1
|
Tanaka T, Kakiuchi S, Tashiro M, Fujita A, Ashizawa N, Eguchi S, Kenmochi T, Egawa H, Izumikawa K. Adherence to recommended vaccination policies for pre- and post-solid organ transplantation patients: A national questionnaire survey in Japan. Vaccine 2023; 41:7682-7688. [PMID: 38007343 DOI: 10.1016/j.vaccine.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Pre-transplant vaccination is recommended for patients undergoing solid organ transplantation (SOT). While appropriate vaccination protocols are implemented at some facilities, transplantation is sometimes performed with inadequate preoperative vaccine management. Vaccination rates vary across facilities, but those of SOT centers in Japan have never been investigated. This study aimed to conduct a nationwide questionnaire survey to assess pre- and post-transplant vaccination policies among SOT facilities in Japan. METHODS The survey was conducted from September to November 2022. All registered (n = 221) solid organ (namely, the lungs, liver, kidneys, pancreas, heart, and small intestine) transplant facilities were asked to complete a web-based survey. RESULTS The survey response rate was 70.2 %. Live and inactivated vaccines were recommended at 64.9 % and 68.9 % of the responding facilities, respectively. The following vaccines were incorporated into the vaccination protocols of facilities: pneumococcal vaccine, 31.7 % (13-valent pneumococcal conjugate vaccine) and 65.4 % (23-valent pneumococcal polysaccharide vaccine); hepatitis B virus vaccine, 67.3 %; severe acute respiratory syndrome coronavirus 2 vaccine, 73.1 %; influenza vaccine, 73.1 %; and zoster vaccines, 23.1 %. The reasons for unresponsiveness to vaccinations included inadequate time before transplantation (60.3 %), cost burden (41.1 %), high number of vaccinations (21.9 %), no recognition of the need for vaccination (17.9 %), and the requirement to explain the need for vaccination (15.2 %). CONCLUSIONS Our study revealed gaps in vaccination practices across nationwide facilities in Japan. The findings indicate the importance of promoting scheduled efficiency and encouraging the national health system to reduce vaccine costs with the support of public subsidies.
Collapse
Affiliation(s)
- Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Satoshi Kakiuchi
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| | - Ayumi Fujita
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Nobuyuki Ashizawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| |
Collapse
|
2
|
Kelgeri C, Kelly DF, Brant A, Patel M, Gupte GL. Principles of immunisation in children with solid organ transplant. Arch Dis Child 2021; 106:219-223. [PMID: 32938624 DOI: 10.1136/archdischild-2020-319822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
Vaccine-preventable diseases (VPD) are a significant risk to paediatric solid organ transplant (SOT) recipients on lifelong immunosuppressive therapy. Children progressing to end-stage organ dysfunction are unable to mount a robust immune response. Hence, it is important to plan vaccination early in the course of disease, especially if a child is anticipated to be a SOT candidate. Vaccine recommendations need to be individualised in this population based on vaccine history and serology. Catch-up or accelerated schedules may be used to complete vaccinations before transplant. Post-transplant, immunisation is recommenced in consultation with the transplant team taking into context the time since transplant and the intensity of the immunosuppressive regime. Inactivated vaccines are safe post-transplant but postexposure prophylaxis may still be required in children with inadequate immunity to VPD. Specific vaccines may be advised for SOT recipients travelling abroad (in consultation with a travel clinic) or those entering high-risk professions. Additionally, the vaccination status of all household members and close contacts should be reviewed and optimised, offering additional protection to the transplant recipient.
Collapse
Affiliation(s)
- Chayarani Kelgeri
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Dominic F Kelly
- Department of Paediatrics, University of Oxford, Oxford, Oxfordshire, UK
| | - Alexandra Brant
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mitul Patel
- Department of Microbiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Girish L Gupte
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
3
|
Albert J, Hanisch B, Sgambat K. Approaches to safe living and diet after solid organ transplantation. Pediatr Transplant 2021; 25:e13783. [PMID: 32721079 DOI: 10.1111/petr.13783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 12/24/2022]
Abstract
SOT recipients are at high risk for developing severe infectious complications following discharge from the hospital. Comprehensive anticipatory guidance surrounding everyday lifestyle choices can potentially prevent exposure to infectious agents from the environment. This paper reviews the risks that pediatric and adolescent SOT recipients encounter through exposures such as household contacts, outdoor activities, travel, animal exposures, and dietary choices. Although strong evidence is lacking, this paper makes recommendations aimed at minimizing the risk of infectious complications and hospitalization in pediatric SOT recipients.
Collapse
Affiliation(s)
- Jonathan Albert
- Pediatric Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA
| | - Benjamin Hanisch
- Pediatric Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA
| | - Kristen Sgambat
- Pediatric Nephrology, Children's National Hospital, Washington, District of Columbia, USA
| |
Collapse
|
4
|
The Importance of Prioritizing Pre and Posttransplant Immunizations in an Era of Vaccine Refusal and Epidemic Outbreaks. Transplantation 2020; 104:33-38. [PMID: 31876696 DOI: 10.1097/tp.0000000000002936] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vaccine-preventable infections are occurring at epidemic rates both nationally and internationally. At the same time, rates of vaccine hesitancy and refusal are increasing across the country leading to decreased herd immunity. For immunosuppressed transplant recipients, this situation poses great risk. Currently, 1 in 6 pediatric solid organ transplant recipients is hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. For many recipients, these infections result in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, despite this risk many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. As a transplant community, we must prioritize immunizations in both pre and posttransplant care. Research is needed to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. Finally, recommendations about administration of live vaccines posttransplant may need to be reevaluated in the setting of measles outbreaks and decreased herd immunity.
Collapse
|
5
|
Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
Collapse
Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
6
|
Abstract
Living safely after organ transplantation starts before transplant and continues after transplant. To minimize a solid organ transplant (SOT) recipient's risk for infection and risk for injury, it is important to plan for numerous potential exposures after transplant. These include potential exposure to others with viral or bacterial illness, potential exposure to food and water sources, participation in recreational activities, resuming sexual activity, living with pets, and opportunities for travel, especially internationally. Addressing these risks head-on ensures that an SOT recipient and their providers can plan accordingly and anticipate measures that will assist with maintaining such health.
Collapse
Affiliation(s)
- Barbra M Blair
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
| |
Collapse
|
7
|
Abstract
Living safely after organ transplantation starts before transplant and continues after transplant. To minimize a solid organ transplant (SOT) recipient's risk for infection and risk for injury, it is important to plan for numerous potential exposures after transplant. These include potential exposure to others with viral or bacterial illness, potential exposure to food and water sources, participation in recreational activities, resuming sexual activity, living with pets, and opportunities for travel, especially internationally. Addressing these risks head-on ensures that an SOT recipient and their providers can plan accordingly and anticipate measures that will assist with maintaining such health.
Collapse
|
8
|
Viral Hepatitis Recommendations for Solid-Organ Transplant Recipients and Donors. Transplantation 2018; 102:S66-S71. [PMID: 29381580 DOI: 10.1097/tp.0000000000002013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
9
|
Tarazona B, Díaz-Menéndez M, Mato Chaín G. International travelers receiving pharmacological immunosuppression: Challenges and opportunities. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.medcle.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
10
|
|
11
|
Tarazona B, Díaz-Menéndez M, Mato Chaín G. International travelers receiving pharmacological immunosuppression: Challenges and opportunities. Med Clin (Barc) 2017; 150:233-239. [PMID: 29096964 DOI: 10.1016/j.medcli.2017.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
There is an increasing number of international travelers receiving immunosuppressive therapy due to the better life expectation and quality offered by this kind of treatment. The complexity of pre-travel counseling in these patients lies in their greater susceptibility to certain travel-related infections and the potential severity of these, as well as in the contraindications and interactions that may occur between certain vaccines and/or prophylaxis and their base therapy. Counseling the traveler represents a challenge for clinicians who have to tailor vaccinations and other recommended preventive measures to the immunosuppressed patients. Thus, pre-travel assessment of patients receiving immunosuppressive therapy should be performed in a specialized Traveler's Medical Unit, working closely with the specialist doctor in charge of treating the patient's underlying medical condition. The purpose of this article is to review available evidence on the health recommendations indicated in the pre-travel administration of vaccines, antimalarial chemoprophylaxis and other measures to prevent communicable diseases in travelers receiving immunosuppressive therapy.
Collapse
Affiliation(s)
- Belisa Tarazona
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Marta Díaz-Menéndez
- Unidad de Medicina Tropical y del Viajero, Hospital Universitario La Paz-Carlos III, Madrid, España.
| | - Gloria Mato Chaín
- Unidad de Vacunación del Adulto, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| |
Collapse
|
12
|
van Aalst M, Verhoeven R, Omar F, Stijnis C, van Vugt M, de Bree GJ, Goorhuis A, Grobusch MP. Pre-travel care for immunocompromised and chronically ill travellers: A retrospective study. Travel Med Infect Dis 2017; 19:37-48. [PMID: 28712659 DOI: 10.1016/j.tmaid.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Immunocompromised and chronically ill travellers (ICCITs) are susceptible to travel related diseases. In ICCITs, pre-travel care regarding vaccinations and prophylactics is complex. We evaluated the protection level by preventive measures in ICCITs by analysing rates of vaccination protection, antibody titres, and the prescription of standby antibiotics. METHODS We analysed, and reported according to STROBE guidelines, pre-travel care data for ICCITs visiting the medical pre-travel clinic at the Academic Medical Centre, The Netherlands from 2011 to 2016. RESULTS We analysed 2104 visits of 1826 ICCITs. Mean age was 46.6 years and mean travel duration 34.5 days. ICCITs on immunosuppressive treatment (29.7%), HIV (17.2%) or diabetes mellitus (10.2%) comprised the largest groups. Most frequently visited countries were Suriname, Indonesia, and Ghana. Most vaccination rates were >90%. Of travellers in high need of hepatitis A and B protection, 56.6 and 75.7%, underwent titre assessments, respectively. Of ICCITs with a respective indication, 50.6% received a prescription for standby antibiotics. CONCLUSION Vaccination rates in our study population were overall comparable to those of healthy travellers studied previously in our centre. However, regarding antibody titre assessments and prescription of standby antibiotics, this study demonstrates that uniform pre-travel guidelines for ICCITs are highly needed.
Collapse
Affiliation(s)
- Mariëlle van Aalst
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Roos Verhoeven
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Freshta Omar
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Cornelis Stijnis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Michèle van Vugt
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Godelieve J de Bree
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Pieterbergweg 17, 1105BM Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100AZ Amsterdam, The Netherlands.
| |
Collapse
|
13
|
Rello J, Manuel O, Eggimann P, Richards G, Wejse C, Petersen JE, Zacharowski K, Leblebicioglu H. Management of infections in critically ill returning travellers in the intensive care unit-II: clinical syndromes and special considerations in immunocompromised patients. Int J Infect Dis 2016; 48:104-12. [PMID: 27134159 PMCID: PMC7110459 DOI: 10.1016/j.ijid.2016.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 12/29/2022] Open
Abstract
This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants) and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients), respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarizes considerations regarding clinical syndromes requiring ICU admission in travellers, covering immunocompromised patients.
Collapse
Affiliation(s)
- Jordi Rello
- CIBERES, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Centre, BH 10/553, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Philippe Eggimann
- Department of Adult Intensive Care Medicine, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Guy Richards
- University of the Witwatersrand, Johannesburg, South Africa
| | - Christian Wejse
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Hakan Leblebicioglu
- Infectious Disease Department, Ondokuz Mayis University Medical School, Samsun, Turkey
| |
Collapse
|
14
|
Abstract
Luks, Andrew M. Clinician's corner: travel to high altitude following solid organ transplantation. High Alt Med Biol. 17:147-156, 2016.-As they regain active lifestyles following successful organ transplantation, transplant recipients may travel to high altitude for a variety of activities, including skiing, climbing, and trekking. This review is intended to provide information for medical providers who may encounter transplant patients seeking advice before planned high altitude travel or care for medical issues that develop during the actual sojourn. There is currently limited information in the literature about outcomes during high-altitude travel following solid organ transplantation, but the available evidence suggests that the physiologic responses to hypobaric hypoxia are comparable to those seen in nontransplanted individuals and well-selected transplant recipients with no evidence of organ rejection can tolerate ascents as high as 6200 m. All transplant recipients planning high-altitude travel should undergo pretravel assessment and counseling with an emphasis on the recognition, prevention, and treatment of altitude illness, as well as the importance of preventing infection and limiting sun exposure. Transplant recipients can use the standard medications for altitude illness prophylaxis and treatment, but the choice and dose of medication should take into account the patient's preexisting medication regimen and current renal function. With careful attention to these and other details, the healthy transplant recipient can safely experience the rewards of traveling in the mountains.
Collapse
Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington , Seattle, Washington
| |
Collapse
|
15
|
Trubiano JA, Johnson D, Sohail A, Torresi J. Travel vaccination recommendations and endemic infection risks in solid organ transplantation recipients. J Travel Med 2016; 23:taw058. [PMID: 27625399 DOI: 10.1093/jtm/taw058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are often heavily immunosuppressed and consequently at risk of serious illness from vaccine preventable viral and bacterial infections or with endemic fungal and parasitic infections. We review the literature to provide guidance regarding the timing and appropriateness of vaccination and pathogen avoidance related to the immunological status of SOT recipients. METHODS A PUBMED search ([Vaccination OR vaccine] AND/OR ["specific vaccine"] AND/OR [immunology OR immune response OR cytokine OR T lymphocyte] AND transplant was performed. A review of the literature was performed in order to develop recommendations on vaccination for SOT recipients travelling to high-risk destinations. RESULTS Whilst immunological failure of vaccination in SOT is primarily the result of impaired B-cell responses, the role of T-cells in vaccine failure and success remains unknown. Vaccination should be initiated at least 4 weeks prior to SOT or more than 6 months post-SOT. Avoidance of live vaccination is generally recommended, although some live vaccines may be considered in the specific situations (e.g. yellow fever). The practicing physician requires a detailed understanding of region-specific endemic pathogen risks. CONCLUSIONS We provide a vaccination and endemic pathogen guide for physicians and travel clinics involved in the care of SOT recipients. In addition, recommendations based on timing of anticipated immunological recovery and available evidence regarding vaccine immunogenicity in SOT recipients are provided to help guide pre-travel consultations.
Collapse
Affiliation(s)
- Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Infectious Diseases, Peter MaCallum Cancer Centre, Melbourne, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Douglas Johnson
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia Department of General Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Asma Sohail
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Joseph Torresi
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia Eastern Infectious Diseases and Travel medicine, Knox Private Hospital, Boronia, VIC, Australia
| |
Collapse
|
16
|
Bialy C, Horne K, Dendle C, Kanellis J, Littlejohn G, Ratnam I, Woolley I. International travel in the immunocompromised patient: a cross-sectional survey of travel advice in 254 consecutive patients. Intern Med J 2016; 45:618-23. [PMID: 25827660 DOI: 10.1111/imj.12753] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/09/2015] [Indexed: 12/11/2022]
Abstract
AIMS Our primary aim was to determine the rate of overseas travel in immunocompromised individuals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology. METHODS We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital. RESULTS We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive individuals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups. CONCLUSIONS Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics.
Collapse
Affiliation(s)
- C Bialy
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - K Horne
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kanellis
- Department of Nephrology, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Melbourne, Victoria, Australia
| | - G Littlejohn
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - I Ratnam
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Services, Melbourne Health, Melbourne, Victoria, Australia
| | - I Woolley
- Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Allen JE, Patel D. Enquiries to the United Kingdom National Travel Advice Line by healthcare professionals regarding immunocompromised travellers. J Travel Med 2016; 23:taw016. [PMID: 27021497 DOI: 10.1093/jtm/taw016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND People who travel while immunocompromised are more at risk of serious travel-related infection. Their condition, medications or treatments can contraindicate, decrease the effectiveness of or increase the toxicity of vaccinations or malaria chemoprophylaxis. Therefore, immunocompromised travellers require careful assessment and specialized pre-travel advice. The aims of this study were to investigate enquiries by healthcare professionals (HCPs) to the UK National Travel Health Network and Centre (NaTHNaC) advice line regarding travellers with immunocompromise and to identify their most common concerns. METHODS Documentation for all calls taken by advisers at the London office during 2013 was reviewed. RESULTS Of the 4910 enquiries to the London NaTHNaC advice line, 397 calls concerned immunocompromised travellers (8.1%). The majority of immunocompromised travellers were planning to visit Sub-Saharan Africa (53%) for the purpose of tourism (43%). Sixty-seven percent of enquiries concerned vaccine use, 11% were about malaria chemoprophylaxis, 20% were about both and 2% were for other reasons. Causes of immunocompromise included inflammatory or autoimmune conditions (43%), cancer (18%), splenic dysfunction (13%), immunosuppressive drugs (12%), human immunodeficiency virus (11%), primary immunodeficiency (1%), neutropenia (0.5%) and thymus abnormalities (0.5%). CONCLUSIONS There were frequent enquires to the advice line by UK HCPs regarding immunocompromised travellers. The travellers in this study had a wide range of underlying medical conditions and varying levels of immunocompromise. These enquiries may reflect a lack of clarity in current national guidelines, difficulties in interpreting them or both. Establishing the reasons for these deficiencies as well as the reasons behind UK HCP concerns and lack of confidence requires further investigation. This research has highlighted potential knowledge gaps and will help inform future guidance and educational activities for UK HCPs advising travellers.
Collapse
Affiliation(s)
| | - Dipti Patel
- National Travel Health Network and Centre, London, UK
| |
Collapse
|
18
|
Dekkiche S, de Vallière S, D'Acremont V, Genton B. Travel-related health risks in moderately and severely immunocompromised patients: a case-control study. J Travel Med 2016; 23:taw001. [PMID: 26929155 DOI: 10.1093/jtm/taw001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of immunocompromised persons travelling to tropical countries is increasing. The hypothesis is that this population is at increased risk of travel-related health problems but there are few data to support it. The objective was to assess the risk of travel-related health problems in immunocompromised persons when compared with the general population of travellers. METHODS A retrospective matched case-control study was performed. Cases were moderately or severely immunocompromised persons travelling to tropical countries and controls were non-immunocompromised persons, matched for demographic and travel characteristics. All participants responded to a phone questionnaire, asking them about any health problem they may have encountered while travelling or during the month following their return. The primary outcome was the incidence of a significant clinical event defined as repatriation, hospitalization during the travel or during the month following the return if due to a travel-related health problem and medical consultations during the trip. RESULTS One hundred and sixteen moderately or severely immunocompromised cases [HIV infection (15), active cancer (25), splenectomized (20), solid organ transplant recipients (4) and use of systemic immunosuppressive medication (52)] and 116 controls were included. Incidence rates of significant clinical events were higher in immunocompromised travellers (9/116, 7.8%) than in controls (2/116, 1.7%) [OR = 4.8 , 95% CI 1.01-22.70; P = 0.048]. Most cases were related to infectious diseases (5/9, 55.5%), others were pulmonary embolism (2/9, 22%), inflammatory disease and trauma (1/9, 11.1% each). There was no significant difference between the two groups regarding common health problems. CONCLUSION Moderately and severely immunocompromised travellers are at increased risk of developing a serious health problem during or after a trip in a tropical country. They should be well informed about the specific risks they are particularly prone to. Travel medicine health professionals should favour effective preventive measures for immunocompromised travellers and envisage stand-by antibiotic treatment.
Collapse
Affiliation(s)
- Souad Dekkiche
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
| | - Serge de Vallière
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Infectious Disease Service, University Hospital, Lausanne, Switzerland
| | - Valérie D'Acremont
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Blaise Genton
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland Infectious Disease Service, University Hospital, Lausanne, Switzerland Swiss Tropical and Public Health Institute, Basel, Switzerland
| |
Collapse
|
19
|
Jain A, Humar A, Lien D, Weinkauf J, Kumar D. Strategies for safe living among lung transplant recipients: a single-center survey. Transpl Infect Dis 2015; 17:185-91. [PMID: 25728826 DOI: 10.1111/tid.12354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/17/2014] [Accepted: 12/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung transplant (LT) recipients are at high risk for infection owing to lifelong immunosuppression and direct communication of the graft with the environment. Guidelines have been established for safe-living strategies after transplantation. We conducted a survey of LT patients to determine compliance with these strategies. METHODS Adult LT outpatients completed a survey consisting of questions on a 5-point Likert scale with the following categories: hand washing, gardening, respiratory infections, food and water safety, animal contact, travel, and occupation. RESULTS A total of 194 LT recipients completed the survey (age 54.4 ± 13.3 years; time post transplant 4.76 ± 3.5 years). Regular hand washing was practiced usually or always by 87.6%. Of those who worked with soil/gardened, 70/99 (70.7%) never wore a mask and 15.7% never wore gloves. Pet ownership was common (52%), but most patients used specific precautions during handling. Over one-third of patients continued employment after transplant but, of these, 56% had modified their occupation often because of perceived infectious risks. Most patients were fully compliant with influenza vaccination (92.3%). Patients <40 years of age were less likely to wear long-sleeved clothing in mosquito season (P = 0.002), more likely to handle pet feces (P = 0.005), and less likely to wear a mask with sick contacts (P = 0.021). CONCLUSIONS We provide important insight into safe-living practices following lung transplantation and identify specific areas and subgroups of patients that could be targeted for enhanced education, with potential significant clinical benefit.
Collapse
Affiliation(s)
- A Jain
- Transplant Infectious Diseases, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
20
|
Patel RR, Liang SY, Koolwal P, Kuhlmann FM. Travel advice for the immunocompromised traveler: prophylaxis, vaccination, and other preventive measures. Ther Clin Risk Manag 2015; 11:217-28. [PMID: 25709464 PMCID: PMC4335606 DOI: 10.2147/tcrm.s52008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Immunocompromised patients are traveling at increasing rates. Physicians caring for these complex patients must be knowledgeable in pretravel consultation and recognize when referral to an infectious disease specialist is warranted. This article outlines disease prevention associated with international travel for adults with human immunodeficiency virus, asplenia, solid organ and hematopoietic transplantation, and other immunosuppressed states. While rates of infection may not differ significantly between healthy and immunocompromised travelers, the latter are at greater risk for severe disease. A thorough assessment of these risks can ensure safe and healthy travel. The travel practitioners' goal should be to provide comprehensive risk information and recommend appropriate vaccinations or prevention measures tailored to each patient's condition. In some instances, live vaccines and prophylactic medications may be contraindicated.
Collapse
Affiliation(s)
- Rupa R Patel
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Pooja Koolwal
- Division of Medical Education, Washington University School of Medicine, St Louis, MO, USA
| | | |
Collapse
|
21
|
Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to Hepatitis A Vaccination in Immunocompromised Travelers. J Infect Dis 2015; 212:378-85. [PMID: 25649170 DOI: 10.1093/infdis/jiv060] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/26/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hepatitis A vaccines are highly immunogenic in healthy patients, but there is uncertainty about their immunogenicity in immunocompromised patients. METHODS Our study included immunocompromised patients who received 1 or 2 hepatitis A vaccinations between January 2011 and June 2013. We assessed factors that influenced the serologic response to vaccination. We performed a literature review of previous studies on hepatitis A vaccination in immunocompromised patients. RESULTS Of 85 immunocompromised patients, 65 used immunosuppressive drugs, 13 had received stem cell transplants, and 7 were infected with human immunodeficiency virus. After vaccination, 65 of 85 (76.5%) developed antibodies. Tumor necrosis factor α blocker use was associated with better serologic responses than other immunosuppressive drugs. Female patients were more compliant than male patients with postvaccination antibody titer measurements. In 11 relevant studies, antibody responses after the first and second vaccination averaged 37% and 82%, respectively. Factors that negatively influenced serologic response rates were high doses of immunosuppressive drugs, fewer hepatitis A vaccinations, and a short interval between vaccination and antibody measurement. CONCLUSIONS Immunocompromised patients showed moderate to good serologic responses to hepatitis A vaccination, but may need more time to develop immunity. Tumor necrosis factor α blocker use was associated with better antibody responses than other drugs. Specifically, male patients should be motivated to return for antibody titer measurements.
Collapse
Affiliation(s)
- Hannah M Garcia Garrido
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Rosanne W Wieten
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| |
Collapse
|
22
|
Mikati T, Griffin K, Lane D, Matasar M, Shah MK. International travel patterns and travel risks for stem cell transplant recipients. J Travel Med 2015; 22:39-47. [PMID: 25327693 DOI: 10.1111/jtm.12166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/14/2014] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stem cell transplantation (SCT) is being increasingly utilized for multiple medical illnesses. However, there is limited knowledge about international travel patterns and travel-related illnesses of stem cell transplant recipients (SCTRs). METHODS An observational cross-sectional study was conducted among 979 SCTRs at Memorial Sloan Kettering Cancer Center using a previously standardized and validated questionnaire. International travel post SCT, pre-travel health advice, exposure risks, and travel-related illnesses were queried. RESULTS A total of 516 SCTRs completed the survey (55% response rate); of these, 40% were allogeneic SCTRs. A total of 229 (44.3%) respondents reported international travel outside the United States and Canada post SCT. The international travel incidence was 32% [95% confidence interval CI 28-36] within 2 years after SCT. Using multivariable Cox regression analysis, variables significantly associated with international travel within first 2 years after SCT were history of international travel prior to SCT [hazard ratio (HR) = 5.3, 95% CI 2.3-12.0], autologous SCT (HR = 2.6, 95% CI 1.6-2.8), foreign birth (HR = 2.3, 95% CI 1.5-3.3), and high income (HR = 2.0, 95% CI 1.8-3.7). During their first trip, 64 travelers (28%) had traveled to destinations that may have required vaccination or malaria chemoprophylaxis. Only 56% reported seeking pre-travel health advice. Of those who traveled, 16 travelers (7%) became ill enough to require medical attention during their first trip after SCT. Ill travelers were more likely to have visited high-risk areas (60 vs 26%, p = 0.005), to have had a longer mean trip duration (24 vs 12 days, p = 0.0002), and to have visited friends and relatives (69 vs 21%, p < 0.0001). CONCLUSIONS International travel was common among SCTRs within 2 years after SCT and was mainly to low-risk destinations. Although the overall incidence of travel-related illnesses was low, certain subgroups of travelers were at a significantly higher risk. Pre-travel health counseling and interventions were suboptimal.
Collapse
Affiliation(s)
- Tarek Mikati
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Public Health, New York, NY, USA
| | | | | | | | | |
Collapse
|
23
|
Aung AK, Trubiano JA, Spelman DW. Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review. Travel Med Infect Dis 2014; 13:31-47. [PMID: 25593039 DOI: 10.1016/j.tmaid.2014.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity.
Collapse
Affiliation(s)
- A K Aung
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - J A Trubiano
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D W Spelman
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
[Traveling with immunosuppression]. Internist (Berl) 2014; 55:259-60, 262-7. [PMID: 24562763 DOI: 10.1007/s00108-013-3367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The rapidly increasing number of patients with immunosuppression is followed by their expectation to lead-as much as possible-a "normal" life, including long-distance travel. The advice and preventive measures for diseases associated with travelling depend overall on the mode of the patient's immunosuppression. This report explains the individual preventive possibilities, limits and risks for travellers with asplenia, common variable immunodeficiency, chronic inflammatory bowel and rheumatic diseases, HIV, as well as for patients having undergone solid organ or bone marrow transplantation or chemotherapy.
Collapse
|
25
|
Kotton CN. Vaccination and immunization against travel-related diseases in immunocompromised hosts. Expert Rev Vaccines 2014; 7:663-72. [DOI: 10.1586/14760584.7.5.663] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Hochberg NS, Barnett ED, Chen LH, Wilson ME, Iyer H, MacLeod WB, Yanni E, Jentes ES, Karchmer AW, Ooi W, Kogelman L, Benoit C, Hamer DH. International travel by persons with medical comorbidities: understanding risks and providing advice. Mayo Clin Proc 2013; 88:1231-40. [PMID: 24120073 DOI: 10.1016/j.mayocp.2013.07.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers. PATIENTS AND METHODS This cross-sectional study was conducted from March 1, 2008, through July 31, 2010, in 5 clinics in the greater Boston area. We assessed all travelers seen for pretravel care and compared demographic characteristics, travel plans, pretravel counseling, and interventions for healthy and high-risk travelers (as defined by medical history or pregnancy). RESULTS Of 15,440 travelers, 2769 (17.9%) were high-risk; 644 of 2769 (23.3%) were immunocompromised travelers, 2056 (74.3%) had medical comorbidities, and 69 (2.5%) were pregnant women. The median age of high-risk travelers was 47 years compared with 32 years for healthy travelers (P=.0001). High-risk travelers visited the clinic a median of 25 days (range, 10-44 days) before departure. Overall, 2562 (93.9%) of high-risk travelers visited countries with medium or high risk of typhoid fever, 2340 (85.7%) visited malaria-risk countries, and 624 (22.8%) visited yellow fever-endemic countries. Of travelers to yellow fever-endemic countries, 8 of 23 (34.8%) pregnant women and 64 of 144 (44.4%) immunocompromised travelers received yellow fever vaccine. Of eligible high-risk travelers, 11 of 76 (14.5%) received a pneumococcal vaccine, 213 of 640 (33.3%) influenza vaccine, and 956 of 2681 (35.7%) either tetanus-diphtheria or tetanus-diphtheria-pertussis vaccine. CONCLUSION High-risk travelers made up nearly 20% of patients in these travel clinics, and they mostly traveled to destinations with malaria and typhoid risk. For health care professionals caring for travelers with underlying medical problems, providing appropriate travel counseling and making vaccine decisions, such as for yellow fever, are complex. Travelers with complicated medical histories may warrant evaluation by an experienced travel medicine specialist.
Collapse
Affiliation(s)
- Natasha S Hochberg
- Department of Medicine, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Travel medicine continues to grow as international tourism and patient medical complexity increases. This article reflects the state of the current field, but new recommendations on immunizations, resistance patterns, and treatment modalities constantly change. The US Centers for Disease Control and the World Health Organization maintain helpful Web sites for both patient and physician. With thoughtful preparation and prevention, risks can be minimized and travel can continue as safely as possible.
Collapse
Affiliation(s)
- Mayan Bomsztyk
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Seattle, WA 98105, USA.
| | | |
Collapse
|
28
|
|
29
|
Travel and transplantation: travel-related diseases in transplant recipients. Curr Opin Organ Transplant 2013; 17:594-600. [PMID: 23147910 DOI: 10.1097/mot.0b013e328359266b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Travel-related diseases may be seen in transplant recipients after travel, after transplant tourism, and via transmission from blood and organ donors, augmented by recent increases in travel, migration, and globalization. Such infections include tuberculosis, Plasmodium (malaria), Babesia, Trypanosoma cruzi (Chagas disease), Strongyloides, Coccidioides, Histoplasma, Leishmania, Brucella, HTLV, dengue, among numerous others. RECENT FINDINGS Review of cohorts of transplant recipients show that they tend to have minimal or suboptimal preparation prior to travel, with limited pretravel vaccination, medications, and education, which poses a greatly increased risk of travel-related infections and complications. The epidemiology of such travel-related infections in transplant recipients, along with methods for prevention, including vaccines, chemoprophylaxis, and education may help SOT recipients avoid travel-related infections, and are discussed in this review. SUMMARY Optimizing the understanding of the risk of tropical, geographically restricted, and other unusual or unexpected, travel-related infections will enhance the safety of vulnerable transplant recipients from potentially life-threatening infections.
Collapse
|
30
|
Kotton CN, Hibberd PL. Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:337-47. [PMID: 23465026 DOI: 10.1111/ajt.12125] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Kotton
- Transplant Infectious Disease and Compromised Host Program; Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
| | | | | |
Collapse
|
31
|
Mikati T, Taur Y, Seo SK, Shah MK. International travel patterns and travel risks of patients diagnosed with cancer. J Travel Med 2013; 20:71-7. [PMID: 23464712 DOI: 10.1111/jtm.12013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Immunocompromised travelers living with cancer can be at increased risk of travel-related illnesses. Their international travel patterns and associated risks remain largely unknown. METHODS This was a retrospective cohort study of all patients diagnosed with cancer who presented for pre-travel health advice between January 1, 2003 and June 30, 2011. Demographics, travel patterns, and infectious diseases exposure risks of immunocompromised travelers were characterized and compared with those of immunocompetent travelers. Reported travel-related illnesses were assessed in both groups. RESULTS A total of 149 travelers were included in this study. Fifty-one percent had solid tumors, 32% had hematological malignancies, and 17% underwent stem cell transplantation. Seventy travelers (47%) were immunocompromised. Immunocompromised travelers had similar demographics, trip itineraries, and infectious diseases exposure risks to hepatitis A, malaria, typhoid fever, and yellow fever as immunocompetent travelers. Most of the reported travel-related illnesses were of minor nature. CONCLUSION Travelers with cancer who have impaired immunity had similar infectious diseases exposure risks and travel patterns as travelers whose cancer is cured or in remission. Improved understanding of travel patterns and risks of patients with cancer may assist in providing more focused pre-travel health interventions to this complex subset of travelers.
Collapse
Affiliation(s)
- Tarek Mikati
- Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA
| | | | | | | |
Collapse
|
32
|
|
33
|
Lortholary O, Charlier C, Lebeaux D, Lecuit M, Consigny PH. Fungal Infections in Immunocompromised Travelers. Clin Infect Dis 2012; 56:861-9. [DOI: 10.1093/cid/cis935] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
34
|
Abstract
PURPOSE OF REVIEW To provide an updated perspective of the most common parasitic infections occurring in solid-organ transplant (SOT) recipients. RECENT FINDINGS Parasitic infections are an emerging problem in SOT programs and represent a diagnostic and therapeutic challenge. Transplantation in endemic areas - including medical tourism, international travel and migration - justify the necessity of considering parasitic infections in the differential diagnosis of posttransplant complications. Molecular techniques, such as PCR, may improve the diagnostic accuracy and help during the follow-up. SUMMARY Parasitic infections are an uncommon but potentially severe complication in SOT recipients. An increase of donors emigrated from tropical areas and more posttransplant patients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Transplant physicians should get familiar with parasitic infections and promote adherence to preventive measures in SOT recipients.
Collapse
|
35
|
Batista MV, Pierrotti LC, Abdala E, Clemente WT, Girão ES, Rosa DRT, Ianhez LE, Bonazzi PR, Lima AS, Fernandes PFCBC, Pádua-Neto MV, Bacchella T, Oliveira APP, Viana CFG, Ferreira MS, Shikanai-Yasuda MA. Endemic and opportunistic infections in Brazilian solid organ transplant recipients. Trop Med Int Health 2011; 16:1134-42. [DOI: 10.1111/j.1365-3156.2011.02816.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
36
|
Struijk GH, Minnee RC, Koch SD, Zwinderman AH, van Donselaar-van der Pant KAMI, Idu MM, ten Berge IJM, Bemelman FJ. Maintenance immunosuppressive therapy with everolimus preserves humoral immune responses. Kidney Int 2010; 78:934-40. [PMID: 20703211 DOI: 10.1038/ki.2010.269] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
While the guidelines for vaccination in renal transplant recipients recommend the use of pneumococcal polysaccharide (PPS) and tetanus toxoid (TT), their efficacy in immunocompromised renal transplant recipients is not known. Here we tested the effect of everolimus on immune responses after vaccination by measuring the capacity of 36 stable renal transplant recipients to mount cellular and humoral responses after vaccination. Twelve patients in each treatment arm received immunosuppressive therapy consisting of prednisolone (P) plus cyclosporine (CsA), mycophenolate sodium (MPA), or everolimus. Patients were vaccinated with the T-cell-dependent antigens immunocyanin and TT, and the T-cell-independent PPS. Treatment with CsA partially inhibited and MPA completely abolished the capacity to mount a primary humoral response, whereas everolimus left this largely intact. Recall responses were inhibited by MPA only. All drug combinations inhibited cellular responses against TT. In patients treated with MPA, B-cell numbers were severely reduced. Thus, combined with P, treatment with MPA completely disturbed primary and secondary humoral responses. Everolimus or CsA allowed the boosting of T-cell-dependent and -independent secondary humoral responses. Treatment with everolimus allowed a primary response.
Collapse
Affiliation(s)
- Geertrude H Struijk
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Parasitic infections are an uncommon but potentially severe complication in solid organ transplant (SOT) recipients. An increase in donors who have emigrated from tropical areas and more transplant recipients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Clinicians should include these infections in their differential diagnosis and promote adherence to preventive measures in SOT recipients.
Collapse
|
38
|
Kotton CN, Hibberd PL. Travel medicine and the solid organ transplant recipient. Am J Transplant 2009; 9 Suppl 4:S273-81. [PMID: 20070691 DOI: 10.1111/j.1600-6143.2009.02920.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
| | | | | |
Collapse
|
39
|
Transplantation and tropical infectious diseases. Int J Infect Dis 2009; 14:e189-96. [PMID: 19647464 DOI: 10.1016/j.ijid.2009.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/03/2009] [Accepted: 04/14/2009] [Indexed: 02/08/2023] Open
Abstract
The number of transplant recipients with tropical infectious diseases is growing due to increasing international travel and the rising number of transplants taking place in the tropics and subtropics. With increases in population migration, the prevalence of individuals infected with geographically restricted organisms also rises. There are three potential categories of tropical infections in transplant patients: (1) donor-related infections transmitted by the graft or through transfusion of blood products; (2) reactivation or recrudescence of latent infections in the donor recipient; and (3) de novo acquisition of infection in the post-transplant period through the traditional route of infection. We present an overall discussion of the association of parasitic (protozoa and helminths) and non-parasitic (viral, bacterial, and fungal) tropical infectious diseases and solid-organ and hematopoietic transplantation. We also suggest potential screening guidelines for some of these tropical infections.
Collapse
|
40
|
Bally S, Caillard S, Moulin B. [Recommendations before travelling for renal transplant patients]. Nephrol Ther 2009; 5:265-79. [PMID: 19406696 DOI: 10.1016/j.nephro.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
Abstract
Travel is now a reasonable objective of CKD patients after renal transplantation. However, immunosuppressive treatment makes them particularly susceptible to infections and may interfere with vaccinations and other drugs. Travel in countries with low health level should be strongly discouraged in the first six months after transplantation or following an acute event. Otherwise, specific consultations should be arranged to prepare the patient as soon as possible. Vaccinations should be started early before departure. Specific immunisations include vaccines against hepatitis A, typhoid, meningococcus and rabies in some cases. Living vaccines are formally contra-indicated. Particular attention should be paid for protection against insects because this is the only effective measure against diseases. In the case of malaria, it should be complemented by adapted chemoprophylaxis that should be started 15 days before the departure date. Advice on hygiene measures should be clarified because this can prevent numerous infections, especially of the digestive tract. Advice on the management of diarrhoea is essential, especially in terms of preventing dehydration. Finally, advice about transport and physical risks, especially those related to sun exposure, should also be addressed.
Collapse
Affiliation(s)
- Stéphane Bally
- Service de néphrologie-dialyse-transplantation rénale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | | | | |
Collapse
|
41
|
Vaccinations du voyageur adulte transplanté d’organes (à l’exclusion des receveurs de cellules souches hématopoïétiques). Med Mal Infect 2009; 39:225-33. [DOI: 10.1016/j.medmal.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 10/04/2008] [Accepted: 11/14/2008] [Indexed: 11/19/2022]
|
42
|
Perkins JD. Balloon dilation only versus balloon dilation plus stenting for posttransplantation biliary strictures. Liver Transpl 2009; 15:106-10. [PMID: 19109840 DOI: 10.1002/lt.21683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND STUDY AIMS Biliary strictures are a major cause of morbidity following liver transplantation. In the present prospective comparative trial, we evaluated balloon dilation vs. balloon dilation plus stenting with regard to technical and clinical efficacy as well as complications. PATIENTS AND METHODS A total of 32 patients with symptomatic biliary strictures after liver transplantation were assigned to balloon dilation (n = 17) or balloon dilation plus plastic stent placement (n = 15). The main outcome parameter was sustained clinical success defined as an interval of at least 3 months without further endoscopic intervention. Additional outcome parameters were assisted clinical success and treatment failure, as well as procedure-related complications. RESULTS The initial technical success and primary clinical success rates in the dilation group were both 100 %; in the stent group, the corresponding rates were 100 % and 93 % (n.s.). The sustained clinical success was 71 % vs. 73 %, respectively (n. s.). The time interval to reach sustained clinical success was 6.1 and 5.1 months, respectively (n. s.). No significant differences were found in assisted clinical success or in treatment failure. Complications were observed in 4.3 % in the dilation group and 13.6 % in the stent group (P < 0.05). Independent of the treatment group, a sustained clinical success in anastomotic strictures was achieved in 100 %, whereas the success rate of strictures of the donor hepatic duct was 50 % and of strictures involving the hilum, only 14 % (P < 0.05). CONCLUSIONS In patients with biliary strictures after liver transplantation, endoscopic balloon dilation alone was as effective as dilation plus stent placement. Stent placement was associated with a significantly higher complication rate. Endoscopic treatment of strictures of the biliary anastomosis is highly effective, whereas attempts to treat more complex strictures are less promising.
Collapse
Affiliation(s)
- James D Perkins
- Liver Transplantation Worldwide, University of Washington Medical Center, Seattle, WA
| |
Collapse
|
43
|
Cohn J, Blumberg EA. Immunizations for renal transplant candidates and recipients. ACTA ACUST UNITED AC 2008; 5:46-53. [DOI: 10.1038/ncpneph1003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/01/2008] [Indexed: 02/01/2023]
|
44
|
Abstract
BACKGROUND Although solid-organ transplant recipients (SOTR) have an increased risk of acquiring illnesses, they may not receive optimal pretravel care. We conducted a cross-sectional survey of travel activities and outcomes among SOTR. METHODS Two thousand five hundred fifty-four consecutive living SOTR from Mayo Clinic were surveyed regarding travel practices, pretravel counseling, exposure risks, and illness using a previously standardized and validated questionnaire. RESULTS One thousand one hundred thirty SOTR (44%) responded to the survey and were included in the study. The most common transplanted organs were liver (519 patients) and kidney (515 patients). Three hundred and three (27%) respondents reported travel outside of the United States or Canada after their transplant. Liver recipients were more likely to travel than other organ recipients. Ninety-six percent of travelers reported that they did not seek specific pretravel healthcare before their trip. Forty-nine SOTR (16%) traveled to destinations at higher risk for infectious diseases; travelers to these destinations were more likely to be men (73% vs. 54% of low-infection risk travelers, P=0.018) or born outside the United Stated or Canada (29% vs. 6% P<0.0001). Twenty-four travelers (8%) required medical attention because of illness; illness was more likely among travelers to high-infection risk (18%) than low-risk (6%) destinations, P=0.004. CONCLUSIONS International travel was common after solid organ transplantation, although the majority traveled to destinations at low risk for infectious disease. Although generally SOTR were able to travel safely, travelers to destinations at high-risk for infection had a significant rate of illness. Pretravel counseling and interventions were infrequent and should be improved.
Collapse
|
45
|
Park S, Ryu S, Jin K, Hwang E, Han S, Kim H, Cho W, Kwak J, Ahn K, Kim H. Acute Colitis Associated With Dengue Fever in a Renal Transplant Recipient. Transplant Proc 2008; 40:2431-2. [DOI: 10.1016/j.transproceed.2008.07.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Sester M, Gärtner BC, Girndt M, Sester U. Vaccination of the solid organ transplant recipient. Transplant Rev (Orlando) 2008; 22:274-84. [PMID: 18684606 DOI: 10.1016/j.trre.2008.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Active immunization is the most important way to protect immunocompromised patients from vaccine-preventable infectious diseases. Although live vaccines are contraindicated for most immunocompromised patients, many inactivated or conjugate vaccines are safe and generally recommended. Some vaccines are known to be of suboptimal immunogenicity in transplant recipients. As a consequence, this may be associated with an impaired ability to mount protective immunity. Nevertheless, even partial protection has been shown to confer significant benefit to this vulnerable patient group. To increase efficacy in generating protective immunity, patients should complete the full complement of recommended vaccinations early in the course of disease before transplantation. This review summarizes the general recommendations for vaccinations of adult transplant recipients and candidates including special considerations for household contacts and health care workers.
Collapse
Affiliation(s)
- Martina Sester
- Department of Internal Medicine IV, University of the Saarland, Homburg, Germany.
| | | | | | | |
Collapse
|
47
|
Coyle LA, Martin MM, Kurien S, Graham JD, Gallagher C, Silver MA, Slaughter MS. Destination Therapy: Safety and Feasibility of National and International Travel. ASAIO J 2008; 54:172-6. [DOI: 10.1097/mat.0b013e318167316d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
48
|
Speil C, Mushtaq A, Adamski A, Khardori N. Fever of unknown origin in the returning traveler. Infect Dis Clin North Am 2008; 21:1091-113, x. [PMID: 18061090 DOI: 10.1016/j.idc.2007.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The returning traveler with fever presents a diagnostic challenge for the health care provider. When evaluating such a patient, the highest priority should be given to diseases that are potentially fatal or may represent public health threats. A good history is paramount and needs to include destination, time and duration of travel, type of activity, onset of fever in relation to travel, associated comorbidities, and any associated symptoms. Pretravel immunizations and chemoprophylaxis may alter the natural course of disease and should be inquired about specifically. The fever pattern, presence of a rash or eschar, organomegaly, or neurologic findings are helpful physical findings. Laboratory abnormalities are nonspecific but when corroborated with clinical and epidemiologic data may offer a clue to diagnosis.
Collapse
Affiliation(s)
- Cristian Speil
- Division of Infectious Diseases, Department of Internal Medicine and Medical Microbiology/Immunology, Southern Illinois School of Medicine, Springfield, IL 62794-9636, USA
| | | | | | | |
Collapse
|
49
|
Roukens AHE, van Dissel JT, de Fijter JW, Visser LG. Health preparations and travel-related morbidity of kidney transplant recipients traveling to developing countries. Clin Transplant 2007; 21:567-70. [PMID: 17645721 DOI: 10.1111/j.1399-0012.2007.00691.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A cross-sectional, descriptive study was conducted among Dutch kidney transplant recipients to investigate travel health knowledge, attitudes and practices while staying abroad. A total of 290 individuals visiting the nephrology outpatient clinic completed the questionnaires. Thirty four percent of the responders had traveled outside Western Europe (WE) and Northern America (NA); 22% of these travelers did not seek pre-travel health advice. Transplant physicians were most frequently consulted for pre-travel advice (53%). Of the responders traveling outside WE and NA 29% were ill during their most recent journey. Diabetic transplant recipients were at the highest risk. Four of seventeen ill recipients (24%) were hospitalized, reflecting the high morbidity of travel-related disease in this patient group. Our data show that there is need for improvement of pre-travel healthcare, and suggest an important role for transplant physicians in providing adequate counseling.
Collapse
Affiliation(s)
- A H E Roukens
- Department of Infectious Diseases, Leiden Unviersity Medical Center, The Netherlands
| | | | | | | |
Collapse
|
50
|
Barsoum RS. Parasitic infections in transplant recipients. ACTA ACUST UNITED AC 2006; 2:490-503. [PMID: 16941042 DOI: 10.1038/ncpneph0255] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 04/12/2006] [Indexed: 01/20/2023]
Abstract
Parasitic infections are important complications of organ transplantation that are often overlooked in the differential diagnosis of post-transplantation pyrexial illness. Although their frequency is unknown, they seem to be much less prevalent than bacterial and viral infections. Only 5% of human pathogenic parasites have been reported to cause significant illness in transplant recipients. Infection can occur via transmission with the graft or blood transfusion, or be acquired de novo from the environment. Recrudescence of dormant infection can lead to active disease. Post-transplantation parasitic disorders tend to cluster into two clinical profiles. First, an acute systemic illness with anemia, constitutional manifestations and variable stigmata of organ involvement; acute graft dysfunction can lead to confusion and acute rejection. Protozoa including malarial Plasmodium, Leishmania, Trypanosoma and Toxoplasma are associated with this profile. The second typical manifestation encompasses a few localized syndromes, usually associated with the lower gastrointestinal tract, caused by either protozoa (Cryptosporidium and microsporidia) or nematodes (Strongyloides and Ascaris). Dissemination of localized infections can lead to life-threatening systemic manifestations. A high index of suspicion is essential, as diagnosis requires special sampling techniques and laboratory procedures. Definitive diagnosis is usually achieved by detecting the parasite in the patient's tissues or body fluids by histological examination or culture, or by polymerase chain reaction amplification of the parasite-specific antigen sequence. Antibody detection using serological techniques is also possible in a few parasitic infections. Certain lesions have characteristic radiological appearances, hence the value of imaging, particularly in the cerebral syndromes. Treatment is usually straightforward (broad spectrum or specific drugs), yet some species are drug resistant.
Collapse
|