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IOS 11 Exam 3
Infections in solid organ transplants
| Question | Answer |
|---|---|
| Majority of transplant are for | Renal due to living donor, and huge list |
| Cause of renal transplant | DM and CHD |
| Risks for infection in solid organ transplant | Immunosuppressants, seropositivity of the donor:recepient, disruption of physical barrier (UTI, cathater) |
| Prevention of infection in solid organ transplant | Immunization 3-6 months after surgery, (pneumococcal every 3-5 years) |
| Solid organ transplant should have Prophylaxis against | CMV, HSV, fungal infections when warranted |
| Risk of infection is based upon | Type of transplant(complexity =increase risk), and location =presentation of infection-Renal=CMV |
| FIrst month after transplantation | Most patient present with infections they had or donor had-HBV, TB, HSV |
| Months 1-6 after transplantation | Opportunisitic infections occur such as CMV, HSV, Varicella zoster, EBV,polyoma virus (JC & BK) |
| >6 months after transplant | Chronic viral infections-CMV retinitis, HBV, post-transplant lymphoproliferative disease due to EBV (children) |
| Life threatening infections are | Cryptococcus neoformans, listeria, nocardia |
| CMV primary infection in organ transplant | Has the highest risk associated with acute rejection |
| CMV- Seconary infection s/s | Direct-neutropenia, thrombocytopenia, inflammatory response. Indirect-injury to organ and rejection |
| Prophylaxis of CMV | CMV (+) donar and negaitve recipient or patient receiving OKT3 or ATG (thymogloblin) Give Valgancyclovir |
| Treatment of CMV | Valgancyclovir |
| Polyoma Virus(JC & BK) clinical presentation | Simular to acute renal rejection with increase in Scr-90% of population has this virus |
| Risks for polyoma (BK &JC) | Immunosuppressive therapy (mycophenolate mofitil), age, BK (+) donor and (-) recipient, CMV |
| How to monitor/diagnosis polymoa BK & JC | Monitor DNA-PCR and renal biopsy is the only method to Dx |
| Treatment of Polymoa BK & JC | Decrease the dose of mycophenolate mofitil, tarolimus, or cyclosporine and possibley give IVID (bind virus), levofloxavin, leucovorin, cidofovir, leflumodie |
| PCP Prophylaxis | Bactrium 6-12 months or pentamine or Dapsone |
| HCV primary prophylaxis | 50% will redevelop by 1 year and 10% will die or lose liver |
| HCV risks | Increased donor age, steroid use, viral genotype 1b, high transplant viral load |
| Treatment of HCV in organ transplant | Decrease immunosuppressant, INF 2b +ribavirin (40-100% increase in rejection) |
| Post transplant lymphoproliferative disorder-PTLD | Generally a B-cell lymphoma seen in children (EBV) |
| Risks for post transplant lymphoproliferative disorder | EBV, CMV, overimmunosuppression (antilymphocyte therapy) |
| Treatment for Post transplant lymphoproliferative disorder | Decrease immunosuppresant (mycophenolyte mofitil) +CHOP-cyclophosphamide, Doxirubin +prednisone +vincristine (+rituximab if CD20+) |
| Candidiasis risk | IV line, broad spectrum antibiotic |
| Treatment of thrush | Nystatin or clotrimazole |
| Treatment of esophaeal candidiasis | Posaconazole 100mg BID then 13 days QD |
| Treatment of Hematogenous Candidiasis | Caspofungin 70mg load then 50mg QD or Ampothercin B |
| Aspergillosis treatment | Ampotercin B or Caspofungin 70mg load then 50mg most common in heart trasnplants |
| Histoplasmosis capsulatum characteristics | Found in the mississippi valley-Fluconazole |
| Blastomyces dermatitides | Found in the great lake area-FLuconazole |
| Coccidoides immitis Characteristics | Found in the southwest- Fluconazole |
Created by:
liza001
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