tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 10)

Kidney transplant recipients are also subject to infections with other intracellular organisms. These patients may develop pulmonary infections with Nocardia, Aspergillus, and Mucor as well as infections with other pathogens in which the T cell/macrophage axis plays an important role. In patients without IV catheters, L. monocytogenes is a common cause of bacteremia ≥1 month after renal transplantation and should be seriously considered in renal transplant recipients presenting with fever and headache. Kidney transplant recipients may develop Salmonella bacteremia, which can lead to endovascular infections and require prolonged therapy. Pulmonary infections with Pneumocystis are common unless the patient is. | Chapter 126. Infections in Transplant Recipients Part 10 Kidney transplant recipients are also subject to infections with other intracellular organisms. These patients may develop pulmonary infections with Nocardia Aspergillus and Mucor as well as infections with other pathogens in which the T cell macrophage axis plays an important role. In patients without IV catheters L. monocytogenes is a common cause of bacteremia 1 month after renal transplantation and should be seriously considered in renal transplant recipients presenting with fever and headache. Kidney transplant recipients may develop Salmonella bacteremia which can lead to endovascular infections and require prolonged therapy. Pulmonary infections with Pneumocystis are common unless the patient is maintained on TMP-SMX prophylaxis. Nocardia infection Chap. 155 may present in the skin bones and lungs or in the CNS where it usually takes the form of single or multiple brain abscesses. Nocardiosis generally occurs 1 month after transplantation and may follow immunosuppressive treatment for an episode of rejection. Pulmonary findings are nonspecific localized disease with or without cavities is most common but the disease may disseminate. The diagnosis is made by culture of the organism from sputum or from the involved nodule. As with Pneumocystis prophylaxis with TMP-SMX is often efficacious in the prevention of disease. The occurrence of Nocardia infections 2 years after transplantation suggests that a long-term prophylactic regimen may be justified. Toxoplasmosis can occur in seropositive patients but is less common than in other transplant settings usually developing in the first few months after kidney transplantation. Again TMP-SMX is helpful in prevention. In endemic areas histoplasmosis coccidioidomycosis and blastomycosis may cause pulmonary infiltrates or disseminated disease. Late Infections Late infections 6 months after kidney transplantation may involve the CNS and include CMV retinitis as well