Because you are taking immunosuppressant medications, certain viruses or bacteria which are normally harmless can cause you to become sick. These are called "opportunistic infections." The types of infections include:
- Bacterial
- Viral
- Fungal
- Other (pneumocystis and tuberculosis)
Bacterial Infections
- Bacterial infections are the most common types of infections that can occur after transplant. Bacteria are found on the skin or in body cavities. Normally, these bacteria do not cause problems, but may lead to infections when you are taking immunosuppressant medications.
- Bacterial organisms include staph, strep, and pseudomonas, among others.
- Bacterial infections may occur at any site within the body including the blood, lungs, urinary system, and incisions. If a bacterial infection is suspected, you will need to come to the hospital for blood, urine, and sputum cultures.
- A culture involves taking a sample of your blood, urine, or sputum (phlegm). The sample is evaluated under a microscope 24, 48, and 72 hours after it is taken to detect evidence of any bacterial growth. If bacterial growth is found, it is identified and tested against the panel of antibiotics to determine which antibiotic is effective in killing that bacteria. You will start taking an antibiotic either by mouth or intravenously (IV), depending upon the severity of the infection.
- It is very important to finish all of the prescribed antibiotics, even if you are feeling better after a few days. If all of the antibiotics are not taken, some of the bacteria may not be killed, and will continue to multiply, causing another infection that may be resistant to the original antibiotic.
Viral Infections
- Viruses are the most common cause of infections in transplant patients after the first month. Viral infections include:
- CMV (cytomegalovirus)
- Herpes (simplex or zoster)
- Hepatitis
- During the pre-transplant screening, you were tested for previous exposure to CMV, herpes, hepatitis, and HIV (AIDS virus).
- Having active hepatitis or HIV would prevent you from being a candidate for transplant. Testing positive for previous exposure to hepatitis B or C would not prevent you from being considered for transplant if there is no liver damage present.
CMV (cytomegalovirus)
- CMV is a common infection following heart transplant, accounting for about 25 percent of all post-transplant infections. More than half of all Americans have had previous exposure to CMV, a benign illness, causing flu-like symptoms. If you or your donor had prior CMV exposure, you will be given a combination of intravenous gancyclovir and oral acyclovir for the first three months after transplant to prevent CMV infection from occurring.
- When you are taking immunosuppressant medications, CMV may cause a more serious illness resulting in hospitalization. Symptoms can range from feeling "lousy", fever, chills, diarrhea, abdominal pain, headache, cough, or flu-like symptoms. Call your doctor if any of these symptoms occur.
Herpes
- The herpes virus may affect as many as 40 percent of the transplant population. Once you have herpes, it lives in a dormant state in your body. Sometimes, it becomes active and most commonly presents itself as a cold sore or fever blister on your lips, esophagus, genital area or anus. If you have had a herpes sore in the past, you will most likely have one again, often in the same place.
- The herpes virus can also appear as "shingles." Shingles are painful blisters along the pathways of nerves on the surface of the skin. The most common sites are the chest, sides of abdomen, and face.
- Avoid anyone with active chicken-pox. It can cause a more severe infection in transplant recipients who were never exposed to the virus, or it may cause shingles in those who previously had chicken-pox.
- Herpes is not life-threatening, but it can be uncomfortable. To prevent a more serious infection, take your herpes medication (Acyclovir) at the first sign of a herpes sore. Acyclovir may be given intravenously, by mouth, or as a topical cream, depending upon the severity of the illness.
Hepatitis
- There are several types of hepatitis: Type A, Type B, and Type C.
- Hepatitis may be contracted through hepatitis-contaminated blood, body secretions, dirty needles, food, contaminated water, sexual intercourse or exchange of body secretions.
- Symptoms of hepatitis include:
- Jaundice (yellowing of the skin)
- Nausea
- Vomiting
- Abdominal pain
- Fever
- Weakness
- Fatigue (feeling over-tired)
- Treatment of hepatitis is difficult, and prevention is best.
- Some patients may receive a heart from a donor who tested positive for hepatitis B or C, but who had no symptoms or clinical history of hepatitis. In this case, special follow-up after transplant may be required.
HIV
- HIV is the virus that produces AIDS (acquired immune deficiency syndrome). The HIV virus may be contracted through sexual contact (heterosexual or homosexual), contaminated blood products, intravenous drug use with contaminated needles, or from mother to child by way of the placenta or birth canal.
- There is an extraordinarily small chance that HIV virus may be contracted through an organ transplant. All blood, organ, and tissue donors are thoroughly screened for HIV infection through a careful screening of medical and sexual history and by blood testing. The history of the donor is obtained as completely as possible because blood testing may not be 100 percent sensitive for the virus.
- Although there is a very small chance that you could contract HIV through an organ transplant or blood transfusion, you must know that every precaution has been taken to assure that the organ and blood are safe. Every effort is made to select donors who will not transmit infection. The transplant team always attempts to make recommendations in your best interest.
Fungal Infections
- Fungal infections may range from very mild (thrush) to life-threatening. Examples of fungal infections include:
- Candida
- Aspergillosis
- Histoplasmosis
Candida
- Candida is a yeast that grows in moist areas of the body, such as the mouth, arm pits, groin or genital area. Candida is also known as thrush or monilia.
- When it occurs in the mouth, it looks like white, fuzzy patches over the roof of your mouth, on your tongue, your throat, or in your esophagus (the tube that goes from your mouth to your stomach). It can be treated with a mouthwash (Nystatin) or troches (Mycelex).
- When it occurs on the skin, candida can be treated with several types of lotions or creams.
- Women can get yeast infections in the vagina. Vaginal yeast infections cause itching and drainage that is white, lumpy and foul smelling.
- If Candida spreads inside the body, it can become a more serious infection, requiring intravenous treatment with antifungal medications such as Amphotericin B.
Aspergillosis
- Aspergillosis may be contracted by breathing fungal spores in damp, dusty places such as attics, basements, barns, or constructions sites.
- Care should be taken to avoid these places, or if necessary, wear a face mask in those areas.
Histoplasmosis
- Histoplasmosis is an air-borne fungal disease found in bird droppings.
- Transplant recipients should avoid exposure to bird droppings, especially in enclosed areas.
Other Infections
Pneumocystis
- Pneumocystis is a pulmonary (lung) infection that occurs mainly in patients who are taking immunosuppressant medications. Symptoms include cough, fever, malaise (feeling lousy), and shortness of breath. Transplant patients are given Bactrim DS every other day for the first year after transplant to help prevent this infection. Patients who are allergic to sulfa drugs may be treated with Pentamidine Aerosol every 4 to 6 weeks, or Dapsone instead of Bactrim.
Tuberculosis
-
Tuberculosis (TB) is a mycobacterial infection that is contracted by breathing infected air-borne droplets. Potential transplant recipients may receive a skin test during the transplant evaluation to determine previous exposure to TB.
Symptoms of tuberculosis include:
- Pneumonia-like symptoms
- Cough
- Coughing up blood
- Night sweats
- Fever