Introduction

Over the past two decades, significant advances were made in the management of infections occurring after transplantation. Even so, infection remains a leading complication of organ transplantation, and the prevention and management of such infections are an important element of care in transplant recipients. Infections are associated with allograft rejection, and therefore, a key to a successful transplantation is the prevention, diagnosis, and treatment of infectious complications.

In this chapter, the most important infectious disease issues that affect different organ-transplant populations are reviewed, including the prophylaxis of infection after transplantation (Table 16.1).

Pretransplantation Infectious Diseases Evaluation

Prevention is, above all, the most important approach to infection in transplant recipients. This begins with a rigorous evaluation to identify previous infections and potential active infectious processes in all candidates before transplantation.

A complete history and physical examination is performed during the pretransplantation screening evaluation. Information regarding past infections is sought, such as childhood illnesses (chickenpox, rubella, measles, and infectious mononucleosis), recurrent sino-pulmonary infections, viral hepatitis, and sexually transmitted diseases. Allergies to antimicrobial agents are documented. Past immunization records are reviewed, and immunizations are administered or updated, if necessary. These vaccines include the inactivated polio, tetanus-diphtheria, influenza, pneumococcal, varicella (if nonimmune), hepatitis B, and hepatitis A (if nonimmune), Haemophilus influenzae type B (pediatric patients), and measles-mumps-rubella (pediatric patients). Dietary habits are obtained, including drinking water source and consumption of raw or undercooked meat, unpas-teurized milk products, and seafood.

Epidemiological exposures are identified through social, sexual, recreational, occupational, and pet and wild animal exposure histories. Certain workplace settings, such as healthcare facilities, prisons, and homeless shelters, increase the risk for exposure to infectious agents, especially tuberculosis. Residence or travel exposure to certain agents can identify candidates that are at risk for reactivation of infection after transplantation. Examples of these pathogens include: Histoplasma capsulatum (Ohio and Mississippi river valleys), Coccidiodes immitis (Southwest-

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