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[Infections in immunocompromised patients (II). The transplanted patient].

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Transplant recipients face significant infection risks, particularly after haematopoietic stem cell transplantation and solid organ transplantation. Monitoring for nosocomial, fungal, viral, and opportunistic infections is crucial throughout recovery.

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Area of Science:

  • Infectious Diseases
  • Transplant Immunology
  • Critical Care Medicine

Context:

  • Transplant recipients are highly susceptible to infections, posing a major clinical challenge.
  • Infections vary in type and timing depending on the transplantation type (hematopoietic stem cell vs. solid organ).
  • Graft-versus-host disease increases infection risk in hematopoietic stem cell transplant recipients.

Purpose:

  • To outline the spectrum and temporal patterns of infections following different types of transplantation.
  • To highlight key pathogens and clinical presentations, including invasive fungal and viral infections.
  • To discuss the impact of immunosuppressive strategies and surgical advances on infection-related outcomes.

Summary:

  • Nosocomial infections are prevalent early after hematopoietic stem cell transplantation (30-100 days), with invasive fungal or P. jirovecii pneumonia presenting as nodular or diffuse lung lesions.
  • Late infections, such as CMV, persist beyond 100 days post-hematopoietic stem cell transplantation.
  • Solid organ transplant recipients experience nosocomial infections in the first month, followed by opportunistic infections (1-6 months), with a shift to community-acquired infections later.

Impact:

  • Improved understanding of infection risks aids in timely diagnosis and management, potentially reducing transplant-related morbidity and mortality.
  • Informed clinical practice can optimize prophylactic and therapeutic strategies for infection prevention in transplant populations.
  • Advances in surgical techniques and immunosuppression have demonstrably reduced infection-related mortality in solid organ transplant recipients.