Cryptococcus neoformans pericarditis in a lung transplant recipient: Case report,literature review and pearls

A 68‐year‐old man presented for outpatient evaluation of dyspnea and new‐onset atrial fibrillation 9 months after undergoing bilateral lung transplantation. Echocardiography prior to cardioversion raised concern for tamponade. Therapeutic pericardiocentesis returned fluid containing 1875 wbc/mcl (68% pmn) and yielded Cryptococcus neoformans in culture. Cryptococcal antigen was detected in serum at a titer of 1:20. Cerebrospinal (CSF) fluid was without evidence of inflammation and without detectable cryptococcal antigen. There was no radiographic evidence of pulmonary cryptococcosis. Cultures of blood and CSF were without growth. Liposomal amphotericin B (3 mg/kg/day) was administered for 15 days. Oral fluconazole was added on day seven of amphotericin, and the patient was discharged to home 3 days later. Daily dosages of prednisone (10 mg), mycophenolate (500 mg), and tacrolimus (3 mg) at discharge were the same as at hospital admission. He was readmitted 12 days later with dyspnea and with re‐accumulation and loculation of pericardial fluid. A pericardial window was created. Pericardial fluid contained 722 wbc/mcl (35% pmn); Cryptococcus was not identified on direct examinations or cultures of pericardial fluid or tissue. Cryptococcus antigen was present in serum at 1:160. Liposomal amphotericin B was resumed and continued for 2 weeks followed by resumption of fluconazole. Mycophenolate was stopped. Prednisone and tacrolimus were continued. Restrictive pericarditis was evident 3 weeks after window creation. Colchicine was initiated, prednisone increased to 15 mg daily and pericardiectomy planned. We aim to raise awareness to Cryptococcus as a potential etiology for pericarditis in solid organ transplant recipients.     

Mycoplasma hominis and Ureaplasma urealyticum infections in the immediate post-lung transplant period: A case series and literature review

Mycoplasma hominis and Ureaplasma species infections in the post-transplant setting are believed to be donor-derived and can be associated with poor outcomes. Difficulty in culturing and identifying these organisms is a significant barrier to diagnosis and early intervention. Tetracyclines, macrolides and fluoroquinolones are the mainstay treatments to cure these infections; however, there are increasing reports of antibiotic resistance. In this case series, we report our single-centre experience with M. hominis and U. urealyticum infection after lung transplantation (9 recipients, all men, mean age 56 years). Delayed diagnosis was common. Young donor age (mean age 23 yrs) and high-risk donor social history (67%) were repeatedly noted in these cases, and all infections were associated with significant morbidity (anastomosis and sternal wound infection, empyema, mediastinitis, pericarditis). Two patients died; with one directly related to Ureaplasma urealyticum infection. In conclusion post lung transplant M. hominis, and U. urealyticum infections are challenging and carry high morbidity. More prospective studies are required to assess the true prevalence, full spectrum of complications and utility of molecular diagnostics to aid early diagnosis and identify antibiotic susceptibility of Mycoplasma and Ureaplasma infections in the post-lung transplant setting.

     

Mycobacterium kansasii pericarditis in a kidney transplant recipient: a case report and comprehensive review of the literature

Mycobacterium kansasii is the second most common non‐tuberculous mycobacteria in kidney transplant recipients (KTRs) and has been reported to cause disseminated infection in KTRs. We report the first case to our knowledge of M. kansasii pericarditis after kidney transplantation in a 54‐year‐old man. The patient was admitted with a 2‐month history of intermittent fever and myalgia, treated with oral prednisolone and mycophenolate mofetil prior to admission. Chest computed tomography showed enlarged mediastinal lymph node and small amount of pericardial effusion. Mediastinoscopic biopsy of mediastinal lymph node revealed reactive hyperplasia, without evidence of granuloma, but acid‐fast bacilli stain of pericardial fluid reported positive finding and pericardial fluid culture identified M. kansasii. The patient has been treated successfully with rifabutin‐based combination therapy. All available cases of M. kansasii infection in kidney transplant patients and M. kansasii pericarditis in human immunodeficiency virus‐infected patients are comprehensively reviewed.     

Retroperitoneal Abscess and Bacteremia due to Mycoplasma hominis in a Polytraumatized Man

Summary We report a case of a retroperitoneal abscess due to Mycoplasma hominis in a young polytraumatized man who developed septicemia under treatment with rifampin and flucloxacillin. M. hominis was recovered from blood cultures as well as from the abscess near the left iliac spine. After 10 days of therapy with clindamycin the patient improved, and intraoperatively taken swabs were culturenegative but still positive by PCR. Received: August 20, 1999 · Revision accepted: October 26, 1999     

利用PCR技术检测阴道毛滴虫体内的人型支原体

采用人型支原体16S rDNA的特异引物，对从广州市多所医院门诊患者分离到的28株阴道毛滴虫进行PCR检测，结果有12株感染了人型支原体，感染率为42.9%。这显示了阴道毛滴虫和人型支原体之间的共生关系在中国具有普遍性。     

Treatment of Candida albicans pericarditis in a heart transplant patient

Pericarditis due to Candida species is a rare clinical entity, associated with thoracic surgery and immunosuppression. We report here the second case of pericarditis due to Candida albicans in a heart transplant patient, which presented as tamponade approximately 3 weeks post transplant, in the absence of evidence of sternal osteomyelitis. The patient was treated with pericardiocentesis and a combination of caspofungin and fluconazole, but the patient ultimately required the explantation of retained epicardial leads and the creation of a pericardial window. This case illustrates that Candida species must be considered in the differential diagnosis in post-transplant pericarditis, and that foreign body removal is, as always, key in helping to resolve such infections. This case also demonstrates the first use of caspofungin with fluconazole to treat Candida pericarditis. We discuss the conflicting data regarding the use of caspofungin, alone or in combination therapy, in treating infections involving biofilms, such as the infected pericardium.     

Pantoea agglomerans pneumonia in a heart–lung transplant recipient: case report and a review of an emerging pathogen in immunocompromised hosts

A. Shubov, P. Jagannathan, P. V. Chin‐Hong. Pantoea agglomerans pneumonia in a heart–lung transplant recipient: case report and a review of an emerging pathogen in immunocompromised hosts. Transpl Infect Dis 2011. All rights reserved Abstract: Pantoea agglomerans is a gram‐negative rod that is frequently found on the exterior of many plants, fruits, vegetables, and in soil, and it is used as a biopesticide in the agriculture industry. Recent reports have implicated P. agglomerans in systemic infections of immunocompromised hosts and neonates, as well as more localized infections in healthy hosts. P. agglomerans as a cause of hospital‐acquired pneumonia has not been well characterized. We report a case of P. agglomerans pneumonia in a heart–lung transplant recipient following transplantation. The organism was susceptible to multiple antimicrobial agents and treated successfully with ertapenem. We review the patient's course and the relevant literature, and discuss implications for the future.     

Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis

Despite the adoption of antifungal prophylaxis, fungal infections remain a significant concern in lung transplant recipients. Indeed, some concern exists that such prophylaxis may increase the risk of infection with drug‐resistant fungal organisms. Here, we describe a case of disseminated Scedosporium prolificans infection, presenting as pericarditis, which developed in a lung transplant patient receiving prophylactic voriconazole for 8 months. The epidemiology and clinical presentation of S. prolificans infections are reviewed, and controversies surrounding antifungal prophylaxis and the development of resistant infections are discussed.     

Hafnia alvei pyelonephritis in a renal transplant recipient: case report and review of an under‐recognized nosocomial pathogen

A.P. Cardile, D. Forbes, V. Cirigliano, B. Stout, N.P. Das, G. Hsue. Hafnia alvei pyelonephritis in a renal transplant recipient: case report and review of an under‐recognized nosocomial pathogen. Transpl Infect Dis 2011: 13 : 407–410. All rights reserved Abstract: We describe the first case to our knowledge of Hafnia alvei pyelonephritis in a renal transplant recipient. Clinicians should consider this under‐recognized pathogen when clinically evaluating immunosuppressed patients with a history of invasive procedures.     

Cerebral toxoplasmosis in an allogeneic peripheral stem cell transplant recipient: case report and review of literature

We present a patient who underwent allogeneic peripheral stem cell transplantation (PSCT) for chronic myelocytic leukemia. Twenty months after the PSCT he experienced status epilepticus. Magnetic resonance imaging (MRI) revealed a focus in the ventral thalamus-hypothalamus region. Using stereotactic biopsy with histology and specific polymerase chain reaction investigation from brain tissue, cerebral toxoplasmosis was diagnosed and treated with antiparasitic therapy. Early recognition of such serious and potentially lethal disease enabled prompt specific treatment. This case report emphasizes the role of stereotactic biopsy in diagnosis of cerebral toxoplasmosis. Other methods such as MRI are non-invasive but not sufficiently specific and sensitive.     

BK virus nephropathy in a heart transplant recipient: case report and review of the literature

The human polyomavirus BK virus (BKV) remains latent in the urinary tract and may be reactivated in immunocompromised states. BKV is noted to be the etiologic agent of polyomavirus-associated nephropathy (PVAN), which is a significant cause of allograft failure in renal transplant patients. Renal dysfunction following non-renal solid organ transplantation is common and is typically attributed to drug toxicity or patient comorbidities. In this article we describe a case of PVAN in the native kidneys of a heart transplant recipient and review the literature. Although this is only the fourth case reported, BKV nephropathy should be considered in the differential diagnosis of new renal failure following non-kidney solid organ transplantation, as early diagnosis of PVAN is necessary to prevent irreversible renal damage.     

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Herpes simplex virus (HSV) hepatitis is often unrecognized clinically with most untreated cases diagnosed postmortem. HSV hepatitis has been reported in solid organ transplant (SOT) recipients, mostly in kidney and liver transplants, and rarely in heart transplant recipients. We describe a fatal case of community‐acquired HSV‐2 hepatitis in a 24‐year‐old heart transplant recipient occurring 3 years after transplant. We also review the literature summarizing HSV hepatitis and the potential role of quantitative HSV polymerase chain reaction monitoring in the SOT population.     

Rhodococcus globerulus bacteremia in an allogeneic hematopoietic stem cell transplant recipient: report of the first transplant case and review of the literature

Rhodococcus species are environmental organisms that predominantly cause opportunistic infections in immunocompromised hosts. Rhodococcus equi is the most common species associated with human infections, but there are uncommon but increasing number of cases of infections caused by non‐equi Rhodococcus species. We report a case of Rhodococcus globerulus bacteremia in an allogeneic hematopoietic stem cell transplant recipient, who presented with subacute systemic illness accompanied by severe hepatitis. In the context of this case, we review the literature on Rhodococcus species infections in transplant recipients.     

Disseminated microsporidiosis in a renal transplant recipient: case report and review of the literature

Microsporidia are opportunistic pathogens that usually cause a limited disease in the gastrointestinal tract. Occasionally, they can cause disseminated disease. In solid organ transplant recipients, disseminated disease has been reported only rarely. We describe a 68‐year‐old woman who presented with fever, cough, and acute kidney injury 6 months after kidney transplantation. Dissemination was confirmed by identification of microsporidial spores in urine and bronchoalveolar lavage fluid. Polymerase chain reaction analysis identified the species as Encephalitozoon cuniculi.     

性高危人群感染解脲脲原体和人型支原体分析

目的　探讨泌尿生殖道支原体在性高危人群中的感染状况。方法　采用培养法对 4 6 8例按摩妇女、95例性乱者、2 12例性病伴侣进行解脲脲原体 (Uu)和人型支原体 (Mh)的检测。结果　按摩妇女、性乱者、性病伴侣泌尿生殖道支原体感染率分别为 6 6 .7%、35 .8%、39.2 % ,与健康人群 (13.5 % )比较 ,差异均有非常显著的统计学意义 (χ2 =174 .5 6、2 0 .91、37.98,P均 <0 .0 0 5 )。按摩妇女支原体感染率与性乱者、性病伴侣比较 ,差异有非常显著的统计学意义 (χ2 =31 78、4 5 .37,P均 <0 .0 0 5 ) ,性乱者与性病伴侣比较 ,差异无显著的统计学意义 (χ2 =0 .31,P>0 .0 5 )。Uu感染率 (2 1.0 % )与Mh(8.0 % )比较 ,前者非常明显地高于后者 (χ2 =33.16 7,P <0 .0 0 5 )。女性支原体感染率 (6 3.0 % )非常明显地高于男性 (2 4 .5 % ) (χ2 =74 .5 5 ,P <0 .0 0 5 )。男性Uu感染率 (9.0 % )与女性(2 0 .0 % )比较 ,女性非常明显地高于男性 (χ2 =10 .19,P <0 .0 0 5 )。Uu和Mh混合感染率 (2 9.6 % )非常明显地高于Uu(17.8% )或Mh(8.0 % )的感染率 (χ2 =2 9.5 6、117.99,P均 <0 .0 0 5 )。结论　Uu、Mh在按摩妇女、性乱者、性病伴侣中流行广、感染率高 ,在性病的防治和监测工作中应加以重视。     

Peritonitis caused by Blastomyces dermatitidis in a kidney transplant recipient: case report and literature review

Blastomyces dermatitidis is a dimorphic fungus endemic to the midwestern, south‐central, and southeastern United States known to cause disseminated infection in immunocompromised individuals. We report a case of B. dermatitidis peritonitis in a renal allograft recipient with new‐onset ascites and cytomegalovirus encephalitis. Peritoneal blastomycosis is a rare clinical entity and, to our knowledge, this patient represents the first known case of peritoneal blastomycosis in a solid organ transplant recipient. We review the clinical characteristics of B. dermatitidis peritonitis as well as the literature on fungal peritonitis with emphasis on dimorphic fungal pathogens. Clinical features suggestive of fungal peritonitis include new‐onset ascites, abdominal pain, and fevers, especially with antecedent or concomitant pneumonia. A high index of clinical suspicion, along with the use of culture and non‐culture diagnostics, is needed for early diagnosis and prompt initiation of therapy.     

The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature

Abstract

There is sparse information on the epidemiology of effusive constrictive pericarditis (ECP). The objective of this article was to review and summarise the literature on the prevalence and outcome of ECP, and identify gaps for further research. The prevalence of ECP ranged from 2.4 to 14.8%, with a weighted average of 4.5% [95% confidence interval (CI) 2.2–7.5%]. Sixty-five per cent (95% CI: 43–82%) of patients required pericardiectomy regardless of the aetiology. The combined death rate across the studies was 22% (95% CI: 4–50%). The prevalence of ECP is low in non-tuberculous pericarditis, while pericardiectomy rates are high and mortality is variable. In this review, of 10 patients identified with tuberculous ECP, only one presumed case had a definite diagnosis of ECP. Appropriate studies are needed to determine the epidemiology of ECP in tuberculous pericarditis, which is one of the leading causes of pericardial disease in the world.     

Leprosy in a renal transplant recipient: review of the literature

Abstract: A 52‐year‐old male underwent living‐related renal transplantation. He received prednisolone, azathioprine, and cyclosporine as immunosuppression protocol. Eleven years after transplantation, he developed pyrexia with multiple nodular lesions on his limbs, trunk, and face. Skin biopsy and smears showed the presence of numerous acid‐fast bacilli with 5% sulfuric acid indicative of Mycobacterium leprae. He was initiated on multidrug therapy (MDT) including dapsone, clofazimine, and rifampicin. After 2 years of MDT, he developed new multiple erythematous, tender subcutaneous nodules in crops over his face and upper limbs. Skin biopsies and histopathological examination confirmed the diagnosis of type 2 lepra reaction or erythema nodosa leprosum. He was managed with an increase in the dose of prednisolone and thalidomide. He was continued on MDT.     

Common infections in the lung transplant recipient

Infections are a major cause of morbidity and mortality after lung transplantation. Pretransplant assessments for infection risk and immunization updates may help reduce posttransplant infections. In addition careful choice of posttransplant prophylaxis for cytomegalovirus and fungal infections is critical. Because of the potential association of infections such as respiratory viral infections and gram-negative bacterial infections with bronchiolitis obliterans syndrome, prompt attention to these pathogens is critical. Choice of antimicrobials for prophylaxis and treatment should take into consideration both adverse effects and drug interactions associated with antimicrobial choice.