CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 4 — Questions and Answers
Question 1: A kidney transplant recipient on tacrolimus and mycophenolate develops fever, productive cough, and bilateral infiltrates 3 months post-transplant. Bronchoalveolar lavage reveals silver-staining cysts. Which organism is most likely responsible?
- Aspergillus fumigatus
- Pneumocystis jirovecii (Correct answer)
- Cytomegalovirus
- Nocardia asteroides
Correct answer: Pneumocystis jirovecii
Pneumocystis jirovecii pneumonia (PJP) presents with bilateral infiltrates and is identified by silver staining of BAL specimens, typically occurring 1–6 months post-transplant in inadequately prophylaxed patients.
Question 2: A transplant coordinator is reviewing post-transplant prophylaxis orders. Trimethoprim-sulfamethoxazole (TMP-SMX) is prescribed primarily to prevent which infection in the early post-transplant period?
- Cytomegalovirus disease
- Pneumocystis jirovecii pneumonia (Correct answer)
- Invasive candidiasis
- BK virus nephropathy
Correct answer: Pneumocystis jirovecii pneumonia
TMP-SMX is the first-line prophylactic agent against Pneumocystis jirovecii pneumonia and also provides coverage against Toxoplasma and some bacterial urinary pathogens in transplant recipients.
Question 3: Which antifungal agent is most commonly used for prophylaxis against invasive Aspergillus infections in lung transplant recipients during the first year post-transplant?
- Fluconazole
- Voriconazole (Correct answer)
- Micafungin
- Amphotericin B deoxycholate
Correct answer: Voriconazole
Voriconazole is the preferred agent for Aspergillus prophylaxis in lung transplant recipients due to its broad mold coverage and oral bioavailability, though drug interactions with calcineurin inhibitors require close monitoring.
Question 4: A liver transplant recipient presents 8 months post-transplant with hematuria and a declining creatinine. Urine PCR is positive for BK virus with a viral load of 10^7 copies/mL. What is the most appropriate initial management?
- Start cidofovir therapy immediately
- Reduce immunosuppression (Correct answer)
- Add leflunomide to current regimen
- Initiate intravenous immunoglobulin therapy
Correct answer: Reduce immunosuppression
The cornerstone of BK virus nephropathy management is reduction of immunosuppression, particularly mycophenolate mofetil and/or calcineurin inhibitors, to restore antiviral immune responses.
Question 5: A transplant coordinator is counseling a heart transplant patient about Toxoplasma gondii risk. Which donor-recipient serostatus combination carries the highest risk for post-transplant toxoplasmosis?
- Donor negative / Recipient negative
- Donor positive / Recipient positive
- Donor negative / Recipient positive
- Donor positive / Recipient negative (Correct answer)
Correct answer: Donor positive / Recipient negative
A seropositive donor transmitting latent Toxoplasma to a seronegative recipient (D+/R−) carries the highest risk, as the recipient lacks pre-existing immunity and is heavily immunosuppressed.
Question 6: When evaluating a potential deceased organ donor for the risk of donor-derived bacterial infection, which of the following findings is most likely to prompt microbiological testing before organ acceptance?
- Donor BMI greater than 30
- Donor history of intravenous drug use (Correct answer)
- Donor creatinine of 1.8 mg/dL
- Donor age over 60 years
Correct answer: Donor history of intravenous drug use
A history of intravenous drug use raises concern for endocarditis, bacteremia with drug-resistant organisms, and bloodborne pathogens, warranting comprehensive microbiological evaluation before organ acceptance.
Question 7: A renal transplant recipient on long-term prednisone and tacrolimus develops painful vesicular lesions in a dermatomal distribution on the trunk 14 months post-transplant. Which antiviral regimen is most appropriate?
- Acyclovir 200 mg five times daily for 5 days
- Valacyclovir 1000 mg three times daily for 7 days (Correct answer)
- Famciclovir 500 mg twice daily for 3 days
- Ganciclovir 5 mg/kg IV twice daily for 14 days
Correct answer: Valacyclovir 1000 mg three times daily for 7 days
Herpes zoster (shingles) in immunocompromised transplant recipients requires high-dose valacyclovir 1000 mg TID for 7 days to achieve adequate antiviral tissue levels and reduce the risk of dissemination.
CCTC CCTC - Certified Clinical Transplant Coordinator Infection Prevention and Management Questions and Answers 4
A kidney transplant recipient on tacrolimus and mycophenolate develops fever, productive cough, and bilateral infiltrates 3 months post-transplant.
Bronchoalveolar lavage reveals silver-staining cysts.
Which organism is most likely responsible?