CHAPTER 117 INFECTIONS IN -lymphopriliferative disease (LPD) - 1-
TRANSPLANT RECEPIENTS 3 months after engrfment
A. BONE MARROW TRANSPLANT - tx: ? EBV specific T cells; Rituximab , INFECTIONS: 1st month of bone marrow ganciclovir; zidovudine transplant HHV -8 - Kaposi' s Sarcoma, primary effusion LEVOFLOXACIN: decreases bacteremia sarcoma, castle man maong bone marrow transplant px RSV and Parainfluena- fatal pneumonia on 1st few days: common org: aerobic( E coli, BMT klebsiella, Pseudomonas and thru skin or - tx: aerosolized Ribavirirn, RSV Ig catheter ( Staph coag -/+) ,Palivizumab beyond 1st few days; Filamentous bacteria Influenza- Oseltamivir and Zanamivir ( Nocardia/ Actininomyctes) Rotavirus- gastoenteritis Late posttransplant: encapsualted org (>6 Polyomavirus BK- hemorrhagic cystitis months after BM reconstitution) B. SOLID ORGAN TRANSPLANT beyond 1st week: fungal (candida) Early period( <1 month)- extracellular TMP-SMX- prophylactic for Pneumocystis; 1 ( Staph, strep, e coli,) month after engrafment and continiung for at - origin : surgical wound or least 1 year anostomotic sites - prophylactic also for Toxoplasma, CMV- 1st 6 months; sever systemic disease Listeria, Nocardia, Strep and haemophilus HHV 6 reactivation- w/in 1st 2 to 4 wks; fever ACYCLOVIR: prophylactic for seropositve and granulocytopenia BMT/SCT; reduce mucositis and prevent HSV CMV rejection related syndromes: pneumonia - glomerulopathy- kidney : 2 wks after BMT excretion of virus of -bronchilitis obliterans- lung seropositve HSV 1 transplant _ also good for Varicella- Zoster virus -vanishing bile duct syndrome- liver (low dose for the entire year) transplant CMV: 30- 90 days after transplant: great Beyond 6 months: defects on CMI ( listeria , concern on the 2nd month nocardia, fungi other intracellular org) -assoc w/ used of alpha CD52 EBV_LPD- 2 months to many years after antibody among GVHD px transplant; heart and lung transplants -Ganciclovir- delay the devt of normal 1) KIDNEY TRANSPLANTS immune rsponse to CMV, not really protective -Early: due ti skin and wound - IVIg and Ganciclovir: tx for CMV infections; Tx: Cephalosporins pneumonia -UTI- due to anatomical alterations HHV-6 / Roseola- 2-4 wks after surgery: ? from surgery (pyelonephritis)-longer duration foscarnet of tx EBV- fatal to transplant recepients appear after 6 mos: shorter duration of tx -Prophylaxis: TMP-SMX - operation >12 hrs - inc incidence of -Middle period- lung infections w/ T- infection celldef( ICbacteria, nocardia, fungi, virus, -PERITONITIS and Intraabdominal parasite) Abscess- Common complication -Legionella pnuemophilia- high -Peritonitis- from biliary leak and mortality primary or 2ndary infx,polymicrobil - CMV- 1 to 4 months -fever, -Abscess- w/in 1st month, spleen, glomerulopathy; tx: administer Ig w/ liver, pericolic and pelvis,Tx: antibiotic and antibodies w/ CMV drainage -EBV reactivation- extranodal prolif of -middle: Cholangitis- devt postsurgical B cells; invade CNS, nasopharynx, liver, small stricture on biliary- fever abdominla paina nd bowel heart and transplanted kidney jaundice -PAPOVAVIRUS:BK-nepropathy; JC -Viral hepatitis- lamiduvine and virus- progressive multifocal adefovir for hepa B leukoencephalopathy 5) Pancreas - L. monocytogenes- most common -infection prevented by draining cause of bacteremia >= 1 month after renal pancreas to urinary tract or bladder transplantation INdwelling cathter- S. aureus- bloodstream -NOCARDIA- skin, bones, lungs and infxn w/in a week CNS, multiple abscess Tuberculosis- w/in 12 months -Late infection (>6 months) - CMV VACCINATION: retinitis, transplant ebow?, invasive fungal For autologous and allogenic BMT recepients- 2) HEART TRANSPLANTS (1 year and 2 years after) -early: sternal wound infxn and 1) pneumococcal mediastinitis -repeated every 5 years for px on -dx: sternal instability and failure to immunosuppresants heal -every 3 years w/ significant exposure -middle: toxoplasmosis, CMV ,CNS risk infxn 2) H. Influenza type b conjugate vaccines - late: EBV-lymphoma like Add: (12-14and 16 months after) 3) LUNG TRANSPLANTS 3) N. meningitides polysaccharide disease -eearly: ischemia and mucosal 4) diphtheia vaccines damage, denervtion and lack of lymph 5) tetanus vaccine drainage 6) inactivated polio vaccine - prophylactic broad spectrum 1st 3 OTHERS: to 4 days antibiotics 7) Live virus MMR- BMT recepients 24 mos 4) LIVER TRANSPLANTS after transplant - infection on early; systemic broad spectrum antibiotic for the 1st 5 days
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