CCTN Infection Prevention and Management in Transplant Recipients 2 — Questions and Answers
Question 1: A kidney transplant recipient is found to have rising BK viremia on routine surveillance. What is the most appropriate initial intervention?
- Reduce immunosuppression, particularly the antimetabolite dose (Correct answer)
- Initiate high-dose intravenous acyclovir therapy
- Add fluoroquinolone antibiotics to suppress viral replication
- Immediately begin cidofovir infusions
Correct answer: Reduce immunosuppression, particularly the antimetabolite dose
The primary treatment for BK viremia in kidney transplant recipients is reduction of immunosuppression, which allows the host immune system to control viral replication, though this must be balanced against rejection risk.
Question 2: Which antifungal agent is most commonly used for prophylaxis against Candida infections in high-risk solid organ transplant recipients during the early post-transplant period?
- Fluconazole (Correct answer)
- Amphotericin B deoxycholate
- Micafungin
- Itraconazole
Correct answer: Fluconazole
Fluconazole is the standard prophylactic antifungal in high-risk transplant recipients (e.g., liver, small bowel) due to its established efficacy, oral bioavailability, and favorable safety profile.
Question 3: A lung transplant recipient develops bronchiolitis obliterans syndrome (BOS). How does BOS increase infection risk?
- Impaired mucociliary clearance and airway structural changes create a favorable environment for bacterial colonization (Correct answer)
- BOS directly suppresses neutrophil function and phagocytosis
- BOS causes T-cell exhaustion, increasing viral reactivation risk
- BOS triggers autoimmune destruction of bronchial-associated lymphoid tissue
Correct answer: Impaired mucociliary clearance and airway structural changes create a favorable environment for bacterial colonization
BOS damages the airway epithelium and mucociliary apparatus, impairing pathogen clearance and promoting chronic bacterial colonization with organisms like Pseudomonas aeruginosa.
Question 4: Which screening test should be performed on all transplant candidates to detect latent tuberculosis prior to transplantation?
- Tuberculin skin test (TST) or interferon-gamma release assay (IGRA) (Correct answer)
- Chest X-ray alone is sufficient for TB screening
- Sputum AFB culture from three consecutive samples
- Bronchoscopy with BAL for mycobacterial culture
Correct answer: Tuberculin skin test (TST) or interferon-gamma release assay (IGRA)
Both TST and IGRA (QuantiFERON-TB Gold) are recommended for pre-transplant latent TB screening, as immunosuppression post-transplant carries a significant risk of reactivating latent infection.
Question 5: A transplant nurse is educating a recipient about food safety. Which food should be specifically avoided to prevent Listeria monocytogenes infection?
- Unpasteurized soft cheeses and ready-to-eat deli meats (Correct answer)
- Well-cooked poultry and pasteurized dairy products
- Canned vegetables and commercially bottled juices
- Fresh fruits that are washed before consumption
Correct answer: Unpasteurized soft cheeses and ready-to-eat deli meats
Listeria thrives in refrigerated, ready-to-eat foods such as deli meats and soft cheeses made from unpasteurized milk, and causes severe invasive disease in immunocompromised transplant recipients.
Question 6: What is the significance of donor-derived Strongyloides stercoralis infection in solid organ transplant recipients?
- It can cause fatal hyperinfection syndrome due to immunosuppression enabling unchecked larval dissemination (Correct answer)
- It is a benign self-limiting infection that resolves without treatment
- It primarily causes graft dysfunction without systemic symptoms
- It is easily prevented by standard post-transplant antifungal prophylaxis
Correct answer: It can cause fatal hyperinfection syndrome due to immunosuppression enabling unchecked larval dissemination
Strongyloides can be transmitted from an infected donor organ; under immunosuppression, the normal host-controlled autoinfection cycle becomes uncontrolled hyperinfection with potentially fatal gram-negative sepsis from larval gut translocation.
Question 7: In a febrile solid organ transplant recipient, why is empiric broad-spectrum antibiotic therapy typically initiated promptly before culture results are available?
- Immunosuppressed patients lack the typical inflammatory response and can deteriorate rapidly from occult bacteremia (Correct answer)
- Standard fever management guidelines recommend antibiotics for all patients with temperatures above 38°C
- Antibiotics reduce the risk of triggering acute rejection episodes associated with infection
- Early antibiotic therapy prevents opportunistic fungal superinfection in all transplant patients
Correct answer: Immunosuppressed patients lack the typical inflammatory response and can deteriorate rapidly from occult bacteremia
Immunosuppression blunts fever and other signs of infection, meaning the patient may already be severely ill by the time symptoms appear, requiring prompt empiric coverage to prevent septic shock.
CCTN Infection Prevention and Management in Transplant Recipients 2
A kidney transplant recipient is found to have rising BK viremia on routine surveillance.
What is the most appropriate initial intervention?