Opportunistic Infections in Transplant Patients – McCarthy

Our case:  2015 renal transplant, nocardia diagnosed shortly after immunosuppressive therapy, possible hx of CMV.

Common infections:  URI and UTI – are still common in the immunosuppressed.  Common things are common.

Opportunistic infections:

  • Viral:  CMV, JC, HBV, HCV, VZV, EBV, HSV
  • Bacterial:  PCP, Listeria, Nocardia
  • Fungal:  Aspergillus, TB

Early Post-Transplantation:  Immediately post-op to 1 month

  • Typical 5Ws:  water, wound, wonder drugs, wind…
  • Opportunistic infections less common

1-6 Months Post-Transplantation: 1-6 mos

  • Peak incidence of opportunistic infections
  • Beware of CMV!  (increases bacterial and fungal infx risk)

Late Post-Transplant:  > 6 mos

  • Decreased rate of opportunistic infections
  • Chronic infections (e.g., CMV) in 10-15%

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