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Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source...

Anemia, leukopenia, thrombocytopenia, as well as pancytopenias can be seen following solid organ transplant. Varying patterns of cytopenia can be seen based on the drugs used in the posttransplant period, infections encountered by the individual, as well as the individual’s immune response and bone marrow function. The chapter discusses the main causes of anemia, leukopenia/neutropenia, and thrombocytopenia. The differential diagnosis for anemia after solid organ transplant includes...

Enterobacteriaceae comprise important pathogens for recipients of solid organ and hematopoietic stem cell transplants. Especially common in the early posttransplant period when transplant recipients are still hospitalized, they can occur at any time following the procedure. Increasing frequency of colonization and invasive disease due to antimicrobial-resistant pathogens has been described in recipients of solid organ and hematopoietic stem cell transplants. In solid organ transplant...

Respiratory viral infections (RVIs) are common among the general population; however, these often mild viral illnesses can lead to serious morbidity and mortality among recipients of hematopoietic stem cell and solid organ transplantation. The disease spectrum ranges from asymptomatic or mild infections to life-threatening lower respiratory tract infection or long-term airflow obstruction syndromes. Progression to lower respiratory tract infection or to respiratory failure is determined by...

Infectious complications are a major cause of morbidity and mortality in patients undergoing solid organ or stem cell transplantation. Over the past years, advances in immunology and molecular biology have greatly contributed to a better understanding of the pathogenesis of opportunistic infections in the immunocompromised host. The lifelong immunosuppression required by the transplant recipients together with the limitations of the current anti-infective agents makes strategies able to...

Infection control and prevention strategies are of great importance to the healthcare system as a whole, but are even more critical in the immunocompromised host. While transplant recipients present unique challenges to clinicians and infection control practitioners alike, standard approaches to infection control are still of foremost importance in this population. The type of transplantation, degree of immune suppression, and duration of time following transplantation help determine the...

Viral infections account for a large proportion of emerging infectious diseases, and the agents included in this group consist of recently identified viruses as well as previously identified viruses with an apparent increase in disease incidence. In transplant recipients, this group can include viruses with no recognized pathogenicity in immunocompetent patients and those that result in atypical or more severe disease presentations in the immunocompromised host. In this chapter, we begin by...

Hematopoietic stem cell transplantation (HSCT) refers to the process of intravenous infusion of self-renewing hematopoietic stem cells to restore normal hematopoiesis and is a rapidly developing and highly effective modality of treatment for a wide range of immunologic, metabolic, hematologic, as well as malignant diseases. Patients undergoing HSCT are at high risk of infectious complications in the peri-transplant period while awaiting immune reconstitution. There has been significant...

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become a widely used modality of therapy for a variety of malignant and nonmalignant diseases. Despite advances in pharmacotherapy and transplantation techniques, infection remains one of the most severe and frequently encountered complications of allo-HSCT.

Ocular infections in transplant patients can be rapidly progressive and result in significant vision loss and morbidity. Approximately 2% of transplant patients in several large series developed serious eye infections, and the most common were viral retinitis and fungal endophthalmitis. Viral retinitis is due to cytomegalovirus, herpes simplex, or herpes zoster. A particularly fulminant form of viral retinitis, progressive outer retinal necrosis, may occur and result in blindness within 1 to...

Infections of the central nervous system (ICNS) contribute significantly to morbidity and mortality in patients receiving solid organ and stem cell transplants. The risk for ICNS is influenced by multiple factors, including the organ transplanted, type and degree of immunosuppression, post-transplant adverse events, as well as donor characteristics. These infections may be classified by anatomic location – intracranial, spinal, and paraspinal – as well as by time of onset. The early...

Endemic fungi are thermally dimorphic and occur naturally in specific geographic areas. Histoplasmosis, coccidioidomycosis, and blastomycosis are the three major disease entities encountered in North America. Even in endemic areas, disease incidence is low among transplant recipients. Infection is typically acquired via inhalation of molds from the environment. Disseminated infection is more likely to occur in immunocompromised individuals. Definitive diagnosis is established by growing the...

Viral hepatitis remains the leading cause of liver failure and is the primary indication for liver transplantation worldwide. Hepatitis viruses are categorized into five distinct subtypes that collectively render significant morbidity and mortality in transplanted patients. Each subtype has a distinct replication pattern, pathology, and treatment. While the primary pathology mediated by these viruses occurs within the liver, significant extrahepatic disease may be observed with particular...

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in transplant recipients. The most common IFI are candidiasis, aspergillosis, pneumocystosis, cryptococcosis, mucormycosis, and endemic mycoses. Clinical presentations are generally non-specific, and fungal etiologies are often suspected when immunocompromised patients present with respiratory symptoms and/or undifferentiated fever that do not respond to empiric antibacterial therapy. Moreover, early treatment can...

Liver transplantation has become an important treatment modality for patients with end-stage liver disease/cirrhosis, acute liver failure, and hepatocellular carcinoma. Although surgical techniques and immunosuppressive regimens for liver transplantation have improved significantly over the past 20 years, infectious complications continue to contribute to the morbidity and mortality in this patient population. The use of standardized screening protocols for both donors and recipients,...

The differential diagnosis of lung infiltrates in transplant patients includes non-infectious processes that may mimic pneumonia. Hydrostatic and non-cardiogenic pulmonary edema, as well as transfusion-related lung injury, may cause bilateral airspace opacification that may be confused with an infectious process. Chemotherapeutic agents, whether administered for treatment of an underlying hematologic malignancy, for induction prior to transplant, or for the treatment of GVHD or graft...

There are numerous fungal pathogens which merit consideration in the hematopoietic cell and solid organ transplant recipients including yeasts, filamentous molds, and endemic fungi. Important differences in the incidence, types, and timeline of infections exist among the differing transplant groups. The overall risk of invasive fungal infection is affected by a multitude of factors including the transplant donor and recipient as well as transplant type. These considerations guide the...

Aspergillus species are ubiquitous fungi that infect humans after their asexual spores are inhaled and deposited in the respiratory tract. Neutrophils and cell-mediated immunity are crucial components of host defenses that prevent invasion of Aspergillus, and these elements are often lacking or impaired in transplant recipients. Aspergillosis is the most common invasive fungal infection in hematopoietic stem cell transplant recipients and the second most common in solid organ transplant...

Transplant infectious diseases are among the most challenging sectors of present-day medicine. Solid organ and hematopoietic stem cell transplants are being performed with increasing frequency, and the threat of infection is ever-present due to a degree of dependence upon potent immunosuppressive agents that ensure sustained engraftment. Accordingly, antibacterial agents will be employed as well. The responses of these patients to bacterial infection can be very different when compared to...

West Nile virus (WNV) is an emerging pathogen endemic in Africa and Europe. Recent events demonstrate the speed with which a vector-borne disease like WNV can disseminate when introduced into a susceptible, pathogen-naïve population, where competent reservoir and vectors are present. Since the arrival of WNV to the North American continent in 1999, it is estimated that 2–4 million people have been infected in the USA alone. It has special relevance to the immunocompromised host populations...