Infectious Disease Flashcards
1
Q
The major infections associated with kidney transplants include…
A
- Infections of the native kidneys
- Infections from dialysis devices
- UTI’s
- Occult abscesses
2
Q
The major infections associated with pancreas transplants include…
A
UTI’s
3
Q
The major infections associated with liver transplants include…
A
- Intra-abdominal infections
- pneumonia
- catheter -related infections
4
Q
The major infections associated with heart transplants include…
A
- catheter-related infections
- VADs
- pneumonia
5
Q
The major infections associated with lung transplants include…
A
- pneumonia
- pulmonary colonization:
- bacterial or fungal infections
6
Q
Standard recommended vaccinations include…
A
- Hepatitis A
- Hepatitis B
- Influenza (yearly) including household contacts
- Varicella virus (if non-immune) – (live vaccine)
- Tdap (tetanus/diphtheria/pertussis)
- Measles, Mumps, Rubella If <2 shots or no disease (live vaccine)
- Human Papillomavirus (HPV) ages 9-26 yrs
- Pneumovax (PPSV23)/Prevnar (PCV13)
- Shingles (Shingrix) if >50 yrs
- Meningococcal (if starting college within 1-2 yrs)
7
Q
The period of required wait time between live vaccines and transplant for adult and pediatric patients is…
A
4 weeks
8
Q
The general rule is: Transplant patients should not receive vaccines that are…
A
live
9
Q
The leading cause of death in SOT recipients is due to …
A
infection
10
Q
As immunosuppression is increased, the risk of infection…
A
increases
11
Q
As immunosuppression is increased, the risk of rejection…
A
decreases
12
Q
Exogenous sources of post-transplant infections include…
A
- Allograft itself
- blood transfusions
- The environment: hospital and community
13
Q
Endogenous sources of post-transplant infections include…
A
the reactivation of latent infections
14
Q
Donor Derived Infections can be determined from…
A
- vaccination history of donor
- infection history of donor
- identifying risky behaviors of donor
- identifying unusual opportunities for exposure such as travel
15
Q
Donor derived infections can include…
A
- CMV
- HIV
- EBV
- Fungal
- Toxoplasma
- Hepatitis
- Syphilis
- PPD (tuberculosis)
16
Q
The period of time that infection risk is highest is…
A
- Early post-op, when immunosuppression doses are the highest
- Anytime immunosuppression is increased to treat rejection
17
Q
Pathogens that patients are exposed to in the hospital include…
A
- VRE: Vancomycin-resistance Enterococcus
- MRSA: Methicillin-resistant Staph Aureus
- C-difficile
18
Q
Community exposures include…
A
- Respiratory viruses (RSV, Influenza)
- Food-borne pathogens (salmonella)
- Geographically restricted infections (Crypto)
19
Q
Non-pharmacologic measures by healthcare workers to prevent infection include…
A
- Reverse Isolation procedures
- Line care/discontinue lines & catheters ASAP
- Anti-infective agents
- Good hand washing/masks
- Sterile technique with dressing changes
- Avoid cross contamination between patients
- CMV negative blood products
- Post- transplant surveillance tests per protocol (CMV/EBV)
20
Q
Non-pharmacologic measures to prevent infection when patient returns home include…
A
- Avoid raw/partially cooked food
- Avoid litter boxes, bird cages, fish aquariums
- Avoid close contact with children who have received:
- Varicella, MMR- virus shed in bodily fluids x 1 month
- Avoid sources for fungal infection (garden soil 1st yr)
- Use bottle water (avoid well water)
- Safe sex
- Consult transplant team for travel out of country
21
Q
Factors that make diagnosis of infection difficult include…
A
- Immunosuppressive agents (steroids) decrease inflammatory response
- Infection may not be associated with fever
- Fever may be caused by other factors:
- Rejection, ischemia, drug reactions, PE, DVTs, malignancy
22
Q
Common procedures for diagnosing infections include…
A
- Thorough history and physical
- Comprehensive diagnostic testing
- ID and pulmonary consults
23
Q
Aggressive diagnostic test usually include…
A
- Blood workup (PCR, IgM, IgG):
- PCR- an active infection
- IgM- More recent exposure, have antibody/immunity, not active infection
- IgG- Exposure was not recent, have antibody/immunity, not active infection
- CT scans,
- MRI
- Bronchoscopy, Biopsies
- Elevated CRP (C-reactive protein)- high with infection
- Normal is less than 10.0
- Elevated Sedimentation rate- high with infection
- Normal is less than 30.0
24
Q
Symptoms that will usually require admission include…
A
- Chest infiltrates present on CXR or CT scan
- Fever > 38.5
- Patient appears toxic
- Patient cannot perform routine ADLs
25
The major pathogens of bacterial infections include…
* Staph
* C. Diff
* Salmonella
* Pseudomonas
26
The major pathogens of viral infections include…
* Influenza
* Herpes
* EBV
* Varicella
* CMV
27
The major pathogens of fungal infections include…
* Candida
* Aspergillus
* PCP
* Histoplasma
28
The major pathogens of parasitic infections include…
* Toxoplasma
* Cryptosporidium
29
The characteristics of CNS infections include…
* Immunosuppressants may mask signs of meningeal irritation or meningitis
* Changes in LOC may be subtle (start with headache, stiff neck, then mental status changes)
* Simultaneous presence of unexplained fever + headache = most reliable indicator of CNS infection:
* Warrants immediate and complete neuro exam
* CT, MRI of brain, LP
30
CNS Syndromes include…
* Acute meningitis
* Chronic or subacute meningitis
* Focal brain syndrome
* Progressive dementia
31
The 3 most common pathogens of CNS infections include…
* Listeria monocytogenes
* Cryptococcus neoformans
* Aspergillus fumigatus
32
The type of infections that cause the most morbidity and mortality is…
Viral infections
33
The major viral infections caused by herpes and hepatitis viruses include…
* Cytomegalovirus
* Epstein Barr Virus
* Herpes simplex 1 and 2
* Varicella Zoster
34
Latent viruses are relevant due to the fact that…
once a herpes virus is present, the patient has the viral genome for life
35
A viral infection is evidenced by…
a + serological testing (polymerase chain reaction - PCR)
36
A viral infection is considered a disease when…
the patient has specific symptoms that are caused by the virus
37
The most common pathogen occurring in 30-70% of all recipients is…
Cytomegalovirus (CMV)
38
CMV effect on the liver includes…
vanishing bile duct syndrome
39
CMV effect on the heart incudes…
coronary artery vasculopathy
40
CMV effect on the lungs include…
bronchiolitis obliterans
41
CMV effect on the kidney includes…
glomerulopathy
42
CMV can be acquired…
* Primary (de novo)
* Reactivation infection
* Superinfection
43
Primary (de novo) CMV infection is acquired when the recipient…
* Receives allograft from CMV-positive donor
* Receives CMV positive blood products
* Rarely, thru contact with person with active CMV infection
44
Primary (de novo) CMV infection is characterized by…
* Higher rates of CMV infection and symptomatic disease
* Occurs earlier in post-transplant period
* Has higher recurrence rates
* Has increased risk of disseminated CMV disease
* Has increased mortality rates
45
Reactivation of CMV is acquired by…
* Patient is CMV positive
* Latent virus is reactivated
* Factors associated with reactivation:
* Sepsis
* Rejection
* Antilymphocyte therapy (ATG)
46
Superinfection of CMV is characterized by…
* CMV positive recipient is infected with NEW exogenous CMV strain from the allograft
* Risk of developing symptomatic CMV disease is \> when that virus is activated from donor origin rather than recipient origin
47
CMV hepatitis tends to occur in…
liver transplant recipients
48
CMV gastroenteritis tends to occur in…
Small Bowel Transplant Recipients
49
CMV pneumonia tends to occur in…
Lung Transplant Recipients
50
Recipients who are at greatest risk for CMV include…
* CMV positive recipients who receive ATG for rejection
* CMV negative recipients who receive allografts from CMV positive donor
51
CMV risk is HIGH when the serology is…
Donor +, Recipient -
52
CMV risk is MODERATE when the serology is…
* Donor +, Recipient +
* Donor -, Recipient +
53
CMV risk is LOW when the serology is…
Donor -, Recipient -
54
CMV Syndrome can include…
* Fever
* Fatigue
* Malaise
* Leukopenia
* Myalgia
* Thrombocytopenia
* Elevated LFTs
55
Tissue-invasion Disease can cause…
* Gastroenteritis
* Myocarditis
* Pneumonitis
* Retinitis (rare in SOT)
* Encephalitis (rare) Pancreatitis (rare)
* Hepatitis:
* Elevated bilirubin and LFTs
* Detection of CMV in biopsy
56
CMV prevention can include…
* Valganciclovir (1st choice)
* Ganciclovir
* Acyclovir
* Valacyclovir
* CMV negative, filtered, or leukocyte poor blood products for all products
57
An example of CMV preemptive therapy for high-risk patients only may include…
IV ganciclovir during ATG for rejection
58
A CMV diagnosis includes…
* CMV Antigenemia Assay
* Quantitative PCR:
* Indicator of active disease
* Results typically in 24 hrs
* More accurate than CMV IgM antibody titers
59
CMV treatment includes…
* IV ganciclovir followed by oral valgan
* Treat until eradicate viremia
* Some period of secondary prophylaxis (1-3 months)
* Oral valganciclovir except:
* Severe disease
* GI disease
* Fluctuating renal function
* CMV hyperimmune globulin for tissue invasive disease
* Immunoglobulin (IVIG)
* Foscarnet
* Ganciclovir-resistant organisms, patients intolerant of ganciclovir
* Adjust dose for renal function!
60
The incidence of Epstein-Barr Virus in transplant recipients is…
20-30% on average
61
The incidence of Epstein-Barr Virus in transplant recipients on ATG therapy is…
higher than normal, at 80%
62
The clinical manifestations of EBV include…
* Lymph node hyperplasia
* Splenomegaly
* Fever
* Pharyngitis
* Abnormal liver function tests (LFTs)
* Atypical mononuclear leukocytes (AMLs)
63
Post-Transplant Lymphoproliferative Disease (PTLD) syndrome ranges …
from benign, self-limiting polyclonal proliferation to aggressive, monoclonal malignant lymphomas
64
PTLD typically occurs when…
* Typically occurs between 8-18 months post-transplant
* Overall incidence = 3%
* Occurs most frequently in abdomen
* Often resistant to therapy
* Associated with morbidity & mortality (varies per organ)
65
Risk factors for PTLD include…
* Primary EBV infection
* Preceding CMV infection
* Immunosuppressants which cause reactivation of latent EBV infection
66
Clinical manifestations of PTLD include…
* Mono-like syndrome
* Weight loss, anorexia
* Fever of unknown origin
* Abdominal pain
* Jaundice
* GI bleeding
* Renal and hepatic dysfunction
* Pneumothorax, pulmonary infiltrates
* CNS changes ( Decreased LOC, seizures)
* Allograft involvement
67
EBV preemptive prophylaxis includes…
* Typically: none
* High- risk patients may receive IV ganciclovir
68
EBV diagnostic tests include…
* Mononucleosis:
* CBC with diff
* EBV IgM and IgG
* LFTs
* Heterophil agglutination antibody test
69
PTLD diagnostic tests include…
* CT scan
* Note: Absence of adenopathy does not rule out PTLD, disease can be entirely extranodal
* Tissue biopsy: Confirmation
70
Treatment option for EBV includes…
Acyclovir
71
Treatment options for PTLD: Early Malignant Polyclonal Polymorphic B-cell Lymphoma includes…
* Acyclovir
* Ganciclovir
* Gammaglobulin Anti-B cell antibodies
* Decrease immunosuppression
72
Treatment options for PTLD: Monoclonal Polymorphic B-cell Lymphoma includes…
* Chemotherapy
* Radiation
* Resection
* Decrease immunosuppression
73
8 members of the Herpes Virus family that can cause disease after SOT includes…
* Herpes simplex virus I and II
* Varicella zoster virus (VZV)
* Cytomegalovirus (HHV-5)
* Epstein Barr virus (HHV-4)
* HHV-6
* HHV-7
* Roseola-infantum
* HHV-8
74
The Varicella Zoster Virus includes…
* Chicken pox in children
* Shingles in adults (herpes zoster) vaccine \>60yrs
75
Symptoms of VZV include…
Itching, painful blister-like lesions which start on face or trunk, fever, headache, chills
76
Treatment of VZV includes…
Varicella zoster hyperimmunoglobulin within 72 hrs of exposure, often hospitalized with disease, IV acyclovir for treatment-lesions crusted over
77
The Bacterial Infection, C. Difficile can be contracted…
From soil, air, water, human and animal feces, most surfaces in hospital Can happen when on antibiotics, ex. clindamycin, cephalosporins (normal bacteria is reduced by antibiotics)
78
Symptoms of C Diff include…
Diarrhea with characteristic odor, Increased WBCs, fever, abdominal pain, dehydration
79
C. Diff is diagnosed via…
stool culture
80
Treatment of C Diff includes…
Flagyl or oral vancomycin
81
The Bacterial Infection, Nocardia can effect…
the brain, lungs and skin most commonly
82
Nocardia is found in…
soil, organic matter, water
83
Nocardia presents as…
* Pneumonia: fever, cough, chest pain
* Brain: headache, lethargy, confusion, seizures
* Skin: cellulitis
84
Diagnosis of Nocardia is via…
Alveolar infiltrate, cavitation on xray, culture of sputum
85
Treatment of Nocardia includes…
Sulfonamides preferred, ceftriaxone
86
Treatment of HCV/HBV includes…
ribavirin, ledipasvir/sofosbuvir
87
Hepatitis A symptoms include…
* Short, mild flu-like illness
* GI upset
* N-V-D
* Loss of appetite
* Weight loss
* Abdominal pain
* Jaundice
88
Hepatitis A prevention includes
Vaccination: Two injections 6 months apart
89
Hepatitis B is typically spread…
* Spread through bodily fluids, sexual contact
* Sharing contaminate needles
* Non-sterilized equipment for tattoos
90
Hepatitis B symptoms are similar to …
Hepatitis A
91
Hepatitis B can lead to…
carcinoma of liver, cirrhosis
92
Treatment of Hepatitis B includes…
* HBV Immune globulin
* Entevavir, Tenofovir, lamivudine, adefovir, interferon
93
Hepatitis B prevention includes…
a vaccine series
94
Hep B Core Ab+ means…
exposure to the actual disease
95
Hep B Surface Ab+ means…
you had the vaccination and you are protected
96
Hep B Surface AG+ means…
the disease is active and you cannot be a living donor
97
80% of Hepatitis C + patients will develop…
chronic hepatitis leading to : liver cancer liver cirrhosis
98
Hepatitis C symptoms are similar to…
Hep A and Hep B
99
Treatment of Hep C includes…
Antiviral drugs: Ribavin Ledipasvir (sofosbuvir)
100
The two strains of Polyomavirus that cause disease in humans is…
BK and JC
101
There is evidence of serologic infection in adults worldwide…
approx 80%
102
Primary infection of BK/JC is acquired in childhood via
respiratory route, contaminated food, or water
103
BK/JC virus tends to persist in the…
kidney, ureters, spleen, and brain
104
Because BK/JC is latent, immunosuppression may cause…
reactivation
105
BK virus typically causes…
* Ureteral ulceration
* Ureteral stenosis
* Graft rejection/loss
106
JC virus typically causes…
* May affect brain cells
* May cause progressive multifocal leukoencephalopathy
107
BK risk factors are associated with…
* BK mismatches- (sero-negative recipients of organs from BKV sero-positive donors)
* Prolonged ischemia times
* Use of tacrolimus and MMF
108
BK clinical syndromes include…
* Renal Transplant Recipients
* Reactivation usually with 1st 3 months post- transplant Late reactivation can occur (1-2 years)
* Reactivation and replication can lead to:
* Viuria
* Ureteral stenosis
* Tubulo-interstitial nephritis
* Severe graft dysfunction or loss
109
JC clinical manifestations include…
* Impaired memory
* Confusion
* Disorientation
* Ataxia
* Hemiparesis
* Incoordination
* Seizures
* Visual abnormalities
110
JC Virus typically results in…
death within 2-6 months of onset of symptoms
111
JC diagnosis includes…
* requires tissue sample I
* In absence of invasive diagnostic procedures, presumptive diagnosis can be made based on presence of JCV DNA in cerebral spinal fluid (by PCR).
* Neurological in nature, rapid progression, diagnosed with tissue
112
Treatment for BK and JC includes…
* No specific antiviral therapy
* Cidofovir used with some success
* Supportive treatment
* Reduction in dose of immunosuppressants
* Close monitoring for rejection
113
Most common portal of entry for fungal infections is…
the respiratory tract
114
Geographical restricted fungal infections include…
* Histoplasmosis
* Coccidioidomycosis: Arizona (specific to region)
* Blastomycosis
115
Symptoms of fungal infections include…
* Fever
* Headache
* May lead to meningitis
* Chest pain
* Weight loss, Night sweats
* Respiratory symptoms: Dry cough, hemoptysis, pneumonia
* Skin Symptoms
116
The most common opportunistic fungal infections include…
* candida
* cryptococci
* aspergillus
117
Treatment for fungal infections include…
* Fluconazole
* Voriconazole
* Micafungin
* Amphotericin B
* Nystatin
118
The major parasitic pathogens include…
* Cryptosporidium
* Strongyloidosis
* Toxoplasma gondii
119
Cryptosporidium can be transmitted via…
* Fecal-oral
* Animal-person
* Contaminated water
120
Cryptosporidium treatment options include…
* Fluid, electrolyte, nutritional support
* Spiramycin (effective for some patients)
121
Cryptosporidium precautions include…
* Boil water for 5 minutes
* Use distilled water
* Use filter water
* Make certain filter holes are small enough to filter out crypto
* Avoid ice cubes that have not been made with appropriate water
* Avoid reconstitutes soda fountain drinks
122
Strongyloidosis can be transmitted via…
Larvae penetrates skin from contaminated soil, may be ingested, fecal oral route
123
Strongyloidosis is difficult to diagnose and therefore results in a mortality rate of…
approx 80%
124
Treatment options for Strongyloidosis include…
* Albendazole
* Ivermectin
* Systemic antibacterial agents for concomitant bacteremia/meningitis
125
The parasitic infection common to heart and heart-lung recipients is…
toxoplasmosis
126
Diagnosis of toxoplasmosis is via…
biopsy
127
Treatment options for toxoplasmosis include…
* Pyrimethamine + folinic acid
* Sulfadiazine + pyrimethamine + folinic acid
* Clindamycin + pyrimethamine + folinic acid
128
Fever is a symptom of many infections, including…
* Bacterial: Abscess, bacteremia, UTI, pneumonia, wound infection
* Viral: CMV, HSV, VZV, Adenovirus
* Parasitic
* Mycobacteria, Higher Bacteria, PCP
* C.diff
* Fungal: Endemic, Candida, Aspergillus
* Non-Infectious
* PTLD, Malignancy
* Graft-versus-Host Disease
* Drug reaction/HUS/Stevens-Johnson
129
Evaluation tests to determine the cause of fever may include…
* Labs including CBC (neutropenia)
* Cultures:
* All Cases: Blood, urine
* If appropriate: Sputum, drainage, fluid, stool, studies for respiratory viruses
* CMV PCR if applicable
* Imaging: CXR: PA and Lateral
* Low threshold for CT Chest
* CT of abdomen/pelvis if appropriate
130
Treatment of fever may include…
antibiotics and reduce the immunosuppression
131
Diarrhea may be a symptom of…
* Clostridium difficile
* Enteric pathogens
* Food-borne Illness
* Salmonella, Shigella, Listeria
* Parasitic Infections
* Giardia, Cryptosporidiosis
* Viral
* Drug Effect
132
Initial evaluation of diarrhea may include…
* Stool for C. difficile toxin assay
* Stool culture (Campylo, Salmonella)
* Stool Fecal Leukocytes
* Giardia/Cryptosporidium, Strongy
* CMV PCR \*, consider hepA
133
Initial intervention for diarrhea may include…
* Reduce MMF, check CNI level
* Consider Antibiotics
* IV Fluids
134
A Primary blood stream infection may be caused by…
* Catheter-associated Bacteremia
* Septic thrombophlebitis
* Right sided endocarditis
* Septic pulmonary emboli
* Donor-derived BSI
135
A Secondary blood stream infection may be caused by…
* Urinary tract infection
* Pneumonia
* Surgical site infection
136
Pneumonia Post-transplant might be associated with…
* Bacterial: S. pneumonia, M. cattarrhalis, H. influenzae
* Atypical Bacteria
* PCP
* Fungal
* Mycobacterial
* Viral: CMV, Respiratory Viruses
* Non-Infectious: Sirolimus, edema
137
An initial evaluation of pneumonia might include…
* Consider Pulmonary Consultation
* CT Scan of Chest without contrast
* Sputum culture (in advance of BAL)
* Nasal swab for respiratory viruses (PCR)
* Empiric antimicrobials
138
Heart and Heart-Lung recipients are at an increased risk of pneumonia due to:
* Disruption of phrenic nerve
* Prolonged intubation
* Decrease protective pulmonary mechanisms
* Increase risk of aspiration and atelectasis
139
The viral pathogens of most concern to Heart and Heart-Lung recipients include…
* CMV
* EBV
* Herpes simplex 1 and 2
* Varicella zoster virus
140
The bacterial infections of most concern to Heart and Heart-Lung recipients include…
* Listeria monocytogenes
* Nocardia asteroides
* Legionella pneumonphila
* Typical and atypical mycobacteria
141
Lung recipients are at an increased risk of infection due to…
* Allograft constant exposed to external environment
* Allograft is denervated
* Blunted cough reflex
* Decrease mucous clearance
* Lymphatic drainage disrupted
* Infections may be transmitted via allograft
* Anastomosis site may be associated with:
* Colonization, airway dehiscence, mediastinitis, bronchial stenosis
* Single lung transplant
* Native lung may harbor occult pre- or post-transplant infections
* Most frequent infected sites
* Lung, mediastinum, pleural space
142
Kidney recipients are at an increased risk of …
* Bacterial UTIs = most common complication
* Recipients at increase risk:
* Prolonged pre-transplant dialysis, DM, post-op foley, allograft trauma, surgical complications associated with ureteral anastomosis
* Incidence in female recipients 2 x higher than in males
* Typically occur within 1st few months post-transplant
* May occur any time, especially when Creatinine \> 2, prednisone \> 20mg, multiple rejections, chronic viral infections
143
Clinical manifestations of UTI for Kidney recipients may include…
* Dysuria
* Frequency
* Urgency
* Hematuria
144
Clinical manifestations of urinary leaks for Kidney recipients may include…
* Increase yellow drainage from wound
* Decreased urine output
145
In Kidney recipients, unilateral leg edema on the side of the transplant may indicate…
secondary infection of a wound-related lymphocele
146
Pancreas recipients are at an increased risk of…
* Sepsis = major cause of death
* Acidity of pancreatic digestive enzyme can erode anastomosis and cause septic peritonitis
* Peritonitis may go undetected until patient c/o:
* Fever, distended abdomen, increased blood glucose levels
147
Treatment for sepsis in pancreas recipients may include…
* hospitalized for aggressive IV antibiotics
* Monitor blood glucose levels
* May require exploratory laparotomy
* Percutaneous drains to exchange abdominal fluid with continuous flush of antiseptic solutions
148
Unrinary Tract Infections in pancreas recipients may be due to…
* Diabetes often associated with altered bladder function due to neurogenic changes and increased residual volume which promote bacterial infection
* Alkaline and protein pancreatic secretions may promote bacterial growth
149
In Bladder-Drained Pancreas recipients, Urinary analysis results may be misleading due to…
* Increase number of WBC and RBC in urine
* Bladder mucosa irritated by pancreatic enzymes
* Obtain C & S if UTI is suspected
150
Liver transplant recipients are at high risk for the following infections:
* Nosocomial gram-negative, candida (75% of all fungal)
* CMV, EBV, pneumocystis, aspergillus (20% of all fungal)
* Similar to infections in general population
* High risk for fungal infections
151
The highest risk for CMV for Liver recipients is for…
CMV seronegative recipient who receives allograft from CMV positive donor
152
The highest risk for Viruses for Liver recipients includes…
* Herpes Simplex Viruses
* EBV
153
The likelihood of a recurrence of original Hep B without treatment for liver recipients is…
60-90% within 5 years
154
The likelihood of a recurrence of original Hep C without treatment for liver recipients is…
100% within 2 years post-transplant
155
Prevention of recurrent Hep B in liver recipients includes…
* Lamivudine prior to transplant
* Post-transplant:
* Hepatitis B immunoglobulin (HBIG)
* Lamivudine (life-long)
156
Prevention of recurrent Hep C in liver recipients includes…
* Pre-transplant: Interferon and ribavarin
* Post-transplant: Interferon and ribavarin
* Response rate is low
157
Intestinal transplant recipients are most susceptible to…
bacterial translocution
158
Prevention of bacterial translocation in intestinal recipients includes…
* Enteral administration ( up to 2 weeks post transplant) of:
* Tobramycin
* Colistimethate
* Amphotericin B
* IV antibiotics if cultures show \> 10 organisms in the presence of sepsis or rejection
* If patient is febrile and doesn’t have source of infection, do endoscopy with tissue biopsy
* Spontaneous bacterial peritonitis
159
Due to the high (65%) cases of intestinal recipients contracting CMV, no seropositive grafts…
into CMV negative recipients
160
Intestinal transplant recipients are at high risk for EBV due to…
high levels of immunosuppression required due to large amounts of lymphoid tissue in graft
161
Intestinal recipients have the highest (20%) rate of PTLD of SOT recipients due to…
* Intestinal graft most commonly affected
* Native residual GI tract may also be affected
* More common in pediatric multivisceral grafts than isolated intestine transplants
162
PTLD treatment for intestinal recipients includes…
* Decrease immunosuppression up to 50%
* Monitor for rejection
* Adjunctive therapy
* Ganciclovir, Acyclovir
* Interferon
* Chemotherapy, Rituximab
* Major cause of death
* Mortality rate up to 50%
