CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 1 — Questions and Answers
Question 1: Which opportunistic infection is most commonly caused by reactivation of a latent fungal infection in immunocompromised transplant recipients in the US?
- Candida albicans
- Aspergillus fumigatus
- Pneumocystis jirovecii (PJP) (Correct answer)
- Cryptococcus neoformans
Correct answer: Pneumocystis jirovecii (PJP)
Pneumocystis jirovecii pneumonia (PJP) is the most common serious opportunistic fungal infection in transplant recipients, occurring due to latent organism reactivation under immunosuppression.
Question 2: A kidney transplant recipient on tacrolimus, mycophenolate, and prednisone presents 6 weeks post-transplant with fever, productive cough, and ground-glass opacities on chest CT. The most likely diagnosis is:
- Acute rejection
- Pneumocystis jirovecii pneumonia (PJP)
- Cytomegalovirus (CMV) pneumonitis (Correct answer)
- Bacterial lobar pneumonia
Correct answer: Cytomegalovirus (CMV) pneumonitis
CMV pneumonitis classically presents at 4–8 weeks post-transplant with fever, cough, and bilateral ground-glass opacities in a recipient on high-level immunosuppression.
Question 3: Standard post-transplant prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) protects against which two pathogens simultaneously?
- CMV and EBV
- PJP and Toxoplasma gondii (Correct answer)
- Aspergillus and Candida
- BK virus and HSV
Correct answer: PJP and Toxoplasma gondii
TMP-SMX provides dual prophylaxis against Pneumocystis jirovecii pneumonia (PJP) and Toxoplasma gondii, and also provides some urinary tract infection prophylaxis.
Question 4: The donor-recipient CMV serostatus combination associated with the HIGHEST risk of CMV disease post-transplant is:
- Donor negative / Recipient positive (D−/R+)
- Donor positive / Recipient negative (D+/R−) (Correct answer)
- Donor positive / Recipient positive (D+/R+)
- Donor negative / Recipient negative (D−/R−)
Correct answer: Donor positive / Recipient negative (D+/R−)
D+/R− mismatch carries the highest CMV disease risk because the seronegative recipient has no pre-existing immunity and receives a primary CMV infection from the donor organ.
Question 5: A transplant coordinator is counseling a new kidney transplant recipient about food safety. Which of the following foods should be AVOIDED post-transplant?
- Well-cooked poultry
- Pasteurized dairy products
- Unpasteurized soft cheeses and raw shellfish (Correct answer)
- Thoroughly cooked eggs
Correct answer: Unpasteurized soft cheeses and raw shellfish
Unpasteurized cheeses and raw shellfish carry Listeria, Salmonella, and Vibrio risks that are particularly dangerous in immunocompromised transplant recipients.
Question 6: BK virus nephropathy is a serious complication primarily seen in which transplant recipient population?
- Liver transplant recipients
- Lung transplant recipients
- Kidney transplant recipients (Correct answer)
- Heart transplant recipients
Correct answer: Kidney transplant recipients
BK polyomavirus reactivates in renal tubular cells, causing BK nephropathy almost exclusively in kidney transplant recipients due to direct viral infection of the allograft.
CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 1
Which opportunistic infection is most commonly caused by reactivation of a latent fungal infection in immunocompromised transplant recipients in the US?