“The microbe is nothing, the terrain is everything.” – Louis Pasteur
Infection Risk After Organ Transplant
Organ transplant recipients are at real risk from infections. Our lowered immunity means we are prone to infections. Worse still, it takes us longer to fight an infection. Therefore, it is crucial for transplant recipients to take extra precautions to protect their health. This post unpacks the most common infections of concern for organ transplant recipients. A later post unpacks the Tips for Preventing Infections.
Infections Lead To Treatments On Repeat
In my case an earlier Eye Enucleation caused Orbital Cellulitis.
At the start of 2024, I developed Orbital Cellulitis, which is an infection of tissue around the eye. The backstory to this is I had my left eye removed (Enucleation) in May 2017 due to a brain tumour on my optic nerve. I had lost my vision in the left eye in November 2009.
Since the eye enucleation I have worn a prosthesis. The prosthesis lens is a thin concave acrylic lens. This lens is similar to a thick contact lens. The lens is painted to identically match my natural eye. It sits over the actual prosthesis which is an orb surgically stitched into the once vacant eye socket. A layer of my natural eye membrane covers the implanted prosthetic orb. This means I can feel an eyelash or dust in my eye, similar to our natural eye’s sensitivity. I know it’s AMAZING! Right?
What Does A Prosthetic Eye Look Like?
Prior to my heart transplant I had worn the pretty painted lens without issue. However, after the transplant with my lowered immunity I started to have trouble with a reoccurring infection called cellulitis. The lens was rubbing on the tissue inside the eye socket, causing irritation. This soon developed into an infection.
Signs Of Infection
I noticed my high fever immediately due to my home health monitoring routine. I also felt a burning sensation and pain when I moved my eyes around. Within hours I had pain on the whole left side of my forehead, temple, cheek and jaw.
I immediately used Chlorsig eye drops and began a course of oral antibiotics. I suggest every medicine and first aid cabinet has a tube of Chlorsig ointment or the drops. It is the strongest antibiotic available over the counter without a need for a prescription. I also keep a box of broad spectrum oral antibiotics on hand.
I called the transplant team doctor on call and he advised me to present at my local ED. Once in ED they admitted me. I was treated with multiple IV antibiotics and fluids. I was also screened for all other forms of infection.
Unfortunately over January to April, the infection kept returning. I was readmitted to hospital four more times. The length of stays varied from 3 days to 2 weeks. Finally since May it appears my lowered immunity has finally gotten on top of the infection.
More Posts To Read
If you would like to know more about what you are not told before having a transplant read my post: What You Need To Know About A Heart Transplant. There is also a three part series about Transplant medications you can find in the BLOG page which has lots of tips and tricks to assist you post transplant. In future I will write a post about coping with Enucleation and an Artificial Eye. Let me know in the comment form below if you would like this to be one of my next posts and I’ll bump it up my content list.
For this post I used a variety of resources and highly recommend them if you need more information. I have provided references and links at the end of the post. Below is an overview of the most common infections encountered by transplant recipients.
Risks After Your Organ Transplant
Solid Organ Transplant Recipients are most at risk from:
- Rejection of the transplanted organ.
- Infection due to the immunosuppressant medications.
- Side effects of the immunosuppressant medications including malignancy.
Infections Following Transplant: Types, Symptoms, and Effective Treatment
Transplant recipients are particularly vulnerable to infections due to several factors, including immunosuppressive medications, exposure from the donor, and their previous history of infections. Early detection and treatment of these infections are critical to ensure the health and longevity of the transplanted organ and the patient.
Prompt reporting of symptoms like fever, cough, shortness of breath, and lethargy, along with diagnostic tests such as sputum samples and nasopharyngeal swabs (NPS), is essential in identifying and managing infections. Below is an overview of the most common infections encountered by transplant recipients.
Bacterial Pneumonia
Bacterial pneumonia can occur early in the postoperative period. Common symptoms include cough (with or without sputum), shortness of breath, and fever. Diagnosis typically involves sputum cultures, and treatment generally involves antibiotics. Early intervention can prevent severe complications.
Respiratory Syncytial Virus (RSV)
RSV is a major cause of lower respiratory tract infections, particularly in infants and young children. Lung and heart transplant recipients are especially susceptible. RSV is prevalent in the autumn and winter months and presents with symptoms similar to colds and flu. Treatment includes oral antibiotics and supportive care.
Other Respiratory Flu Viruses
Influenza, H1N1 (Swine Flu), and Human Metapneumovirus (hMPV) are common during the autumn and winter seasons. These viruses can lead to severe respiratory illness in transplant patients, often requiring hospitalisation and isolation. Immediate treatment with antiviral medications is crucial to managing these infections.
Aspergillus
Aspergillus is a fungal infection that often appears as a lesion or cavity on a chest x-ray and can be detected in sputum samples or bronchoscopy washings. Due to the persistence of fungal infections, long-term antifungal therapy is necessary, sometimes lasting several months.
Cytomegalovirus (CMV)
CMV can be life-threatening if not treated promptly. Both the recipient’s and the donor’s CMV status are important indicators of risk for CMV activation. High-risk patients usually receive prophylactic intravenous ganciclovir, followed by oral valganciclovir, to prevent infection.
Epstein-Barr Virus (EBV)
In the general population, EBV is often harmless. However, in transplant recipients, it can be associated with post-transplant lymphoproliferative disorder (PTLD), a type of cancer. Monitoring EBV status is crucial for early detection and intervention.
Herpes Simplex Virus (HSV)
HSV can cause oral cold sores and ulcers, which can appear at any time post-transplant. Early reporting and antiviral treatment are important to prevent severe outbreaks and complications.
Pneumocystis Jiroveci Pneumonia (PJP)
PJP is a serious fungal infection that can cause severe chest infections in transplant patients. Prophylactic treatment with Bactrim DS twice a week is standard to prevent this infection.
Methicillin-Resistant Staphylococcus Aureus (MRSA)
MRSA can be cultured from the skin, wounds, sputum, blood, and urine. It is typically treated with Vancomycin. Patients with MRSA are usually isolated in single rooms to prevent the spread of this resistant infection.
Vancomycin-Resistant Enterococci (VRE)
Routine rectal swabs are used to test for VRE. If present, patients are isolated in single rooms. Infection control measures are critical to preventing the spread of VRE within healthcare settings.
Finally …
Managing infections in transplant recipients requires vigilance, early detection, and prompt treatment. Regular home health monitoring and reporting of symptoms, along with routine diagnostic testing, are essential strategies in preventing severe complications. By understanding and managing these common infections, transplant recipients can achieve better health outcomes and maintain the function of their transplanted organs.
Where are you on your transplant journey? Are you a carer or relative of a donor or transplant recipient? Reach out and let me know in the form below.
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References
“Infections Following Transplant: An Overview.” Transplantation Proceedings, vol. 51, no. 3, 2019, pp. 1012-1018. Transplantation Proceedings
Fishman, Jay A. “Infection in Solid-Organ Transplant Recipients.” New England Journal of Medicine, vol. 357, no. 25, 2007, pp. 2601-2614. NEJM
“Respiratory Syncytial Virus (RSV) Infection.” Centers for Disease Control and Prevention, 2022. CDC
Kotton, Camille N. “Management of Cytomegalovirus Infection in Solid Organ Transplant Recipients.” American Journal of Transplantation, vol. 13, no. s4, 2013, pp. 93-106. American Journal of Transplantation
Florescu, Diana F., and James S. Sandkovsky. “Infection Prophylaxis in Solid Organ Transplant Recipients.” Current Opinion in Organ Transplantation, vol. 19, no. 4, 2014, pp. 381-392. Current Opinion in Organ Transplantation
“MRSA Infections.” Mayo Clinic, 2023. Mayo ClinicPappas, Peter G., et al. “Clinical Practice Guidelines for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.” Clinical Infectious Diseases, vol. 62, no. 4, 2016, pp. e1-e50. Clinical Infectious Diseases
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