Transplant infections Flashcards
How does CMV differ between solid organ transplant recipients and stem cell transplant recipients?
- for solid organ transplants, more common in donor positive/recipient negative. For stem cell transplant, more common in donor negative/recipient positive.
- pneumonitis is more common in stem cell transplants
- G.I. involvement is typically esophagitis in stem cell transplant’s and colitis and solid organ transplants
When should you worry about PTLD?
In the middle or late. After transplant. Over one month. In a patient with lymphadenopathy, fever, or extra nodal mass
Which virus commonly occurs in pre-engraftment for stem cell transplant’s?
Herpes simplex virus. You need prophylaxis
What type of bacterial infections are common in the late phase of stem cell transplant‘s?
Encapsulated bacteria like strep pneumo
Which fungal infections are common after stem cell transplants?
Candida, Aspergillosis, Mucor
How may strongyloides present after a transplant?
Hyper infection syndrome (secondary pneumonia and GN bacteremia)
How long is Bactrim given after a transplant?
At least 1 year
To prevent PJP, listeria, toxo
What anti fungal should be give. Early after stem cell transplant?
Posaconazole or Voriconazole
How does CMV Prophylaxis differ between stem cell and solid organ transplant recipients?
SOT: You give valganciclovir for patients who are donor positive/recipient negative, those receiving lymphocyte depleting agents, and with all lung transplants for 3 to 6 months
HSCT: Perform monitoring and preemptive therapy rather than prophylaxis
Which vaccination is contraindicated after solid organ transplant?
MMR
Live VZV
Try to give all others BEFORE
Flu always safe
Which vaccinations need to be given after stem cell transplant?
6 months post: Pneumococcal, TDAP, H. influenzae, meningococcal, inactivated polio, hepatitis B
24 months post: MMR, live VZV (try to give >4 weeks before transplant if not immune)
