The AST Handbook of Transplant Infections

Deepali Kumar, Atul Humar

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781444397932
• Edition: 1
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

Whether you need to manage a post-transplant infection or reduce the possibility of infection, you will find effective guidance in this handbook. The work of the American Society of Transplantation Infectious Diseases Community of Practice, this reference exclusively uses tables and flowcharts to speed up decision making.

This distinguished group of investigators and teachers provide point of care information on optimum management of infection in adult and pediatric organ and stem cell transplant patients. The unique tables and flowcharts are devised by the authors, backed up with extensive references, making the book a fully researched yet easy to use guide.

The fast growing specialty of transplantation will be well served by this book as increasing numbers of successful procedures mean transplant teams have to be ever more alert to the possibility of and need for action in the event of ensuing infection.

PART I

General Issues and Infectious Syndromes

Chapter 1

Timeline of Infections After Organ Transplant

Christian van Delden

Chapter 2

Timeline of Infections After Hematopoietic Stem Cell Transplant

Sarah P. Hammond & Francisco M. Marty

Chapter 3

Immune Reconstitution After Myeloablative Stem Cell Transplant

Sarah P. Hammond & Francisco M. Marty

Chapter 4

Pre-transplant Infectious Disease Evaluation of the Organ Transplant Candidate

Staci A. Fischer

Routine screening	Optional testing (if clinically indicated only)	Organ-specific considerations
CMV antibody EBV antibody HIV antibody Hepatitis C antibody Hepatitis B surface antigen and antibody; hepatitis B core antibody Rapid plasma reagin PPD or interferon-release assay for latent tuberculosis Toxoplasma antibody (in heart transplant candidates) Recipients should be screened for protective antibody to vaccine-preventable viral infections, particularly varicella, measles and mumps. Those without IgG antibody should be vaccinated pre-transplant if not already on immunosuppressive therapy A thorough history should be completed to identify potential exposures to infections with a latent or chronic phase which could reactivate on immunosuppressive therapy. Such infections include Mycobacterium tuberculosis, endemic fungi such as Coccidioides, and Strongyloides (see ‘Optional testing’ column) Should an infection be identified in the screening of the potential organ transplant recipient, consultation with an infectious disease specialist may be indicated to guide pre-transplant treatment, timing of transplantation when delay is possible, and/or post-transplant monitoring	HSV antibody HTLV-I/II antibody Toxoplasma antibody (in non-heart transplant candidates) Trypanosoma cruzi antibody in recipients from endemic areas (e.g. Mexico, Central America, South America) Coccidioides antibody in recipients from endemic areas (e.g. south-western USA, Mexico, Central America, South America) Histoplasma antibody in recipients from endemic areas (e.g. Ohio and Mississippi river valleys in the USA, other river valleys in North and Central America, Eastern and Southern Europe, Africa and Australia) Strongyloides antibody in recipients from endemic areas (e.g. Appalachian USA, Central America, South America, sub-Saharan Africa, South-east Asia, Eastern Europe) Brucella serology in recipients from endemic areas (e.g. Middle East, Mediterranean basin, eastern Europe, Asia, Africa, Central and South America). Ingestion of unpasteurized milk or chesses from endemic areas is a risk factor for infection West Nile Virus serology Human herpes virus-8 (HHV-8) serology BK virus serology (kidney transplantation)	Patients with end-stage organ disease are susceptible to certain infections which should be diagnosed and treated prior to transplantation if at all possible. Specific considerations include the following: Kidney – hemodialysis catheter-related bloodstream infections, peritonitis in peritoneal dialysis patients, hepatitis B, hepatitis C, complicated UTIs Pancreas – wounds and osteomyelitis related to diabetic neuropathy Heart – infection of ventricular assist devices (localized drive line infections or bloodstream infections mimicking endocarditis) should be aggressively treated but do not preclude transplantation. Chagas disease (trypanosomiasis) should be ruled out in the patient from an endemic area with dilated cardiomyopathy. Toxoplasmosis is a particular concern in cardiac transplantation, in which donor transmission can occur in the seronegative recipient of a seropositive heart, resulting in acute myocarditis or disseminated infection Liver – hepatitis B, hepatitis C, cholangitis, spontaneous bacterial peritonitis, intravenous catheter-related infections, including candidemia Lung – sputum cultures to determine colonizing bacteria, mycobacteria and fungi should guide perioperative antimicrobial choices

CMV, cytomegalovirus; EBV, Epstein–Barr virus; HSV, herpes simplex virus; HTLV, human T-cell lymphotrophic virus; IgG, immunoglobulin G; PPD, purified protein derivative; UTI, urinary tract infection.

References: [1] Am J Transplantation 2009; 9(s4): S7 (updated guidelines on screening donors and recipients); [2] Clin Infect Dis 2002; 35: 1513 (detailed discussion of screening of recipients prior to transplantation); [3] Clin Infect Dis 1997; 24: 18; [4] www.cdc.gov/travel/yellowbook/2010 (updated information on travel-related infections with details on areas of endemicity for the pathogens noted above).

Chapter 5

Pre-transplant Infectious Disease Evaluation of the Hematopoietic Stem Cell Transplant Candidate

Staci A. Fischer

Routine screening of all recipients	Optional testing (if clinically indicated only)	Comments
CMV EBV antibody HIV antibody, NAT Hepatitis C antibody, NAT Hepatitis B surface antigen and antibody; hepatitis B core antibody HSV-1 and 2 antibody Rapid plasma reagin Varicella zoster virus IgG PPD testing (the role of interferon-release assays for detection of latent tuberculosis in the potential HSCT recipient is currently unclear)	Hepatitis B NAT HTLV-I/II antibodies West Nile virus NAT Toxoplasma IgG antibody Trypanosoma cruzi antibody in donors from endemic areas (e.g. Mexico, Central America, South America) Strongyloides antibody in recipients from endemic areas (e.g., Appalachian USA, Central America, South America, sub-Saharan Africa, South-east Asia, eastern Europe) Coccidioides antibody in recipients from endemic areas (e.g. south-western USA, Mexico, Central America, South America) Histoplasma antibody in recipients from endemic areas (e.g. Ohio and Mississippi river valleys in the USA, other river valleys in North and Central America, eastern and southern Europe, Africa and Australia) Brucella serology in recipients from endemic areas (e.g. Middle East, Mediterrane...

Table of contents

• Cover
• Contents
• Title
• Copyright
• List of Contributors
• Preface
• Acknowledgements
• Part I: General Issues and Infectious Syndromes
• Part II: Specific Pathogens
• Part III: Donor Issues
• Part IV: Prevention of Infections after Transplantation
• Part V: Post-transplant Medications and Drug Interactions
• Index