CCTN Infection Prevention and Management in Transplant Recipients

Question 1

Which prophylactic medication is routinely prescribed to prevent Pneumocystis jirovecii pneumonia (PCP) in solid organ transplant recipients?

Accepted Answer

Trimethoprim-sulfamethoxazole (TMP-SMX)

Answer

Fluconazole

Answer

Valganciclovir

Answer

Dapsone monotherapy

Question 2

In a CMV donor-positive/recipient-negative (D+/R-) transplant scenario, what is the recommended management strategy?

Accepted Answer

Universal prophylaxis with valganciclovir for 3–6 months

Answer

Pre-emptive therapy based on weekly CMV PCR monitoring only

Answer

No prophylaxis needed since the recipient has no prior exposure

Answer

Acyclovir prophylaxis for the first 30 days

Question 3

Which live vaccines are contraindicated in solid organ transplant recipients on maintenance immunosuppression?

Accepted Answer

MMR (measles-mumps-rubella) and varicella zoster live vaccine

Answer

Inactivated influenza and pneumococcal vaccines

Answer

Hepatitis B and recombinant zoster vaccine

Answer

Tetanus, diphtheria, and pertussis (Tdap)

Question 4

BK polyomavirus nephropathy is a significant concern primarily in which type of solid organ transplant recipient?

Accepted Answer

Kidney transplant recipients

Answer

Liver transplant recipients

Answer

Heart transplant recipients

Answer

Lung transplant recipients

Question 5

A transplant recipient presents with fever, productive cough, and CT findings showing bilateral ground-glass opacities three months post-transplant. Which organism should be highest on the differential?

Accepted Answer

Pneumocystis jirovecii

Answer

Streptococcus pneumoniae

Answer

Mycobacterium tuberculosis

Answer

Candida albicans

Question 6

What is the primary mechanism by which trimethoprim-sulfamethoxazole provides prophylaxis against Toxoplasma gondii in transplant recipients?

Accepted Answer

It inhibits folate synthesis, which is essential for Toxoplasma replication

Answer

It disrupts the parasite's cell membrane permeability

Answer

It blocks Toxoplasma entry into host macrophages

Answer

It stimulates innate immune recognition of the parasite

Question 7

During the first month post-transplant, which category of infections predominates and reflects the patient's pre-transplant health status and surgical complications?

Accepted Answer

Donor-derived and recipient pre-existing infections, plus surgical-site and nosocomial infections

Answer

Opportunistic infections from immunosuppression such as CMV and PCP

Answer

Community-acquired respiratory infections from environmental exposure

Answer

Reactivation of latent viral infections like EBV and VZV