recipients. Pulmonary cryptococcal disease is the most common clinical presentation, and the central nervous system involvement is the most common extrapulmonary site. Diagnosis is confirmed by isolation of the fungus from culture samples and measuring cryptococcal antigen in various body fluids including serum and...

Toxoplasma gondii and Strongyloides stercoralis are important parasitic infections in transplant recipients. These helminths can lead to severe and often life-threatening disease in immunocompromised patients. Toxoplasma gondii can cause an undifferentiated febrile syndrome, encephalitis, pneumonitis, myocarditis, hepatitis, and retinochoroiditis, whereas S. stercoralis infestation, can lead to the hyperinfection syndrome, which carries a high mortality rate. Effective therapies are...

This chapter discusses recent developments in diagnostics for cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), community respiratory viruses (CRVs), parvovirus, hepatitis viruses, HIV, and other viral agents of importance in solid organ and hematopoietic stem cell transplantation.

Mycobacterial disease is commonly encountered during transplant evaluations and can be a major source of morbidity and mortality among transplant recipients. The impact of TB and NTM around the world has gained increased awareness, and the global impact of disease varies from country to country thus making mycobacterial epidemiology an important aspect of disease management. Risk factors for both tuberculosis (TB) and nontuberculous mycobacteria (NTM) must be assessed by transplant...

Caring for immunocompromised patients is challenging. Despite significant advances, infection remains a major cause of morbidity and mortality, and as such, these patients are frequently exposed to antimicrobial agents. Antimicrobial stewardship programs (ASPs) can assist transplant centers in optimizing antibiotic usage, particularly in this age of growing microbial resistance and the scarcity of new anti-infective agents in development. The collaborative approach of antimicrobial...

As organ transplant recipients live longer and healthier lives after transplant, they increasingly partake in foreign travel, for leisure, adventure, work, or to visit friends or relatives. A review of cohorts of transplant recipients shows that they tend to have minimal or suboptimal preparation prior to travel, with limited pre-travel vaccination, medications, and education, and overall poses greatly increased risk of travel-related infections and complications. Enhancing the knowledge of...

Vaccines are an essential component of protection against infection after solid organ transplantation for both children and adults. Unfortunately, many transplant recipients are undervaccinated. In general, vaccination before transplantation results in better immunologic response, and the period before transplant is a special opportunity to provide protection for this vulnerable population. Live vaccines, such as MMR, varicella/zoster, nasal influenza, yellow fever, oral polio, and others...