Recommended Vax
NO LIVE VACCINES POST TXP. Must wait 4 weeks before txp after live vax
Hep A
Hep B
influenza
Varicella- live
Tdap
MMR- live
HPV-9-26 years old
Pneumonia, prevnar
Shingles > 50
Meningococcal - if starting college
Exogenous Vs Endogenous
Exo:Allograft, blood transfusions, environment
Endo: reactivation of latent infection
PCR
Method of testing- CMV or COVID- active infection
IgM
In the moment- recent exposure, not active infection
IgG
Gone- exposure was not recent, not active infection
Elevated CRP
C reactive protein- elevated with infection, normal less than 10
CNS infections
Immunosuppression can mask memingeal irritation but LOC, even subtle is red flag. Fever + headache red flag
Viral infections
Direct effect: clinical syndromes - pneumonia, hepatitis
Indirect- injury to the actual graft or malignancy
CMV
Occurrence: 30-70%
Direct effects: tissue injury
Clinical disease
Allograft is more suseptable
CMV part 2
Liver: vanishing bile syndrome
Heart: coronary artery vasculopathy
Lung: brochiolitis obliterates
Kidney: glomerulopathy
CMV 3
Can precipitate rejection
CMV pt 5- acquiring
Primary: comes with allograft
Reactivation: latent disease
Superinfection: cmv + recipient is infected with new exogenous strain
CMV- greatest risk
CMV positive recipients that receive ATG
CMV negative recipients that receive CMV positive organ
CMV treatment
Check PCR-IV Ganciclovir and oral Valgan- dose for renal function
EBV
Occurrence: 20-30%
Clinical manifestations- lymph node and spleen enlargement, fever, LFT increase
PTLD- post transplant lymphoproliferative disease
Malignant lymphomas, risk factor is being infected with EBV.
- CT scan and then biopsy
PTLD
Acyclovir and REDUCE immunosuppresion
Varicella Zoster Virus
Chicken pox in kids
Shingles in adults
Treatment: varicella zoster hyperimmunoglobulin w/in 72 hours exposure
IV Acyclovir
C diff
Fever, increase WBC, pain
Diagnosis- stool sample
Treatment: flatly or vanco
Nocardia - bacterial
Gram + aerobic bacteria
Symptoms: pneumonia, brain (headache, lethargy), skin (cellulitis)
Diagnosis: acid fast stain
Treatment: sulfonamides, ceftriaxone
Legionella
Gram negative, causes legionnaires disease
Presents: Pneumonia, fever, chills
Diagnosis: sputum culture and cxray
Treatment: cipro, quinolones, rifampin
Hepatitis A
Spread via decal route
No treatment
rest and symptom management
Vax available
Hepatitis B
Can lead to HCC and cirrhosis
HBV imunnoglobulin, vir class drugs
Prevention: vax series
Hepatitis B part 2
-Hep B core AB+ is exposure to the actually disease
-Hep B surface AB + shows you have the vaccine and protective
-Hep B surface AG + is active disease and you cannot be a living donor
