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    Pneumonia Infection in Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents - FIGURAS

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    Pneumonia Infection in Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents - FIGURAS

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    Jorge Alvarez
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    Pneumonia Infection In Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents - FIGURAS

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    49 views3 pages

    Pneumonia Infection in Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents - FIGURAS

    Uploaded by

    Jorge Alvarez
    o

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    21/9/2020 Pneumonia Infection In Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents

    Pneumonia Infection In Organ Transplant Recipients


    Authors: Nina Singh, M.D., Kevin M. Chan, M.D., Garth Garrison, M.D.

    Table of Contents
    Monograph Tables/Figures What's New Reviews History
    Collapse All | Expand All

    Epidemiology
    Figure 1. Temporal relationship between infectious etiology and time after transplantation.
    Etiologic Agents
    Diagnostic Techniques The risk for bacterial and fungal pneumonia is greatest in the first four weeks and decreases after three months, whereas the risk

    Approach to Diagnosis for CMV infection peaks after the discontinuation of antiviral prophylaxis in at-risk patients. Non-CMV viral infection is typically

    Conclusion community acquired and develops more than 6 months after surgery.

    References

    Figure 2. Suggested approach to suspected pneumonia in a solid organ transplant recipient.


    Focal radiographic consolidative changes in conjunction with findings suggestive of bacterial pneumonia lead to empiric antibiotic
    therapy. Patients presenting > 6 months after transplantation are treated for community acquired pneumonia with observation while
    those < 6 months post-procedure are treated for nosocomial infection. All patients in the latter category, lung transplant recipients,
    and those non-responsive to empiric therapy should have bronchoscopy performed. Patients with diffuse or nodular opacities
    should receive empiric treatment but bronchoscopy should be performed to obtain a diagnosis. In patients without a diagnosis after
    bronchoscopic evaluation, radiologic percutaneous biopsy or surgical lung biopsy should be considered.

    www.antimicrobe.org/t35.asp 1/3
    21/9/2020 Pneumonia Infection In Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents
    Table 1. Noninvasive testing for obtaining a microbiological diagnosis in solid organ
    transplant patients with pneumonia
    Sample Laboratory studies
    Serum Blood cultures
    CMV quantitative viral load by PCR
    Aspergillus galactomannen antigen
    Histoplasma, Cryptococcus, Blastomycosisantibody titer
    Histoplasma, Cryptococcus antigen

    Urine Pneumococcal antigen


    Legionella antigen
    Histoplasmaantigen

    Nasopharyngeal swab or Routine culture and Gram stain


    sputum
    Fungal culture and stain
    AFB culture and stain
    Viral antigen testing for RSV, parainfluenza, influenza,
    adenovirus

    Table 2. Radiographic signs associated with microbiological diagnoses


    Finding Suspected pathogen
    Focal consolidation Bacterial pathogens
    "Tree-in-bud opacity" Atypical pathogens including fungi and mycobacteria
    Ground glass opacity P. jiroveci, viral infections including CMV in at-risk patients
    Nodular opacity Fungi and mycobacteria
    "Halo sign" Aspergillus
    Pneumothorax P. jiroveci

    Table 3. Laboratory evaluation of bronchoalveolar lavage (BAL) samples

    Gram stain and quantitative culture

    Fungal evaluation (wet mount stain and culture)

    Essential studies Mycobacterial evaluation (AFB stain and culture)

    Viral detection and culture (CMV, HSV, Adenovirus, RSV,


    Parainfluenza virus)

    Gomori methamine silver stain or PCR for P. jiroveci

    Aspergillus galactomannan antigen

    Nocardia culture
    Optional studies
    Actinomyces culture

    Toxoplasmosis IFA/DFA

    www.antimicrobe.org/t35.asp 2/3
    21/9/2020 Pneumonia Infection In Organ Transplant Recipients - Infectious Disease and Antimicrobial Agents

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    www.antimicrobe.org/t35.asp 3/3

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