Infectious Disease Compendium

Bone Marrow Transplant Infections

Diagnosis

A wide variety of infections can get the transplant infection. Infection depends on whether it is early or late after the transplant and what the immunosuppression is (prednisone/cyclosporine worse than other immunosuppression regimens). From a practical point of view, they all act like AIDS patients with CD4 <200.

Epidemiology

I am going to go out on a limb here and suggest getting a bone marrow transplant. Some infections come in the transplanted organ, some reactivate as a result of immunosuppression in the patient and some are newly acquired .

Microbiology

- Graft vrs Host disease: can mimic infection.

- Wound infection: usual suspects (streptococcal and S. aureus) but any organism can infect these patients. - Pneumocystis: especially early, with prednisone. Often will manifest as the prednisone is being weaned off. These days most patients are on prophylactic trimethoprim/sulfamethoxazole.

- Cytomegalovirus: can be severe and when causes pneumonia, leads to death. Prophylaxis is part of the care.

- Toxoplasma: esp in the heart and bone marrow transplants patients. Can reactivate in the transplanted heart.

- PML: due to the JC virus, it is a white matter brain melt down.

- Cryptococcus neoformans: meningitis, it may start as a pneumonia.

- Listeria monocytogenes: usually a meningitis but can present as a febrile non focal illness.

- Moulds: Aspergillus and Mucormycosis lead the list, lung and brain are the most commonly involved organs.

- Post Transplant Lymphoproliferative Disease: Epstein Barr virus caused pseudo-lymphoma, presents with fever and rapidly growing lymph nodes.

- Reactivation local disease and/or dissemination of Tuberculosis, Herpes simplex, Herpes Zoster, Coccidioides immitis, Histoplasma, Penicillium, and Strongyloides stercalis depending on past exposure history.

Empiric Therapy

Except for sepsis, get the diagnostic tests done before you start empiric therapy. Be invasive if you have to; best outcomes are probably with earlier, rather than later, therapy.

Pearls

Rants

Children, do not try this at home, let a professional help you.