Flashcards in Infection Prophylaxis/Tx in Transplant Patients Deck (50)
What puts a patient at risk for CMV?
What is the risk category for +/-
What is the risk for +/+ or -/+ ?
What is the risk for -/-
What is the clinical presentation of CMV?
non-specific febrile syndrome- fever, low WBC, abdominal pain, nausea, vomiting, diarrhea, arthralgia
Tissue invasive infection- hepatitis, pneumonitis, enteritis
What are the prophylactic treatments for CMV?
Duration dependent on risk- usually 3-6 months
What is the treatment of CMV?
valganciclovir/ganciclovir at higher doses
CMV IVIg- Cytogam
treat for 2 weeks min, until serology undetectable/symptoms resolved
What are some side effects of CMV tx?
needs to be renally adjusted
Bone marrow supression
What puts a patient at risk for pneumocystis pneumonia?
Immunosuppression- transplant, chemo, HIV, chronic steroid therapy, neutropenia
What is the clinical presentation of pneumocystis pneumonia?
Fever, cough, dyspne, hypoxemia, abnormal chest X-ray
What are the agents for the prophylactic treatment of pneumocystis pneumonia?
Sulfa/trimethoprim - Bactrim/Spetra
Pentamidine (if sulfa allergy)
Atovaquone (if sulfa allergy)
What are the drugs for the treatment of pneumocystis pneumonia?
Same meds as prophylaxis just higher doses
What are the risks for the herpes simplex virus?
What is the clinical presentation of herpes?
orolabial, genital or perianal local warts
cutaneous, esophagitis, hepatitis, pneumonia
How is HSV detected?
PCR to check for herpese DNA
What are the agents for the prophylaxis of herpes?
ganciclovir, valganciclovir, acyclovir
Continue for a month post transplant
What drugs are used in the treatment of herpes?
Acyclovir IV or acyclovir, famcyclovir or valacyclovir PO
Doses need to be adjusted for renal insufficiency
Continue treatment till lesions are gone
What puts a patient at risk for candida?
type of transplant, acute renal failure
How does candida present clinically?
candidemia, UTIs, pulmonary
what are the agents used for the prophylaxis of candida?
Prophylaxis is controversial
can be universal or targeted
Antifungals at least 14 days post transplantation
Fluconazole, amphotericin B
What agents are used in the treatment of candida?
What viral infection does not have a prophylactic treatment?
What is the BK virus?
a childhood infection that is asymptomatic/dormant in genitourinary tract. Can cause nephrotoxicity in kidney transplant patients
How do you diagnose BK?
routine screening, detection by urine or blood OCR
Biopsy for neuropathy
How do we treat BK virus?
add leflunomide (Arava)
Add Iv Ig
What vaccinations should be given pre-transplant?
Complete vaccination series and boosters before transplant
Live and inactivated vaccines safe
When can patients receive vaccines after transplant?
inactivated vaccines safe, avoid live
can give 3-6 months after transplant
Which vaccines cannot be given to a transplant patient?
What are metabolic complications post transplant?