Infectious Disease Flashcards
The leading cause of death in SOT recipients is due to…
infection
What are the 3 exogenous sources of infection post transplant?
- the allograft itself
- blood transfusions
- environment (hospital, community)
Endogenous sources of post-transplant infection include…
reactivation of latent infections
What are the possible donor derived infections?
8 items
- CMV
- HIV
- EBV
- Fungal
- Toxoplasma
- Hepatitis
- Syphilis
- PPD (Tuberculosis)
What does a blood PCR test for?
active infection
What does a postive serum IgM result indicate?
a recent exposure, not active infection
What does a positive serum IgG result indicate?
- A non-recent exposure
- not an active infection
- has antibody/immunity
What are the common bacterial pathogens post transplant?
4 items
- staph
- c. diff
- salmonella
- pseudomonas
What are the common viral pathogens post transplant?
5 items
- Flu
- Herpes
- EBV
- Varicella
- CMV
What are the common fungal pathogens post transplant?
4 items
- candida
- aspergillus
- PCP
- histoplasma
What are the common parisitic pathogens post transplant?
2 items
- toxoplasma
- cryptosporidium
What 2 signs are the most reliable indicator of CNS infection?
unexplained fever + headache
CNS syndromes include…
4 items
- acute meningitis
- chronic/subacute meningitis
- focal brain syndrome
- progressive dementia
What are the 3 most common CNS pathogens?
- listeria monocytogenes
- cryptococcus neoformans
- aspergillus fumigatus
What is the name of the serological testing for active viral infections?
PCR
CMV of the liver causes…
vanishing bile duct syndrome
CMV of the heart causes…
coronary artery vasculopathy
CMV of the lungs causes…
bronchiolitis obliterans
CMV of the kidney causes…
glomerulopathy
What is a superinfection?
a recipient is infected with a new exogenous strain
CMV risk is HIGH when the serology is…
Donor +
Recipient -
CMV risk is MODERATE when the serology is…
- Donor +, Recipient -
- Donor -, Recipient +
CMV risk is LOW when the serology is…
Donor -, Recipient -
CMV syndrome can include what signs/symptoms?
7 items
- fever
- fatigue
- malaise
- leukopenia
- myalgia
- thrombocytopenia
- Elevated LFTs
What is the 1st choice preference for CMV prevention?
Valganciclovir
Other options include ganciclovir, acyclovir, valacyclovir
CMV preemptive therapy is given when for heart transplant patients? What is given?
During ATG for rejection, IV ganciclovir
What medication is given for CMV treatment?
IV ganciclovir followed by oral valgan
With what conditions would oral valgan not be given?
3 items
- severe disease
- GI disease
- fluctuating renal function
What medication is given in place of ganciclovir for resistant organisms or for patients intolerant of gancivlovir?
Foscarnet
What is the incidence of EBV in transplant recipients on ATG therapy?
80%
What are the clinical manifestations of EBV?
6 items
- Lymph node hyperplasia
- splenomegaly
- fever
- pharyngitis
- Abnormal LFTs
- Atypical mononuclear leukocytes
When does PTLD most commonly occur?
Between 8-18 months post transplant
What are the risk factors for PTLD?
3 items
- Primary EBV infection
- Preceding CMV infection
- Immunosuppressants
What signs/symptoms could you see in PTLD?
10 items
- mono-like syndrome
- weight loss, anorexia
- fever of unknown origin
- abdominal pain
- jaundice
- GI bleeding
- renal and hepatic dysfunction
- pneumothorax/pulmonary infilitrates
- CNS changes
- allograft involvement
What is the way to confirm PTLD?
tissue biopsy
absence of adenopathy does not rule out PTLD
What is used to treat EBV?
acyclovir
What are the treatment options for PTLD: Early Malignant Polyclonal Polymorphic B-cell Lymphoma?
3 items
- ganciclovir
- Gammaglobulin Anti-B cell antibodies
- decrease immunosuppression
What are the treatment options for PTLD: Monoclonal Polymorphic B-cell Lymphoma?
- chemo
- radiation
- resection
- decrease immunosuppression
What is the treatment for VZV?
- Varicella zoster hyperimmunoglobulin within 72 hours of exposure
- IV acyclovir for lesions crusted over
What are 2 antibiotics used to treat C. Diff?
- flagyl
- oral vancomycin
Where in the body does the bacterial infection, Nocardia, affect?
3 items
- brain (CNS effects)
- lungs (pneumonia)
- skin (most common) (cellulitis)
Where is Nocardia found in the environment?
3 items
- soil
- organic matter
- water
How is Nocardia diagnosed?
3 items
- Alveolar infiltrate
- cavitation on xray
- sputum culture
What is the treatment for Nocardia?
Sulfas (ceftriaxone)
What is the incidence of HCV in SOT recipients?
10-20%
What is the incidence of HBV in SOT recipients?
about 50%
What 2 liver effects can HBV lead to?
- carcinoma
- cirrhosis
What is the treatment for HBV?
- HBV immune globulin
- Entevavir, tenofovir, lamivudine, adefovir, interferon
Hep B Core Ab + means what?
Exposure to the actual disease
Hep B Surface Ab + means what?
you had the vaccination and are protected
Hep B Surface Ag + means what?
the disease is active
What is the treatment for HCV?
- ribavin
- ledipasvir (sofosbuvir)
What are the 2 strains of polyomavirus that can cause disease in humans?
BK and JC
What percent of adults worldwide test positive for serologic infection of polyomavirus?
80%
Childhood infections of BK/JC is caused in what ways?
2 items
- via the respiratory tract
- contaminated food/water
Where does BK/JC tend to reside in the body?
4 items
- kidney
- ureter
- brain
- spleen
BK/JC is a(n) ___ infection and may cause ___
a. latent, reactivation
b. super, antibiotic resistance
c. fungal, organ rejection
d. viral, jaundice
a
What does BK virus typically cause?
4 items
- uretral ulceration
- ureteral stenosis
- graft rejection/loss
- tubulo-interstitial nephritis
What body part does the JC virus typically affect?
brain
What increases the risk of contracting BK?
3 items
- Recipient -, donor + organs
- prolonged ischemia times
- Use of tacro and MMF
When does BK reactivation typically occur?
1st three months post transplant
When does late BK reactivation typically occur
1-2 years post transplant
JC clinic manifestations typically involve…
CNS changes
JC virus typically results in what within 2-6 months of onset of symptoms?
death
How is JC diagnosed?
2 items
- tissue sample
- JCV DNA in CSF
What is the treatment for JC and BK?
- no specific antiviral treatment
- reduction in immunosuppression
What fungus is typically found only in the eastern US?
histoplasmosis and
blastomycosis
What fungus is typically found only in Arizona (west and southwest)
coccidioidmycosis
What are the 3 most common opportunistic fungal infections?
- candida
- cryptococci
- aspergillus
How are fungal infections treated?
- fluconazole
- voriconazole
- micafungin
- amphotericin B
- nystatin
What are the 3 major parasitic infections?
- cryptosporidium
- strongyloidosis
- toxoplasma gondii
How is cryptosporidum transmitted?
- fecal-oral
- animal-person
- contaminated water
How is cryptosporidium treated?
spiramycin
How is strongyloidosis transmitted?
- larvae penetrates skin (contaminated soil, ingestion, fecal-oral route)
What is the mortality rate of strongyloidosis?
80% (difficult to diagnose)
How is strongyloidosis treated?
3 items
- albendazole
- ivermectin
- antibacterial agents (for concomitant disease)
Which parasitic infection is common to the heart and lungs?
toxoplasmosis
How is toxoplasmosis diagnosed?
biopsy
What is the treatment for toxoplasmosis?
3 items
- Pyrimethamine + folinic acid
- Sulfadiazone + Pyrimethamine + folinic acid
- Clindamycin + Pyrimethamine + folinic acid
The presence of which organisms in a positive blood culture are unlikely to indicate to bacteremia?
3 items
- cornybacterium
- non-anthracis bacillus
- propionibacterium acnes
The presence of which organism in a blood culture should be assumed to indicate true bacteremia unless proven otherwise?
coagulase-negative staphylococci
The presence of which organisms in a blood culture are likely to indicate true bacteremia?
5 items
- staph aureus
- staph pneumoniae
- enterobacteriaceae
- p. aeruginos
- c. albicans
The disruption of which nerve causes heart or heart/lung recipients to be at greater risk for pneumonia?
phrenic
What viral pathogens are most concerning to heart or heart/lung recipients?
4 items
- CMV
- EBV
- HSV 1 and 2
- VZV
What bacterial pathogens are most concerning to heart or heart/lung recipients?
4 items
- listeria monocytogenes
- nocardia asteroides
- legionella pneumonphila
- typical or atypical mycobacteria
What is the likelihood of recurrence of Hep B without treatment for liver recipients?
60-90% within 5 years
What is the likelihood of recurrence of Hep C without treatment for liver recipients?
100% within 2 years
What is given to prevent recurrent Hep B in liver recipients?
lamivudine
What is bacterial translocation in intestinal recipients?
Movement of bacteria from GI tract to other parts of body?
What is gven to prevent bacterial translocation in intestinal recipients?
4 items
- tobramycin
- colistimethate
- amphotericin B
- IV antibiotics
What transplant patients have the highest rate of PTLD? Why?
intestine, high levels of immunosuppression required d/t large amounts of lymphoid tissue in graft
What is the most common site of CMV infection for heart transplant patients?
GI tract
