Emerging Transplant Infections: Clinical Challenges and Implications

Preface
Contents
About the Editors
Contributors
Part I: General Introduction
	1 Impact of Infection on Transplant Outcomes: Transplant Infectious Disease Expertise as an Essential Component of Transplant ...
		Introduction
		The Essential Role of Infectious Disease Specialists in the Care of Transplant Patients
		Conclusion
		References
	2 Introduction to Immunosuppression, Tolerance, and Infection Risk
		Introduction
		T-Cell, B-Cells, and the Innate Immune System Involvement in Rejection
		Other Elements of the Immune System Involved in Transplantation
		Therapeutics Impacting Immunosuppression
		Calcineurin Inhibitors
		Antiproliferative Agents
		mTOR Inhibitors
		Corticosteroids
		Co-stimulation Blockade
		Induction Therapies
			Anti-CD25 Monoclonal Antibodies
			Anti-CD52 Monoclonal Antibodies
			Polyclonal Antibodies
		Conclusion
		Key Points
		References
	3 Changing Definition of Immunosuppression: Targeted Therapies and Resulting Emerging Infections and Their Prevention
		Introduction
		Belatacept
			Key Findings and Suggestions
		Basiliximab
			Key Findings and Suggestions
		Rituximab and Obinutuzumab
			Key Findings and Suggestions
		Alemtuzumab
			Key Findings and Suggestions
		Eculizumab
			Key Findings and Suggestions
		Ruxolitinib
			Key Findings and Suggestions
		Ibrutinib
			Key Findings and Suggestions
		Bortezomib
			Key Findings and Suggestions
		Brentuximab
			Key Findings and Suggestions
		Conclusions
		References
	4 Stem Cell Transplantation: Infection Risk by Transplant Type and Emerging Trends in Infection Management
		Introduction
		Risk of Infection Post-HSCT
			General Immune Reconstitution After Hematopoietic Stem Cell Transplantation
			Aplastic Period
			NK Cells and T-Cells
			B-Cells and Immunoglobulins
			Graft-Versus-Host Disease
		Special Donor Populations
			Umbilical Cord Blood Transplantation
			Haploidentical Transplantation
		Pre-HSCT Recipient Infectious Disease Evaluation
		Prophylaxis and Management of Infection Post-HSCT
			Bacterial Infections
				Bloodstream Infections
			Diagnosis
			Management
				Gram-Positive Bacterial Infections
				Multidrug-Resistant Gram-Negative Bacterial Infections
			Bacterial Pneumonia
				Clostridioides Difficile
			Diagnosis
			Management
				Recurrent CDI
				Secondary Prophylaxis
			Fungal Infections
		Yeasts
			Disease Epidemiology
				Candida auris
			Diagnosis
				Blood Cultures
				Fungal Antigen Testing: Serum 1,3-Beta-D-Glucan
				Nanodiagnostics
				Candida auris-Specific Diagnostics
			Management
				Candida Species
				Candida auris
				Cryptococcus
		Molds
			Disease Epidemiology
			Clinical Impact
			Diagnosis
				Culture
				Galactomannan
				Aspergillus PCR
				Radiographic Studies
				Fungal Metabolite Testing
			Management
				Prophylaxis
				Treatment
				Pneumocystis Jiroveci
		Viral Infections
			Herpes Simplex Virus
			Varicella Zoster
			Cytomegalovirus
			Diagnosis
				Preemptive Management
				Prophylaxis: Shift in Management
				Drug-Resistant CMV Infection
			Epstein-Barr Virus
			Adenovirus
			BK Virus
		Parasitic Infections
			Toxoplasmosis
				Strongyloides
			Post-HSCT Vaccinations
		Conclusions
		Key Points
		Cross-References
		References
	5 Evolving Epidemiology of Transplant Infections: Impact of Population Shifts and Climate Change
		Introduction
		Migration and Population Shift
			Modern Patterns of Human Migration and Infection
			Shifting Populations and the Changing Epidemiology of Infectious Diseases
			Preventative Strategies and Global Demographic Changes
		Climate Change and Infectious Diseases
			Climate Change and Parasitic Infections
			Climate Change and Vector-Borne Infections
			Climate Change and Fungal Infections
			Climate Change and Bacterial Infections
		Conclusion
		Key Points
		References
	6 Hospital Epidemiology and Infection Control in the Transplant Center
		Introduction
		Hand Hygiene
		Central Line-Associated Bloodstream Infections
		Catheter-Associated Urinary Tract Infections
		Clostridioides difficile
		Surgical Site Infections
		Preventing Infections Associated with the Healthcare Environment
			Environmental Mold
			Waterborne Pathogens
		Colonization with Multidrug-Resistant Organisms
		Respiratory Viruses
			Influenza
			Respiratory Syncytial Virus
			Adenovirus
			Other Respiratory Viruses
		Varicella-Zoster Virus
		Measles
		Healthcare Personnel Vaccination
		Conclusion
		Key Points
		Cross-References
		References
	7 Antimicrobial Stewardship for Transplant Candidates and Recipients
		Introduction
		Implementing Antimicrobial Stewardship in Transplant Patients
			Formulary Management
			Pre-prescription Authorization and Post-prescriptive Review
			Antimicrobial Agent Selection
			Antibiotic Allergy Assessment
			Dose Optimization and Drug Interactions
			Intravenous-to-Oral Conversion
			Clinical Pathways and Guideline Development
			Diagnostic Test Stewardship
		Syndrome- and Drug-Specific Targets
			Antibiotic Stewardship
				Febrile Neutropenia
				Asymptomatic Bacteriuria in Organ Transplant Recipients
			Antiviral Stewardship
				Aerosolized Ribavirin for Management of RSV
				Cytomegalovirus (CMV)
			Antifungal Stewardship
		Antimicrobial Stewardship Program Metrics
		Conclusion
		Key Points
		References
	8 Antimicrobial Prophylaxis in the Age of Emerging Transplant Infections
		Introduction
		Perioperative Antibacterial Prophylaxis in Solid Organ Transplantation
		Antibiotic Prophylaxis After Transplantation
		Antifungal Prophylaxis After Transplantation
		Mycobacterial Prophylaxis After Transplantation
		Influenza Prophylaxis After Transplantation
		Herpes Simplex Virus and Varicella Zoster Virus Prophylaxis After Transplantation
		Cytomegalovirus Prophylaxis After Transplantation
		BK Polyomavirus Prophylaxis After Transplantation
		Parasitic Prophylaxis in Transplantation
		Conclusion
		Key Points
		References
	9 Pretransplant Screening for Infection Exposure: Approach to the Patients with Epidemiologic and Geographic Risk Factors
		Introduction
		Bacterial Infections
			Bacterial Pathogens of Special Interest
		Mycobacterial Infections
			Tuberculosis
			Nontuberculous Mycobacteria
			M. abscessus
			Non-M. abscessus Non-M. tuberculosis Mycobacterial Infections
		Fungi
			Endemic Fungal Infections
				Histoplasmosis
				Blastomycosis
				Paracoccidioidomycosis
				Coccidioidomycosis
				Cryptococcosis
			Aspergillus and Other Molds
		Parasitic Infections
			Chagas Disease
			Schistosomiasis
			Strongyloidiasis
			Leishmaniasis
			Malaria
			Toxoplasmosis
		Viral Infections in the Transplant Candidate
			Blood-borne Pathogens
		Endemic Human Herpes Viruses
		Viral Infections with Geographic Associations
			Human Herpesvirus-8 (HHV-8)
			HTLV-1
		Flaviviruses (Arboviruses)
			West Nile Virus (WNV)
			Zika, Chikungunya, and Dengue Viruses
		Conclusion
		KeyPoints
		References
	10 Transplant Tourism and the Traveling Transplant Recipient: Infection Mitigation and Treatment Strategies
		Introduction
		Part 1: Transplant Tourism
			Introduction
			Transplant Tourism and Infectious Complications
			Conclusion
			Key Points
		Part 2: The Traveling Transplant Recipient
			Introduction
			Risk of Infection While Abroad
				Viral Infections
					Respiratory Viral Infections
						Influenza
						Measles
						Middle Eastern Respiratory Syndrome
					Gastrointestinal Viral Infections
						Norovirus
						Hepatitis A
						Hepatitis B
						Hepatitis E
						Polio
					Vector-Borne Viral Infections
						Yellow Fever
						Japanese Encephalitis
						Dengue, Chikungunya, and Zika
						Rabies
				Bacterial Infections
					Salmonella enterica Serovar Typhi
					Vibrio cholerae
					Enterotoxigenic Escherichia coli (ETEC)
					Neisseria meningitidis
					Streptococcus pneumoniae
					Clostridium tetani
					Corynebacterium diphtheriae
					Bordetella pertussis
				Mycobacterial Infections
					Mycobacterium tuberculosis
				Fungal Infections
				Parasitic Infections
					Vector-Borne Parasite Infections
						Plasmodium Species
						Leishmania Species
						Trypanosoma Species
						Babesia Species
					Environmentally Transmitted Parasite Infections
						Strongyloides stercoralis
						Schistosoma Species
					Ingested Parasitic Infections
			Pre-departure Infectious Disease Evaluation and Recommendations
				Vaccine Recommendations
				Risk Reduction of Non-vaccine-Preventable Infections
				Prevention of Food-Borne Illnesses and Diarrhea
				Respiratory Infections
				Insect Protection
				Environmental Exposures
				Blood-Borne Pathogens
				Sexually Transmitted Infections (STI)
				Post-travel Evaluation
			Conclusion
			Key Points
		References
	11 Preventative Health in Solid Organ Transplant: Safe Living Post-transplant
		Introduction
		Pre-transplant Evaluation
		Vaccination
		Everyday Living Strategies
		Activities of Leisure
		Sexual Health
		Food and Water Safety
		Animal and Insect Precautions
		Travel Advice
		Conclusion
		Key Points
		References
	12 Vaccination Strategies in Solid Organ and Stem Cell Transplant
		Introduction to Vaccination in Transplant Recipients
		Specific Vaccine Recommendations
			Vaccination Against Influenza
			Vaccination Against Pneumococcal Disease
			Vaccination Against Meningococcal Disease
			Vaccination Against Hepatitis B Virus
			Vaccination Against Hepatitis A Virus
			Vaccination Against Human Papillomavirus
			Vaccination Against Varicella Zoster Virus
				Vaccination against primary varicella
					Recommendations in SOT
					Recommendations in HSCT
				Vaccination against herpes zoster
					Recommendations in SOT
					Recommendations in HSCT
			Vaccination Against Measles, Mumps, and Rubella
			Other Routine Vaccines
		Special Considerations in Vaccination of the Transplant Recipient
			Other Specifics Regarding Vaccine Timing
			Travel Vaccines
			Immunization of Household Contacts
		Conclusion
		Key Points
		Cross-References
		References
Part II: Bacterial Infections Introduction
	13 Multidrug-Resistant Organisms: Pre-transplant Evaluation and Management
		Introduction
			Vancomycin-Resistant Enterococcus
		Disease Epidemiology
			Solid Organ Transplant
			Bone Marrow Transplant
			Clinical Impact in Transplant
				Solid Organ Transplant
				Bone Marrow Transplant
		Disease Diagnostics and Clinical Evaluation
		Management
			Prevention
			Decolonization
			Treatment
				Methicillin-Resistant Staphylococcus aureus (MRSA)
		Disease Epidemiology
			Solid Organ Transplantation
			Stem Cell Transplantation
		Clinical Implications
			Solid Organ Transplantation
			Stem Cell Transplantation
		Disease Diagnostics
		Management
			Prevention
			Infection Control
			Decolonization
			Treatment
		Carbapenem-Resistant Enterobacteriaceae (CRE), Acinetobacter Species, and Pseudomonas aeruginosa
			Disease Epidemiology
			Solid Organ Transplant
			Bone Marrow Transplant
			CRE Screening
			Disease Diagnostics
				Treatment of CRE
			Prevention of CRE Infection
		Conclusion
		References
	14 Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resi...
		Introduction
		Disease Epidemiology
			ESBL-Producing Enterobacterales
			Carbapenem-Resistant Enterobacterales
		Clinical Impact in Transplant
			ESBL-Producing Enterobacterales
			Carbapenem-Resistant Enterobacterales
		Disease Diagnostics and Clinical Evaluation
			ESBL-Producing Enterobacterales
			Carbapenem-Resistant Enterobacterales
		Management
			ESBL-Producing Enterobacterales
			Carbapenem-Resistant Enterobacterales
		Conclusion
		Key Points
		References
	15 Pseudomonas aeruginosa Infections in Transplant: Epidemiology and Emerging Treatment Options
		Epidemiology of Pseudomonas aeruginosa Infection in the Transplant Population
			Solid Organ Transplantation
			Host Factors in Solid Organ Transplant Recipients
			Hematopoietic Stem Cell Transplantation
			Host Factors in Hematopoietic Stem Cell Transplant Recipients
		Pathogenesis of Infection
			Microbiology
			Environmental Factors in Transplant Recipients
		Recent Diagnostic Advances
			Resistance to Antimicrobials
		Emerging Therapeutic Strategies
			Ceftolozane-Tazobactam
			Ceftazidime-Avibactam
			Cefiderocol
			Meropenem-Vaborbactam
			Imipenem-Relebactam
			Plazomicin
			Investigational Agents: Aztreonam-Avibactam, Intravenous Fosfomycin
		Conclusion
		Key Points
		References
	16 Management of Acinetobacter Infections in the Immunosuppressed Host
		Introduction
		Disease Epidemiology
		Clinical Impact in Transplant
		Diagnosis
		Treatment
		Carbapenems
		Polymyxins
		Sulbactam
		Tetracyclines and Glycylcyclines
		Combination Therapy
		Cefiderocol
		Infection Prevention
		Conclusion
		Key Points
		References
	17 Burkholderia in Transplant: Important to Speciate and Important to Treat
		Introduction
		The Importance of Burkholderia Speciation
		B. pseudomallei Complex
			Transplantation and Bpc
			Management of Bpc
		B. gladioli
			Transplantation and B. gladioli
			Management of B. gladioli
		B. cepacia Complex
			Bcc Virulence Features
			Bcc Antibiotic Resistance Mechanisms
			Bcc Associated with CF
			Outcomes of Bcc Infection
			Bcc Associated with Contaminated Medicines, Medical Fluids, and Devices
			Transplantation and Bcc
			Current Strategies to Manage Bcc
				Preventive Strategies
				Prophylaxis Strategies
				Supportive Therapy
				Interoperative Therapies
				Immunosuppressive Therapies Post-Transplant
				Antibiotic Therapy
			Novel Strategies to Manage Bcc
				Novel Antibiotics
				Cysteamine
				OligoG
				Phage Therapy
				Other Potential Therapies
		Conclusion
		Key Points
		Cross-References
		References
	18 Mycobacterium tuberculosis in Transplantation
		Introduction
		Disease Epidemiology
		Clinical Impact in Transplantation
		Diagnostic Strategies and Screening
		Treatment of Active TB
		Prevention/Treatment of Latent TB
		Conclusion
		References
	19 Rapidly Growing Mycobacterial Infections in Transplant: Evolving Epidemiology and Treatment Options
		Introduction
		Disease Epidemiology
		Diagnosis
			Diagnostic Challenges
			Species Identification
		Management
			The Role for Macrolides
			Species- and Site-Specific Treatment Considerations
				M. abscessus Complex
					Pulmonary Disease
					Extrapulmonary Disease
				M. chelonae
					Pulmonary Disease
					Extrapulmonary Disease
				M. fortuitum
					Pulmonary Disease
					Extrapulmonary Disease
			Role for Surgery in Extrapulmonary RGM Disease
			Catheter-Associated Infections
			Treatment of Less Common RGM Isolates
			Management Considerations Unique to Transplant Recipients
			Prevention
		Clinical Impact in Transplant
			Impact on Transplant Candidacy
			Impact on Transplant Recipients and Transplant Centers
		Conclusion
		Key Points
		Cross-References
		References
	20 Slow-Growing Nontuberculous Mycobacteria in Transplant
		Introduction
		Epidemiology
			Slow-Growing Mycobacteria: Organisms and Mode of Transmission
			Incidence of NTM in Transplant Recipients
			Timing of Infection
			Risk Factors
		Clinical Impact
		Presentation and Diagnosis
			Clinical Presentation
			Diagnosis
		Management
			General Principles
			MAC
			M. chimaera
			M. kansasii
			Other Slow-Growing NTM
			Duration of Therapy
			Prevention
		Conclusion
		Key Points
		References
	21 Nocardia Infections in Transplantation: Diagnosis, Management, and Impact on Outcomes
		Introduction
		Disease Epidemiology of Nocardia
			Routes of Infection
			Nocardia Species Responsible for Infection in Humans
			Incidence and Risk Factors for Nocardiosis in Solid Organ Transplant Recipients
			Incidence and Risk Factors for Nocardiosis in Hematopoietic Stem Cell Transplant Recipients
		Clinical Impact on Solid and Hematopoietic Stem Cell Transplantation
			Mortality
			Treatment-Associated Morbidity
			Graft Outcomes
		Disease Diagnostics and Clinical Evaluation of Nocardia
			Pulmonary Nocardiosis
			Cutaneous Manifestations
			Central Nervous System Manifestations
			Other Presentations of Nocardiosis
			General Approach to Diagnosis of Nocardiosis
		Management
			Empiric Therapy
			Duration of Therapy
			Drug Toxicity Monitoring
			The Role of Adjunctive Surgery
			Immunosuppression Reduction and Immune-Based Therapy
			Use of Oxazolidinone Antimicrobials in Therapy: Linezolid and Tedizolid
			Prevention
		Conclusion
		Key Points
		Cross-References
		References
	22 Mycoplasma and Ureaplasma Infections in Transplantation: A Big Impact Despite the Lack of a Cell Wall
		Disease Epidemiology
		Clinical Impact in Transplant
			Lung, Heart, and Combined Heart-Lung Transplantation
			Liver Transplantation
			Kidney Transplantation
			Kidney-Pancreas Transplantation
			Hematopoietic Stem Cell Transplantation
		Disease Diagnostics and Clinical Evaluation
		Management
		Conclusions
		Key Points
		References
	23 Clostridioides Difficile: Where Should the Management Strategies in Transplant Vary?
		Introduction
		Epidemiology of C. difficile in Transplant Recipients
		Pathogenesis of C. difficile
		Diagnosis of C. difficile Infection: Clinical Evaluation and Available Emerging Diagnostics
		Approach to Patient Management Including Emerging Treatment Modalities and Options for Prophylaxis, Prevention, and Prognosis ...
		Prophylaxis
		Probiotics
		Conclusions
		Key Points
		References
Part III: Viral Infections Introduction
	24 Cytomegalovirus in Solid Organ Transplant Recipients: Prevention, Diagnosis, and Treatment
		Disease Epidemiology
		Clinical Impact in Solid Organ Transplant
		Disease Clinical Evaluation and Diagnostics
			CMV Serology
			CMV Nucleic Acid Testing
			CMV Culture and Pathology
			CMV Immune Assays
		Management (Both Clinical Management and Preventative Care)
			Prevention
			Vaccines
			Immunoglobulins
			Treatment of Active Infection
			Treatment Resistant and Refractory Disease
		Key Points, Research Needs, and Future Trends
		References
	25 Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients: Prevention, Diagnosis, and Treatment
		The Virus
			Epidemiology and Risk Factors
		Immune Reconstitution
		Clinical Manifestations
			Definitions
				CMV Syndrome
				Pneumonia
				Gastrointestinal (GI) Disease
				Retinitis
				Encephalitis
				GU Disease
				Other End-Organ Disease Categories
			Clinical Manifestations of CMV
		Diagnosis
			Quantitative Nucleic Acid Testing
		Preventive Strategies
			Preemptive Therapy
			Prophylaxis
		Treatment
			Antivirals
			Resistance
			Adoptive CMV-Specific T-Cell Therapy
			Vaccines
		Concluding Remarks
		References
	26 Herpes Simplex and Varicella Zoster in Transplant Candidates and Recipients
		Introduction
		Disease Epidemiology
			Herpes Simplex
			Varicella
		Clinical Impact in Transplant
			HSV
			VZV
		Disease Diagnostics and Clinical Evaluation
			Pretransplant
			Posttransplant
				HSV
				VZV
		Management
			Clinical Disease
				HSV
					Chronic Suppression
					Acyclovir Resistance
				VZV
					Primary Varicella
					Reactivation Disease
		Prevention
			Primary Infection
				HSV
				VZV
			Pretransplant Vaccination (Table 5)
				SOT
				HSCT
			Posttransplant Vaccination (Table 5)
				SOT
				HSCT
			Posttransplant Postexposure prophylaxis for VZV
			Prevention of Reactivation
			Antiviral Medication
				SOT
				HSCT
			VZV Vaccination (Table 9)
				SOT
					Pretransplant Vaccination
					Posttransplant Vaccination
				HSCT
					Pretransplant Vaccination
					Posttransplant
		Special Considerations
			Infection Control
			Pregnancy
			IV Acyclovir Shortage
		Conclusion
		Key Points
		References
	27 Epstein-Barr Virus and Posttransplant Lymphoproliferative Disorders
		Introduction
		Disease Epidemiology
			EBV Infection and PTLD After SOT
			Risk Factors for PTLD After SOT
			EBV Infection and PTLD After HSCT
		Clinical Impacts on Transplantation
			Disease Presentation and Spectrum
			Outcome of PTLD After SOT and HSCT
		Diagnosis of EBV Disease and PTLD
			Serologic Testing
			Nucleic Acid Detection
			Cell-Mediated Immune Responses
			Tissue Histopathology
			Radiographic Imaging
		Management and Prevention of EBV Disease and PTLD
			The Management of EBV Disease Including PTLD
			EBV Disease and PTLD Treatment in SOT
				Reduction of Immunosuppression
					Rituximab
					Chemotherapy
				Additional Strategies
			EBV Disease and PTLD Treatment in HSCT
			Prevention of EBV and PTLD
		Conclusion
		Key Points
		References
	28 HHV-6, HHV-7, and HHV-8: Forgotten Viruses in Transplantation
		Introduction
		Human Herpesvirus-6
			Overview
				Background
				Chromosomally Integrated HHV-6
				Diagnosis and Antivirals
			HHV-6 Infection in HSCT Recipients
				Epidemiology and Risk Factors
				Association with Infectious Syndromes
				Association with Transplant-Related Events
				Chromosomally Integrated HHV-6 After HSCT
				Utility of Treating HHV-6 After HSCT
			HHV-6 Infection in SOT Recipients
				Epidemiology and Risk Factors
				Association with Infectious Syndromes
				Association with Transplant-Related Events
				Chromosomally Integrated HHV-6 After SOT
			HHV-6 in HSCT and SOT: Challenges and Future Directions
		Human Herpesvirus-7
			Overview
			HHV-7 Infection in HSCT Recipients
			HHV-7 Infection in SOT Recipients
			HHV-7 in HSCT and SOT: Challenges and Future Directions
		Human Herpesvirus-8
			Overview
				Biology
				Overview of Well-Known Manifestations
				Epidemiology
				Diagnosis and Antiviral Therapy
			HHV-8 Infection in SOT Recipients
				Epidemiology, Risk Factors, and Clinical Manifestations
				Donor and Recipient Screening
				Management
			HHV-8 Infection in HSCT Recipients
			HHV-8 in HSCT and SOT: Challenges and Future Directions
		Conclusions and Future Directions
		Key Points
		References
	29 Influenza Infections in Solid Organ and Stem Cell Transplant Recipients
		Introduction
		Influenza Incidence in SOT Recipients
		Influenza Incidence in HSCT Recipients
		Incidence of Hospital Admission and Intensive Care Unit (ICU) Admission After Influenza Infection in SOT and HSCT Recipients w...
			Hospital Admission
			ICU Admission
		Clinical Presentation of Influenza in SOT Recipients
			Fever
			Lower Respiratory Tract Infection
			Graft Dysfunction
		Clinical Presentation of Influenza in HSCT Recipients
			Fever
			Lower Respiratory Tract Infection
		Diagnosis
		Treatment and Outcomes
			Adjunctive Therapy
		Risk Factors for Mortality and ICU Admission
		Prophylaxis
			Chemoprophylaxis
		Vaccination
		Influenza Vaccination in SOT Recipients
		Vaccine Strategy
			Repeated Vaccination
			High-Dose Vaccination
			Intradermal Versus Intramuscular
			Adjuvanted Vaccine
		Influenza Vaccination Side Effects in SOT Recipients
		Vaccination in HSCT Recipients
			Timing of Vaccination
		Vaccine Strategy
			Repeated Vaccination
			High-Dose Vaccination
			Adjuvanted
			Donor Vaccination and Pre-HSCT Vaccination
		Conclusion
		Key Points
		References
	30 Respiratory Syncytial Virus in Transplant: Stopping the Short-Term Spread, Solving the Longer-Term Problems
		Introduction
		Disease Epidemiology
		Clinical Impact in Transplant
		Disease Diagnostics and Clinical Evaluation
		Prevention
			Infection Control
			Vaccine
		Treatment of Respiratory Syncytial Virus Infection
			Ribavirin
			Immunoglobulins
			New Treatments
		Key Points
		Conclusion
		References
	31 Respiratory Viral Pathogens in Solid Organ and Hematopoietic Stem Cell Transplant Recipients
		Introduction
		Respiratory Virus Epidemiology Among Transplant Patients
		Clinical Presentations of Respiratory Viral Pathogens in Transplant Recipients
		Disease Progression and Complications
		Diagnostic Overview
		Common and Uncommon Respiratory Viral Pathogens
		Influenza
			Treatment
			Prevention
		Respiratory Syncytial Virus
			Treatment
			Prevention
			Human Metapneumovirus
			Treatment and Prevention
		Parainfluenza Viruses
			Treatment and Prevention
		Rhinovirus
			Treatment and Prevention
		Coronavirus
			Treatment and Prevention
		Adenovirus
			Treatment and Prevention
		Bocavirus and Other Uncommon Respiratory Viruses
		Infection Control Practices to Protect Transplant Patients from Respiratory Viruses
			Unique Donor and Recipient Issues
		Conclusions
		Key Points
		References
	32 Transplant Adenovirus Infection: Clinical Syndromes, Diagnosis, and Management
		Introduction
		Virology
		Epidemiology
			Mode of Transmission
			Epidemiology in Transplant Populations
				Epidemiology in Hematopoietic Stem Cell Transplant
				Epidemiology in Solid Organ Transplant Recipients
		Clinical Presentation
			Hematopoietic Stem Cell Transplant
			Solid Organ Transplant
				Liver Transplant
				Renal Transplant
				Lung Transplant
				Heart Transplant
				Intestinal Transplant
		Diagnosis
		Treatment
		Prevention
		Conclusion
		Key Points
		References
	33 BK Polyomavirus After Solid Organ and Hematopoietic Cell Transplantation: One Virus - Three Diseases
		Introduction
		Polyomavirus-Associated Nephropathy: PyVAN
			Pathology and Clinical Impact
			Clinical Evaluation and Diagnostics
			Disease Epidemiology and Risk Factors
			Management
		Polyomavirus-Associated Hemorrhagic Cystitis: PyVHC
			Pathology and Clinical Impact
			Clinical Evaluation and Diagnostics
			Disease Epidemiology and Risk Factors
			Management
		PyV-Associated Urothelial Cancer: PyVUC
		Conclusion
		Key Points
		References
	34 Challenges of Human Papillomavirus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients
		Introduction
		Pathogenesis of HPV Infection
			Initial Infection
			Terminology
			Development of HSIL
			Immune Mechanisms of HPV Infection
		Epidemiology of HPV in SOT and HSCT Recipients
			HPV Infection
			SIL
			Progression from HSIL to Invasive Cancer
			HPV-Related Malignancies in SOT and HSCT Recipients
			Non-melanomatous Skin Cancer in SOT and HSCT Recipients
		Prevention of HPV-Related Complications in SOT and HSCT Recipients
			Cervical Cancer Screening
			Anal Cancer Screening
			Other HPV-Related Malignancies
			Prophylactic HPV Vaccination
		Conclusion
		Key Points
		References
	35 Solid Organ Transplantation in HIV Positive Patients
		Introduction
		Pathophysiology and Organ Involvement
			Kidney
			Liver
		Patient Selection for Transplantation for a HIV Positive Transplant
			Preoperative Investigations
			Contraindications to Transplantation in the HIV Positive Recipient
		Donor Options
			HIV Negative Donors
			HIV Positive Donors
			Considerations When Utilizing a HIV Positive Donor
				History of HIV Disease
				Renal Impairment in the Donor
				Donor Screening for Other Infections
		Antiretroviral Therapy
		Immunosuppression Choices
		Rejection
		Recurrence of HIVAN
		Second Viral Strain
		Opportunistic Infection
			Prophylactic Therapy Against Common Infections
			Vaccinations Prior to Transplant
			Vaccinations Post-transplant
		Conclusion
		Key Points
		References
	36 Hepatitis A Infections in Transplant
		Introduction
		Epidemiology
		Structure
		Transmission
		Diagnosis
		Clinical Presentation
		Transplant for HAV
		Prevention
			Food Precautions
			Immunization
				Immunocompromised Hosts
				Pretransplant
					Solid Organ Transplant
					Stem Cell Transplant
				Posttransplant
					Solid Organ Transplant
					Hematopoietic Stem Cell Transplant
				Travel Recommendations
				Postexposure Prevention
		Conclusion
		Key Points
		References
	37 Hepatitis E Infections in Transplants
		Introduction
		Disease Epidemiology: Transmission
		Clinical Impact on Transplant: Both Solid Organ and Bone Marrow/Stem Cell
			Clinical Manifestations
			Chronic Infections
			Extrahepatic Manifestations
		Diagnosis Including Clinical Evaluation and Available/Emerging Diagnostics
			Serological Tests
			Antigen Detection
			Molecular Diagnosis
			Natural History and Diagnostic Algorithm
		Management Including Emerging Treatment Modalities and Options for Prophylaxis/Prevention
			Immunosuppressive Regimen Management
			Ribavirin Monotherapy
			Other Antivirals
			Prevention
		Conclusion
		Key Points
		References
	38 Hepatitis B and Hepatitis D Infections in the Transplant Setting
		Introduction
		Diagnostic Evaluation of Organ Recipients and Donors
			Evaluation of Stage of Liver Disease
		HBV Reactivation and Implications for Transplant Recipients
		Natural History of Post-Transplant Recipients with Chronic Hepatitis B
			Liver Transplant Recipients
			Other Solid Organ Transplant Recipients
			Hematopoietic Stem Cell Transplant Recipients
			Anti-HBc-Positive, HBsAg-Negative Transplant Recipients
		Management of Hepatitis B in the Transplant Setting
			Overview of HBV Therapies
			Vaccination to Prevent De Novo HBV in the Transplant Setting
			Prevention of Recurrent HBV in Liver Transplant Recipients
			Prevention of De Novo Infection in Recipients of Anti-HBc-Positive Donors
				Liver Transplantation
				Non-liver Transplantation
			Managing Anti-HBc-Positive Transplant Recipients (HBsAg-Negative)
			Management of Recipients of HBsAg-Positive Donors
				Liver Transplantation
				Non-liver Transplantation
			Managing Transplant Recipients with Chronic Hepatitis B
		Hepatitis D Virus
			Liver Transplant Recipients
		Conclusion
		Key Points
		Cross-References
		References
	39 Emerging Management of Hepatitis C in Transplant
		Introduction
		Pretransplant HCV Management
			Treatment Efficacy in Patients with Decompensated  Cirrhosis
			Functional and Clinical Evolution Following DAAs
			Potential Harms of Treating Patients on the Waiting List
			DAA Benefits in Patients with HCC on the Waiting List for Liver Transplant
			Impact of DAA on LT Waiting Lists
		Posttransplant HCV Management
			DAA Regimens After Liver Transplantation
			Impact of DAA on Posttransplant Outcomes of HCV-Positive Recipients
			Impact of DAA on the More Extensive Use of HCV-Positive Donors
		Use of Viremic Donor Organs for Transplant into HCV-Negative Recipients
		Conclusion
		Key Points
		References
	40 West Nile Virus and Transplantation
		Epidemiology
		Disease Manifestation
		Diagnostic Considerations and Laboratory Testing for WNV
			Geographic Regions at Higher Risk for WNV
			Laboratory Testing
			Diagnostic Imaging
		Management of West Nile Virus Infection
		Prevention
			Blood Donor Screening in the United States
			Organ Donor Screening
		Environmental Prevention of West Nile Virus Infection
		Key Points
		Conclusion
		References
	41 Emerging Tropical Viral Infections: Dengue, Chikungunya, and Zika
		Introduction
		Disease Epidemiology
			Dengue
			Chikungunya
			Zika
		Clinical Impact on Transplantation
			Dengue
			Chikungunya
			Zika
		Diagnosis of DENV, CHIKV, and ZIKV
			Dengue
			Chikungunya
			Zika
		Management of DENV, CHIKV, and ZIKV Infections in Transplant Recipients
			Dengue
			Chikungunya
			Zika
		Preventive Measures
			Vector Control
			Vaccines
			Blood Supply Safety
		Screening Recommendations and Donor Deferral
		Conclusions
		Key Points
		References
	42 Yellow Fever: Prevention in Transplant Candidates and Emerging Treatment Data for Liver Transplant
		Introduction
			Epidemiology
				Clinical Manifestations
				Diagnosis
				Prevention
		Prevention in Transplant Candidates
			Hematological Malignancies and HSCT Candidates
			Kidney Transplant Candidates
			Liver Transplant Candidates
		Liver Transplantation as an Emerging Treatment Option
		Conclusions
		Key Points
		References
	43 Viral Encephalitides Including Rabies and Lymphocytic Choriomeningitis Virus: Impact in Transplant Donors and Recipients
		Introduction
		Rabies Virus
			Signs and Symptoms
			Diagnosis
			Treatment
		Lymphocytic Choriomeningitis Virus (LCMV)
			Signs and Symptoms
			Diagnosis
			Treatment
		Emerging Viruses
		Prevention of Donor Association Transmission
		Prevention of Recipient-Acquired Infection
		Challenges and Next Steps
		Conclusions
		Key Points
		References
Part IV: Fungal Infections Introduction
	44 Candida Infections in Solid Organ Transplantation
		Introduction
		Epidemiology, Risk Factors, and Prophylaxis
			Lung Transplant
			Heart Transplant
			Liver Transplant
			Kidney
			Pancreas
			Small Intestine
		Donor-Derived Candida Infections
		Candida Diagnostics
			Culture-Based Diagnostic Methods
			Non-culture Diagnostic Methods
				1-3-β-d-Glucan, Mannan, and Anti-mannan Antibodies
			Polymerase Chain Reaction
			T2 Magnetic Resonance (T2MR)
		Treatment
			Special Considerations: Emergence of Candida auris
			Therapeutic Drug Monitoring
		Conclusion
		Future Directions
		KeyPoints
		References
	45 Aspergillus in Solid Organ and Stem Cell Transplant Patients: Emerging Options for Diagnosis and Management
		Introduction
		Cryptic Emergence of Resistant Aspergillus Species and Azole-Resistant Strains
		Diagnosis of Aspergillosis
			Clinical Manifestations
			Bronchoscopy
		Microbiology
			Immunohistochemistry for Aspergillus
		Serological and Molecular Tests
			Galactomannan Antigen Detection
			(1-3)-β-D-Glucan
			Aspergillus Polymerase Chain Reaction (PCR)
		Newer Tests
			Monoclonal Antibodies
			Urinary Antigen Detection
			Volatile Organic Compounds
			MicroRNA
		Radiological Diagnosis
			Positron Emission Tomography (PET)
		Diagnostic Algorithm
		Treatment of Invasive Aspergillosis
			Voriconazole
			Isavuconazole
			Other Azoles
			Echinocandins
			Polyenes
			New Antifungals Currently Under Investigation
		Combination Therapy
			Voriconazole plus Echinocandin Therapy
			Liposomal Amphotericin B plus Echinocandin Therapy
		Duration of Therapy
		Susceptibility Testing
		Prevention
			HSCT Recipients
			SOT Recipients
		Conclusions
		Key Points
		References
	46 Management of Mucorales Infections in Transplant Patients
		Introduction
			Mucorales: The Pathogens
		Epidemiology
			Causative Pathogens
			Risk Factors
		Clinical Features
		Diagnosis
			Imaging
			Histopathology
			Culture and Microscopy-Based Diagnostic Methods
			Serology and Antigen Testing
			Molecular-Based Methods
				Detection in Fresh and Formalin-Fixed Tissue
			Detection in Blood and Body Fluids
				Position of PCR-Based Methodologies
			Molecular Techniques to Identify Mucorales from Cultures
			Next-Generation Sequencing
		Management of Mucormycosis
			Susceptibility Data
			Antifungal Therapy
				Prevention: Antifungal Prophylaxis
				First-Line Antifungal Therapy
				Step-Down Therapy
				Is There a Role for Up-Front Antifungal Combination Therapy?
					Salvage Antifungal Treatment
					Treatment Duration
					Therapeutic Drug Monitoring (TDM)
			Surgical Treatment
			Adjunctive Treatments
				Topical Antifungals
				Iron Chelators
					Augmentation of Host Immunity and Reversal of Host Risk Factors
					Hyperbaric Oxygen
		Conclusions
		Key Points
		References
	47 Non-Aspergillus Fungal Infections in Transplant Patients
		Introduction
		Epidemiology
		Diagnosis
		Clinical Disease
		Therapy
			Superficial and Deep Local Infections
			Pneumonia
			Central Nervous System Infection
			Disseminated Infection
		Alternative Therapy
		Prophylaxis
		Infection Control
		Conclusion
		Key Points
		References
	48 Management of Cryptococcosis in Transplant Candidates and Recipients
		Introduction
		Disease Epidemiology
		Epidemiology and Risk Factors in Solid Organ Transplant
		Epidemiology and Risk Factors in Stem Cell Transplant
		Clinical Impact on Transplant
		Diagnosis
		Management
		Emerging Treatment Modalities
		Prevention and Control
		Conclusion
		Key Points
		References
	49 Pneumocystis jiroveci in Transplant: Recognizing Risk, Understanding Prevention, and Implementing Treatment
		Introduction
		Microbiology
		Host-Pathogen Interactions
		Epidemiology and Prevention (Tables 1 and 2)
		Clinical, Radiographic, and Diagnostic Considerations (Fig. 1)
			Clinical Findings
			Radiographic Manifestations
			Direct Microscopy
			Molecular Methods
			Beta-Glucan Testing
			Other Tests
		Treatment (Table 3)
			Specific Agents
			Resistance Issues
			Steroids
			Response to Therapy
		Conclusion
		Key Points
		References
	50 Coccidioidomycosis in Transplantation
		Introduction
		Coccidioidomycosis in Solid Organ and Hematologic Stem Cell Transplantation
			Epidemiology
			Mycology and Immunity
			Clinical Manifestations
			Laboratory Diagnosis of Coccidioidomycosis
			Prevention of Coccidioidomycosis in Transplantation
				Prophylaxis of Recipient of Organs from a Coccidioides-Infected Donor
			Treatment of Coccidioidomycosis in Transplantation
			Hematopoietic Stem Cell (Blood and Marrow) Transplantation (HSCT)
		Conclusion
		Key Points
		Cross-References
		References
	51 Emerging Epidemics in Transplant: Histoplasmosis, Blastomycosis, and Paracoccidioidomycosis
		Introduction
		Histoplasmosis
			Disease Epidemiology
			Clinical Impact on Transplant Patients
			Pathogenesis
			Clinical Manifestations
			Diagnosis
			Treatment
			Prophylaxis
		Blastomycosis
			Disease Epidemiology
			Clinical Impact in Transplant Patients
			Pathogenesis and Clinical Manifestations
			Diagnosis
			Treatment
			Prophylaxis
		Paracoccidioidomycosis
			Disease Epidemiology
			Clinical Impact in Transplant Patients
			Pathogenesis and Clinical Manifestations
			Diagnosis
			Treatment
			Prophylaxis
		Common Antifungal Drugs Used to Treat the Endemic Mycoses
			Itraconazole
			Fluconazole
			Amphotericin B
		Conclusions
		Key Points
		References
Part V: Parasitic Infections Introduction
	52 Toxoplasma gondii in Solid Organ and Stem Cell Transplant: Prevention and Treatment
		Introduction
		Burden of Toxoplasmosis in Transplant Patients
			Toxoplasmosis in HSCT Transplant Patients
			Toxoplasmosis in SOT Transplant Patients
		Clinical Signs
		Diagnosis of Toxoplasmosis in Transplant Patients
			Serology
			Parasite Detection
			Histopathologic Examination
			Imaging
			Patient Management
		Treatment
		Prevention of Toxoplasmosis in Transplant Patients
			Pretransplant Serologic Screening for Toxoplasmosis
			Anti-Toxoplasma Chemoprophylaxis
				For Which Patients and for How Long?
				Prophylaxis Protocols
			Patient Counseling and Hygienic Measures
			Diagnostic Follow-Up After Transplantation
		Conclusion
		Key Points
		References
	53 Strongyloides: Emerging Challenges and Prevention
		Introduction
		Epidemiology
		Clinical Impact on Transplant
		Diagnosis Including Clinical Presentation and Available/Emerging Diagnostics
		Management Including Emerging Treatment Modalities and Options for Prophylaxis/Prevention
		Conclusions
		Key Points
		References
	54 Chagas Disease: Coming to a Transplanted Patient Near You
		Introduction
		Epidemiology
			Modes of Transmission
			The Burden of Disease
		Natural History and Pathogenesis
		Diagnosis
			Methods of Laboratory Diagnosis
			Acute ChD Diagnosis
			Chronic ChD Diagnosis
			Reactivation of ChD Diagnosis
		ChD in the Transplant Scenario
			Acute ChD Transmitted Through the Graft from Infected Donors
				Acute ChD Through Solid-Organ Transplantation
				Acute ChD Through Hematopoietic Stem Cell Transplantation
			Transfusion-Transmitted ChD Related to the Transplant Procedure
			ChD Reactivation Among Chronic T. cruzi-Infected Recipients
				ChD Reactivation in Non-heart Solid-Organ Transplantation
				ChD Reactivation in Heart SOT
				ChD Reactivation in Hematopoietic Stem Cell Transplantation
			De Novo Infection
		Pretransplant Risk Assessment and Management of Donors and Recipients
			Pretransplant Risk Assessment
			Acceptability Criteria of a Positive Donor
				Solid-Organ Transplantation
				Hematopoietic Stem Cell Transplantation
			Pretransplant Treatment of a Positive Donor
			Pretransplant Treatment of a Positive Recipient
		Posttransplant Management of the Recipients
			Posttransplant Surveillance of Negative Recipient from Positive Donor or Positive Recipient
			Posttransplant Prophylaxis for Seronegative and Seropositive Recipients
				Posttransplant Prophylaxis for Seronegative Recipients of Organs from Positive Donors
				Posttransplant Prophylaxis for Seropositive Recipients
			Posttransplant Preemptive Therapy
		ChD Treatment
			Nifurtimox
			Benznidazole
			Immunosuppressive Management
			Monitoring After Treatment and Criteria of Cure
			Secondary Prophylaxis
		Prevention
		Conclusion
		Key Points
		References
	55 Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management
		Introduction
			Leishmaniasis: A General Overview
		Visceral Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management
			Disease Epidemiology
			Clinical Impact in Transplant (SOT and HSCT)
			Disease Diagnostics and Clinical Evaluation
			Management
				Risk for Donor Transmission
				Risk for the Recipient: Infection and Reactivation
				Treatment
				Secondary Prophylaxis and Follow-Up
			Conclusion
		Key Points
		Cutaneous Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management
			Disease Epidemiology
			Clinical Impact in Transplants (SOT and HSCT)
			Disease Diagnostics and Clinical Evaluation
			Management
			Conclusion
		Key Points
		References
	56 Malaria in Transplant Candidates and Recipients: Diagnosis and Management
		Introduction
		Clinical Impact
			Donor-Derived Malaria and Solid Organ Transplantation
			Malaria and Hematopoietic Stem Cell Transplantation (HSCT)
		Screening and Diagnosis
		Treatment
		Prevention in Travelers
		Recommendations in the Transplantation Setting
			Infected Donors
		Key Points
		References
	57 Pathogenic Intestinal Parasites in Transplant Recipients
		Introduction
		Intestinal Protozoa
			Cryptosporidium spp.
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
			Cryptosporidiosis in Transplant Recipients
				Overview
				Cryptosporidium as a GVHD Mimic
				Cryptosporidium and Renal Failure
				Extra-intestinal Manifestations of Cryptosporidium
				HSCT and Cryptosporidium in Hyper-IgM Syndrome (HIGM1)
			Cyclospora cayetanensis
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Cyclospora in Transplant Recipients
			Cystoisospora belli
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Cystoisospora in Transplant Recipients
			Giardia spp.
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Giardia in Transplant Recipients
			Blastocystis spp.
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Blastocystis in Transplant Recipients
			Entamoeba histolytica
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				E. histolytica in Transplant Recipients
			Dientamoeba fragilis
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				D. fragilis in Transplant Recipients
			Balantidium coli
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				B. coli in Transplant Recipients
			Intestinal Helminths
			Intestinal Nematodes
			Soil-Transmitted Helminths
			Ascaris lumbricoides
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Ascaris in Transplant Recipients
			Hookworm Infection
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				Hookworm in Transplant Recipients
			Trichuris trichiura (Whipworm)
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				T. trichiura in Transplant Recipients
			Strongyloides stercoralis
		Other Intestinal Nematodes
			Capillaria philippinensis
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				C. philippinensis in Transplant Recipients
			Intestinal Cestodes
			Taenia saginata (Beef Tapeworm)
			Taenia solium (Pork Tapeworm)
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				T. solium in Transplant Recipients
			Hymenolepis nana
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				H. nana in Transplant Recipients
			Diphyllobothrium latum
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				D. latum in Transplant Recipients
			Dipylidium caninum
				Epidemiology
				Clinical Presentation
				Diagnosis
				Treatment
				D. caninum in Transplant Recipients
			Intestinal Flukes
		Conclusion
		Key Points
		References
	58 Acanthamoeba, Naegleria, and Balamuthia in Transplant Patients: An Emerging Threat
		Introduction
		Disease Epidemiology
			Acanthamoeba
				Ecology and Pathobiology
				Risk Factors and Incidence
			Naegleria fowleri
				Ecology and Pathobiology
				Risk Factors and Incidence
			Balamuthia
				Ecology and Pathobiology
				Risk Factors and Incidence
		Clinical Evaluation and Disease Diagnostics
			Acanthamoeba
			Naegleria fowleri
			Balamuthia
		Clinical Impact in Transplant
			Acanthamoeba
			Naegleria fowleri
			Balamuthia
		Management
			Drug Interactions and Toxicities
			Acanthamoeba
			Naegleria fowleri
			Balamuthia
		Key Points
		References
Part VI: Emerging Clinical Challenges
	59 Ventricular Assist Devices, ECMO, and Cardiac Support Devices: Challenges in the Bridge to Transplant
		Introduction
		Types of Mechanical Circulatory Support
		Current Changes to UNOS Listing Criteria in the United States [14]
		Definitions of VAD Infections
		Epidemiology of VAD Infections
		Microbiology
		Pathogenesis
		Risk Factors for Infections
		Strategies for Prevention
		Clinical Outcomes
		Management of Infection
		Significant Circumstances
		Post-heart Transplant Outcomes in VAD Infection
		Cerebrovascular Risk in VAD Infection
		Conclusions
		Key Points
		References
	60 Emerging Transplant Infections: Cystic Fibrosis
		Introduction
		MDR/XDR Organisms
		Burkholderia
			Epidemiology
			Clinical Impact in Transplant
			Diagnostics and Clinical Evaluation
			Management
		Scedosporium
			Epidemiology
			Clinical Impact in Transplant
			Diagnostics and Clinical Evaluation
			Management
			Scedosporium Apiospermum
			Lomentospora (formerly Scedosporium) Prolificans
		Mycobacterium Abscessus
		Bacteriophage Therapy
		CFTR Modulators
		Emerging Considerations in the Patient with Cystic Fibrosis
		Conclusion
		Key Points
		References
	61 Vascular Composite Allografts (VCA): New Transplants, New Infections
		Background
			Introduction
			Introduction to Immunosuppression and Infection Risk
				Induction Immunosuppression
				Maintenance Immunosuppression
				Rejection
				Perioperative Antibiotics
				Graft Preparation
		Tissue-Specific Risk of Infection
			Mucosa
			Skin
			Muscle
			Bone
			Nerve
			Lymphoid Tissue
			Blood Vessel
			Salivary Glands
		Organ-Specific Infections Particular to VCA
			General History
				Abdominal Wall Graft
				Face
				Hand
				Larynx
				Penile
				Uterine
		Systemic Infections that Can Be Predicted from Donor Testing
			Cytomegalovirus
			Epstein-Barr Virus
			Toxoplasma
			Syphilis
		Additional Considerations
			Vaccinations
			Safe Living Practices Posttransplant
				Environmental Exposures
				Future Directions
		Conclusion
		Key Points
		References
Part VII: Considering Emerging Infections in Differential Diagnosis
	62 Emerging Diagnostics for Transplant Infectious Diseases
		Introduction
			Epidemiology and Impact of Antimicrobial Resistance in Transplant Populations
		Emerging Diagnostics for Bloodstream Infections
			Molecular Methods Performed on Positive Blood Culture Bottles
			Molecular Methods Performed on Blood Specimens
			Impact of Rapid Molecular Diagnostics on Clinical Outcomes in Transplant Populations
			Magnetic Resonance-Based Methods
			Metagenomic Sequencing
		Emerging Diagnostics for Respiratory Infections
			Aspergillus PCR
				Aspergillus PCR for Diagnosis of Invasive Pulmonary Aspergillosis
			Aspergillus PCR for Diagnosis of Resistance in Aspergillus Species
			Gas Chromatography-Mass Spectrometry of Exhaled Metabolites
			Multiplex PCR
			Metagenomic Sequencing
		Emerging Diagnostics for CNS Infections
			Multiplex PCR
			Metagenomic Sequencing
		Emerging Diagnostics for Gastrointestinal Infections
			Multiplex PCR
		Conclusion
		Key Points
		References
	63 Rashes to Recognize in the Immunocompromised Transplant Patient: Focus on the Solid Organ Transplant Recipient
		Introduction
		Superficial Fungal Infections
			Disease Epidemiology
			Clinical Impact in Transplant
			Disease Diagnostics and Clinical Evaluation
			Management
		Viral Infections
			Disease Epidemiology
			Clinical Impact in Transplant
			Disease Diagnostics and Clinical Evaluation
			Management
		Bacterial Infections
			Disease Epidemiology
			Clinical Impact in Transplant
			Disease Diagnostics and Clinical Evaluation
			Management
		Special Considerations for the Blood and Marrow Transplant Patient
		Cutaneous Graft-Versus-Host Disease
		Cytomegalovirus Reactivation Among HSCT Patients
		Conclusion
		Key Points
		References
	64 Ophthalmic Infections in Transplant
		Introduction
		Epidemiology of Ocular Infections After Organ Transplantation
		Ocular Anatomy
		Approach to the Patient with Suspected Ocular Infection
		Herpesvirus Infections
		Fungal Infections
		Bacterial Infections
		Parasitic Infections
		Summary and Key Points
		References
	65 Pulmonary Syndromes in Transplantation
		Introduction
		Solid Organ Transplantation
			Infectious Pulmonary Complications
				Phase I: Perioperative Period to 30 Days After SOT
				Phase II: 1 to 6-12 Months After SOT
				Phase III: Beyond 6-12 Months After SOT
			Noninfectious Pulmonary Complications
				Lung Transplant Complications
					Airway Complications
					Primary Lung Graft Dysfunction
					Acute Lung Rejection
					Chronic Lung Rejection
				Drug-Induced Lung Toxicity
				Malignancy
		Hematopoietic Stem Cell Transplantation
			Infectious Pulmonary Complications
				Phase I: Pre-engraftment Neutropenia
				Phase II: Early Post-Engraftment
				Phase III: Late Post-Engraftment
			Noninfectious Pulmonary Complications
				Early
					Idiopathic Pneumonia Syndrome
				Late
		Evaluation of Patient with Pulmonary Symptoms
			Recipient and Donor Epidemiologic Exposures
			Diagnostic Evaluation
			Imaging
		Empiric Antimicrobial Therapy
		Conclusions
		Key Points
		Cross-References
		References
	66 Diarrhea in Transplant: Diagnosis and Management
		Introduction
		Etiology of Diarrhea in Transplant Recipients
			Emerging Infections
		Diagnostic Evaluation
			Enteric Bacterial Pathogens (Salmonella, Shigella, Campylobacter, E. coli, Yersinia, Vibrio sp.)
			Colonoscopy
		Management of Transplant Recipients with Diarrhea
		Conclusion
		Key Points
		References
	67 Altered Mental Status in the Solid Organ Transplant Recipient
		Introduction
		Timeline of Etiologies for Altered Mental Status
			Postoperative Period (<1 Month)
			Early Posttransplant Period (1-6 Months)
			Late Posttransplant Period (>6 Months)
		Organ-Specific Risk Factors and Complications Leading to Altered Mental Status
			Liver Transplantation
			Kidney Transplantation
			Heart Transplantation
			Lung Transplantation
			Intestinal and Multivisceral Transplantation
		Workup of Transplant Recipient with Altered Mental Status
		Management and Prevention
		Conclusions
		Key Points
		References
	68 Transplant Infectious Disease Evaluation of Cytopenias
		Introduction
		Overview of Cytopenias and Their Relevance in Transplantation
		Etiologies of Transplant-Associated Cytopenias
			Etiologies Impacting Both SOT and HSCT
				Infections
					Cytomegalovirus
					Parvovirus
					Adenovirus
					Human Herpesviruses 6 and 7
					Human Herpesvirus 8
					Epstein-Barr Virus (EBV) and Post-Transplant Lymphoproliferative Disorder
					Histoplasma capsulatum
					Mycobacteria
				Drugs
				Hemophagocytic Lymphohistiocytosis
				Thrombotic Microangiopathy
				Autoimmune Cytopenias
				Passenger Lymphocyte Syndrome
			Etiologies Unique to SOT: Graft-Versus-Host Disease
			Etiologies Unique to HSCT: Graft Failure
		Approach to Diagnosis of Transplant-Associated Cytopenias
		General Approach to Management of Transplant-Associated Cytopenias
		Conclusion
		Key Points
		Cross-References
		References
	69 Common and Emerging Infections in Pediatric Transplant Recipients
		Introduction
		Vaccine-Preventable Diseases
		Special Considerations in Pediatric Vaccination
			Rotavirus
			Measles
			Varicella
			Human Papillomavirus
			Influenza
			Additional Age-Specific Considerations
		Common, Non-Vaccine-Preventable Infections
			Respiratory Viral Infections
				Solid Organ Transplants
				Hematopoietic Cell Transplants
				Preventative Strategies
			Cytomegalovirus
			Epstein-Barr Virus
		Emerging Infections
			Enterovirus D68
			Acute Flaccid Myelitis
			Arboviruses
		Diagnostic Testing
			Determination of Serostatus
			Clostridioides Difficile
		Unique Aspects of Antimicrobial Therapy for Pediatric Transplant Patients
			Lack of Antimicrobial Dosing Data and Indication in Pediatrics
			Variations in Pediatric Pharmacokinetics
			Limitations in Route of Drug Administration
			Limitations in Adverse Event Assessment in Pediatrics
		Summary
		References
Index