Infection Prophylaxis/Tx in Transplant Patients Flashcards Preview

Therapeutics Spring 2015 > Infection Prophylaxis/Tx in Transplant Patients > Flashcards

Flashcards in Infection Prophylaxis/Tx in Transplant Patients Deck (50)
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1

What puts a patient at risk for CMV?

Latent reactivation
Donor transmission

2

What is the risk category for +/-

Donor/recipient
Highest risk

3

What is the risk for +/+ or -/+ ?

medium risk

4

What is the risk for -/-

lowest risk

5

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
Graft injury

6

What are the prophylactic treatments for CMV?

Duration dependent on risk- usually 3-6 months
Valganciclovir
Ganciclovir
Acyclovir

7

What is the treatment of CMV?

valganciclovir/ganciclovir at higher doses
CMV IVIg- Cytogam
treat for 2 weeks min, until serology undetectable/symptoms resolved

8

What are some side effects of CMV tx?

needs to be renally adjusted
Bone marrow supression

9

What puts a patient at risk for pneumocystis pneumonia?

Immunosuppression- transplant, chemo, HIV, chronic steroid therapy, neutropenia

10

What is the clinical presentation of pneumocystis pneumonia?

Fever, cough, dyspne, hypoxemia, abnormal chest X-ray

11

What are the agents for the prophylactic treatment of pneumocystis pneumonia?

Sulfa/trimethoprim - Bactrim/Spetra
Dapsone
Pentamidine (if sulfa allergy)
Atovaquone (if sulfa allergy)

12

What are the drugs for the treatment of pneumocystis pneumonia?

Same meds as prophylaxis just higher doses

13

What are the risks for the herpes simplex virus?

Past serostatus
reactivation
new infection

14

What is the clinical presentation of herpes?

orolabial, genital or perianal local warts
cutaneous, esophagitis, hepatitis, pneumonia
fever, leukopenia

15

How is HSV detected?

PCR to check for herpese DNA

16

What are the agents for the prophylaxis of herpes?

ganciclovir, valganciclovir, acyclovir
Continue for a month post transplant

17

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

18

What puts a patient at risk for candida?

mucocutaneous infection
type of transplant, acute renal failure

19

How does candida present clinically?

candidemia, UTIs, pulmonary

20

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

21

What agents are used in the treatment of candida?

amphotericin B
fluconazole
itraconazole
voriconazole
fungins

22

What viral infection does not have a prophylactic treatment?

BK virus

23

What is the BK virus?

a childhood infection that is asymptomatic/dormant in genitourinary tract. Can cause nephrotoxicity in kidney transplant patients

24

How do you diagnose BK?

routine screening, detection by urine or blood OCR
Biopsy for neuropathy

25

How do we treat BK virus?

minimize immunosupression
add leflunomide (Arava)
add Cipro
Add Iv Ig

26

What vaccinations should be given pre-transplant?

Complete vaccination series and boosters before transplant
Live and inactivated vaccines safe
annual influenza/pneumococcal

27

When can patients receive vaccines after transplant?

inactivated vaccines safe, avoid live
can give 3-6 months after transplant

28

Which vaccines cannot be given to a transplant patient?

MMR
Varicella
Zostavax
Nasal Influenza
all live

29

What are metabolic complications post transplant?

hyperlipidemia

30

What causes hyperlipidemia in a transplant patient?

immunosupressives, diet, obesity, diabetes, age, meds