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BONE MARROW TRANSPLANT INFECTIONS: 1st month of bone marrow transplant LEVOFLOXACIN: decreases bacteremia maong bone marrow transplant px 1st few days: common org: aerobic( E coli, klebsiella, Pseudomonas and thru skin or catheter ( Staph coag -/+) beyond 1st few days; Filamentous bacteria ( Nocardia/ Actininomyctes) Late posttransplant: encapsualted org (>6 months after BM reconstitution) beyond 1st week: fungal (candida) TMP-SMX- prophylactic for Pneumocystis; 1 month after engrafment and continiung for at least 1 year - prophylactic also for Toxoplasma, Listeria, Nocardia, Strep and haemophilus ACYCLOVIR: prophylactic for seropositve BMT/SCT; reduce mucositis and prevent HSV pneumonia : 2 wks after BMT excretion of virus of seropositve HSV 1 _ also good for Varicella- Zoster virus (low dose for the entire year) CMV: 30- 90 days after transplant: great concern on the 2nd month -assoc w/ used of alpha CD52 antibody among GVHD px -Ganciclovir- delay the devt of normal immune rsponse to CMV, not really protective - IVIg and Ganciclovir: tx for CMV pneumonia HHV-6 / Roseola- 2-4 wks after surgery: ? foscarnet EBV- fatal to transplant recepients of tx of tx
-lymphopriliferative disease (LPD) - 13 months after engrfment - tx: ? EBV specific T cells; Rituximab , ganciclovir; zidovudine HHV -8 - Kaposi' s Sarcoma, primary effusion sarcoma, castle man RSV and Parainfluena- fatal pneumonia on BMT - tx: aerosolized Ribavirirn, RSV Ig ,Palivizumab Influenza- Oseltamivir and Zanamivir Rotavirus- gastoenteritis Polyomavirus BK- hemorrhagic cystitis B. SOLID ORGAN TRANSPLANT Early period( <1 month)- extracellular ( Staph, strep, e coli,) - origin : surgical wound or anostomotic sites CMV- 1st 6 months; sever systemic disease HHV 6 reactivation- w/in 1st 2 to 4 wks; fever and granulocytopenia CMV rejection related syndromes: - glomerulopathy- kidney -bronchilitis obliterans- lung transplant -vanishing bile duct syndrome- liver transplant Beyond 6 months: defects on CMI ( listeria , nocardia, fungi other intracellular org) EBV_LPD- 2 months to many years after transplant; heart and lung transplants 1) KIDNEY TRANSPLANTS -Early: due ti skin and wound infections; Tx: Cephalosporins -UTI- due to anatomical alterations from surgery (pyelonephritis)-longer duration appear after 6 mos: shorter duration
-Prophylaxis: TMP-SMX -Middle period- lung infections w/ Tcelldef( ICbacteria, nocardia, fungi, virus, parasite) -Legionella pnuemophilia- high mortality - CMV- 1 to 4 months -fever, glomerulopathy; tx: administer Ig w/ antibodies w/ CMV -EBV reactivation- extranodal prolif of B cells; invade CNS, nasopharynx, liver, small bowel heart and transplanted kidney -PAPOVAVIRUS:BK-nepropathy; JC virus- progressive multifocal leukoencephalopathy - L. monocytogenes- most common cause of bacteremia >= 1 month after renal transplantation -NOCARDIA- skin, bones, lungs and CNS, multiple abscess -Late infection (>6 months) - CMV retinitis, transplant ebow?, invasive fungal 2) HEART TRANSPLANTS -early: sternal wound infxn and mediastinitis -dx: sternal instability and failure to heal -middle: toxoplasmosis, CMV ,CNS infxn - late: EBV-lymphoma like 3) LUNG TRANSPLANTS -eearly: ischemia and mucosal damage, denervtion and lack of lymph drainage - prophylactic broad spectrum 1st 3 to 4 days antibiotics 4) LIVER TRANSPLANTS - infection on early; systemic broad spectrum antibiotic for the 1st 5 days risk
- operation >12 hrs - inc incidence of infection -PERITONITIS and Intraabdominal Abscess- Common complication -Peritonitis- from biliary leak and primary or 2ndary infx,polymicrobil -Abscess- w/in 1st month, spleen, liver, pericolic and pelvis,Tx: antibiotic and drainage -middle: Cholangitis- devt postsurgical stricture on biliary- fever abdominla paina nd jaundice -Viral hepatitis- lamiduvine and adefovir for hepa B 5) Pancreas -infection prevented by draining pancreas to urinary tract or bladder INdwelling cathter- S. aureus- bloodstream infxn w/in a week Tuberculosis- w/in 12 months VACCINATION: For autologous and allogenic BMT recepients(1 year and 2 years after) 1) pneumococcal -repeated every 5 years for px on immunosuppresants -every 3 years w/ significant exposure 2) H. Influenza type b conjugate vaccines Add: (12-14and 16 months after) 3) N. meningitides polysaccharide disease 4) diphtheia vaccines 5) tetanus vaccine 6) inactivated polio vaccine OTHERS: 7) Live virus MMR- BMT recepients 24 mos after transplant