Infectious Complications

  • E. D. Bateman
  • A. A. Forder


Infection remains a major cause of death and morbidity in patients undergoing cardiac transplantation, especially in the first few months when immunosuppression is at its highest1–9. Study of these infections provides an alarming, though fascinating, insight into the delicate relationship between the transplant recipient and the wide variety of organisms, both pathogens and opportunists, in our environment. Although bacteria are the most common causative organisms (30–60%), other etiological agents such as viruses (20–50%), fungi (14–25%), and protozoa (up to 5%), account for a proportion of infectious episodes3, 4. In our own and other centers, these complications have prompted a critical assessment of conditions favoring infection, of means for preventing them, and of diagnostic approaches to identification of causative organisms.


Transplant Patient Herpes Zoster Heart Transplant Invasive Aspergillosis Heart Transplant Recipient 
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  1. 1.
    Baumgartner, W.A., Reitz, B.A., Oyer, P.E., Stinson, E.B. and Shumway, N.E. (1979). Cardiac homotransplantation. Curr. Probl. Surg., 16, 1PubMedCrossRefGoogle Scholar
  2. 2.
    Barnard, C.N., Barnard, M.S., Cooper, D.K.C., Curchio, C.A., Hassoulas, J., Novitzky, D. and Wolpowitz, A. (1981). The present status of heterotopic cardiac transplantation. J. Thorac. Cardiovasc. Surg., 81, 433PubMedGoogle Scholar
  3. 3.
    Cooper, D.K.C., Lanza, R.P., Oliver, S.P., Forder, A.A., Rose, A.G., Uys, C.J., Novitzky, D. and Barnard, C.N. (1983). Infectious complications following heterotopic heart transplantation. Thorax, 38, 822PubMedCrossRefGoogle Scholar
  4. 4.
    Hofflin, J.M., Potasman, I, Baldwin, J.C., Oyer, P.E, Stinson, E.B. and Remington, J.S. (1987). Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids. Ann. Intern. Med., 106, 209PubMedGoogle Scholar
  5. 5.
    Renlund, D.G., Gilbert, E.M., O’Connell, J.B., Gay, W.A., Jones, K.W., Burton, N.A., Doty, D.B., Karawnde, S.V., DeWitt, C.W., Menlove, R.L., Herrick, C.M. and Bristow, M.R. (1987). Age-associated decline in cardiac allograft rejection. Am. J. Med., 83, 391PubMedCrossRefGoogle Scholar
  6. 6.
    Baumgartner, W.A., Augustine, S., Borkon, M., Gardner, T.J. and Reitz, B.A. (1987). Present expectations in cardiac transplantation. Ann. Thorac. Surg., 43. 585PubMedCrossRefGoogle Scholar
  7. 7.
    Gentry, L.O. and Zeluif, B.J. (1986). Diagnosis and treatment of infection in cardiac transplant patients. Surg. Clin. North Am., 66, 459PubMedGoogle Scholar
  8. 8.
    Emery, R.W., Cork, R., Christensen, R., Levinson, M.M., Icenogle, T.B., Riley, J., Ott, R.A. and Copeland, J.G. (1986). Cardiac transplantpatients at one year. Cyclosporine vs. conventional immunosuppression. Chest, 90, 29PubMedCrossRefGoogle Scholar
  9. 9.
    Schulman, L., Smith, C., Drusin, R., Rose, E., Enson, Y. and Reemtsma, K. (1986). Respiratory complications of heart transplantation. J. Heart Transplant., 5, 387Google Scholar
  10. 10.
    Rubin, R.H., Wolfson, J.S. and Cosimi, A.G. (1981). Infection in the renal transplant recipient. In Dixon, R.E. (ed.) Nosocomial Infections. p. 121. (New York: Yorke Medical Books)Google Scholar
  11. 11.
    Jamieson, S.W., Stinson, E.B. and Shumway, N.E. (1982). Cardiac transplantation. In Morris, P.J. (ed.) Tissue Transplantation. p. 147. (Edinburgh: Churchill Livingstone)Google Scholar
  12. 12.
    Baumgartner, W.A. (1983). Infection in cardiac transplantation. Heart Transplant., 3, 75Google Scholar
  13. 13.
    Fabre, J.W. (1982). Specific immunosuppression. In Morris, PJ. (ed.) Tissue Transplantation. p. 80. (Edinburgh: Churchill Livingstone)Google Scholar
  14. 14.
    Cooper, D.K.C., Lanza, R.P. and Barnard, C.N. (1984). Non-compliance in heart transplant recipients: the Cape Town experience. Heart Transplant. 3, 248Google Scholar
  15. 15.
    Parker, M.T. (1978). Microbiological facilities for the surveillance and control of the spread of infection in hospitals. In Daschner, F. (ed.) Proven and Unproven Methods in Hospital Infection Control. p. 35. (Stuttgart: Fischer)Google Scholar
  16. 16.
    Snydman, D.R., Werner, B.G., Heinze-Lacey, B., Berardi, V.P., Tilney, N.L., Kirkman, R.L., Milford, E.L., Cho, S.I., Bush, H.L., Levey, A.S., Strom, T.B., Carpenter, C.B., Levey, R.H., Harmon, W.E., Zimmerman, C.E., Shapiro, M.E., Steinman, T., Logerfo, F., Idelson, B., Shroter, P.J., Levin, M.J., Mclver, J., Leszczynski, J. and Grady, G.F. (1987). Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N. Engl. J. Med., 317, 1049PubMedCrossRefGoogle Scholar
  17. 17.
    Wreghitt, T.G., Gray, JJ. and Balfour, A.H. (1986). Problems with serological diagnosis of Toxoplasma gondii infections in heart transplant recipients. J. Clin. Pathol., 39, 1135PubMedCrossRefGoogle Scholar
  18. 18.
    Hakim, M., Esmore, D., Wallwork, J., English, T.A.H. and Wreghitt, T. (1986). Toxoplasmosis in cardiac transplantation. Br. Med. J., 202, 1108CrossRefGoogle Scholar
  19. 19.
    Minoli, L., Grossi, P., Marone, P., Maserati, R., Malfitano, A., Martinelli, L. and Sessa, F. (1986). Are HBsAg carriers suitable for heart transplantation? J. Heart Transplant., 5, 364Google Scholar
  20. 20.
    Applefeld, M.M., Newman, K.A., Sutton, F.J., Reed, W.P., Roffman, D.S., Talesnick, B.S. and Grove, W.R. (1987). Outpatient dobutamine and dopamine infusions in the management of chronic heart failure: clinical experience in 21 patients. Am. Heart J., 114, 589PubMedCrossRefGoogle Scholar
  21. 21.
    Frist, W.H., Oyer, P.E., Baldwin, J.C, Stinson, E.B. and Shumway, N.E. (1987). HLA compatibility and cardiac transplant recipient survival. Ann. Thorac. Surg., 44, 242PubMedCrossRefGoogle Scholar
  22. 22.
    Hess, N. (1986). Update on infection rates with only protective isolation. J. Heart Transplant., 5, 393Google Scholar
  23. 23.
    McKenzie, F.N., Menkis, A.H., Tadros, N, Stiller, C.R., Keown, P.A. and Kostuk, W.F. (1986). The limited role of protective isolation after heart transplantation. J. Heart Transplant., 5, 381Google Scholar
  24. 24.
    Gamberg, P., Miller, J. and Lough, M.E. (1986). Impact of protective isolation on the incidence of infection after heart transplantation. J. Heart Transplant., 5, 378Google Scholar
  25. 25.
    Preston, G.A., Larson, E.L. and Stamm, W.E. (1981). The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. In Dixon, R.E. (ed.) Nosocomial Infections. p. 285. (Atlanta: Yorke Medical Books)Google Scholar
  26. 26.
    Armstrong, D. (1981). The diagnostic microbiology laboratory in the care of the immunosuppressed patient. In Lorian, V. (ed.) Significance of Medical Microbiology in Care of Patients. p. 73. (Baltimore: Williams & Wilkins)Google Scholar
  27. 27.
    Bartlett, J.G. (1982). Making optimum use of the microbiology laboratory. J. Am. Med. Assoc., 247, 857 (Part 1), 1336 (Part 2), 1868 (Part 3)CrossRefGoogle Scholar
  28. 28.
    Matthay, R.A. and Moritz, E.D. (1981). Invasive procedures for diagnosing pulmonary infection. A critical review. Clin. Chest Med., 2, 3PubMedGoogle Scholar
  29. 29.
    Bartlett, J.G. (1977). Diagnostic accuracy of transtracheal aspiration: bacteriologic studies. Am. Rev. Respir. Dis., 115, 777PubMedGoogle Scholar
  30. 30.
    Zavala, D.C. and Schoell, J.E. (1981). Ultra-thin needle aspiration of the lung in infectious and malignant disease. Am. Rev. Respir. Dis., 123, 125PubMedGoogle Scholar
  31. 31.
    Wimberley, N., Faling, L.J. and Bartlett, J.G. (1979). A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am. Rev. Respir. Dis., 119, 337PubMedGoogle Scholar
  32. 32.
    Willcox, P.A., Benatar, S.R., Potgieter, P.D., Ferguson, A.D. and Bateman, E.D. (1981). Fiberoptic bronchoscopy: experience at Groote Schuur Hospital. S. Afr. Med. J., 60, 651PubMedGoogle Scholar
  33. 33.
    Beyt, B.E., King, D.K. and Glew, R.H. (1977). Fatal pneumonitis and septicaemia after fiberoptic bronchoscopy. Chest, 72, 105PubMedCrossRefGoogle Scholar
  34. 34.
    Robbins, H. and Goldman, A.L. (1977). Failure of a ’prophylactic’ antimicrobial drug to prevent sepsis after fiberoptic bronchoscopy. Am. Rev. Respir. Dis., 116, 325PubMedGoogle Scholar
  35. 35.
    Willcox, P.A., Bateman, E.D., Potgieter, P.D. and Benatar, S.R. (1987). Is fiberoptic bronchoscopy of value in the diagnosis of pulmonary shadows in renal transplant recipients? Am. Rev. Respir. Dis., 135A, 411Google Scholar
  36. 36.
    Meyers, J.D. and Thomas, E.D. (1981). Infection complicating bone marrow transplantation. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 507. (New York: Plenum)Google Scholar
  37. 37.
    Britt, R.H., Enzmann, D.R. and Remington, J.S. (1981). Intracranial infection in cardiac transplant recipients. Ann. Neurol., 9, 107PubMedCrossRefGoogle Scholar
  38. 38.
    Young, L.S. (1981). Fever and septicaemia. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 75. (New York: Plenum)Google Scholar
  39. 39.
    Penn, R.L., Lambert, R.S. and George, R.B. (1983). Invasive fungal infections. The use of serologic tests in diagnosis and management. Arch. Intern. Med., 143, 1215PubMedCrossRefGoogle Scholar
  40. 40.
    Rubin, R.H. and Greene, R. (1981). Etiology and management of the compromised patient with fever and pulmonary infiltrates. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 123. (New York: Plenum)Google Scholar
  41. 41.
    Fisher, B.D. and Armstrong, D. (1977). Cryptococcal interstitial pneumonia: value of antigen determination. N. Engl. J. Med., 297, 1440PubMedCrossRefGoogle Scholar
  42. 42.
    Van der Bij, W., Van Dijk, R.B., Prenger, K.B., Prop, J., Torensma, R. and The, T.H. (1986). Antigen test for early diagnosis of active cytomegalovirus infection in heart transplant recipients. J. Heart Transplant., 5, 364Google Scholar
  43. 43.
    Rubin, R.H. (1981). Infection in the renal transplant patient. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 553. (New York: Plenum)Google Scholar
  44. 44.
    Smith, C.R., Lipsky, J.J., Laskin, O.L., Hellman, D.B., Mellits, E.D., Longstreth, S. and Lietman, P.S. (1980). Double-blind comparison of the nephrotoxicity of gentamicin and tobramycin. N. Engl. J. Med., 302, 1106PubMedCrossRefGoogle Scholar
  45. 45.
    Tuder, R.M., Renya, G.S. and Bensch, K. (1986). Mycobacterial coronary arteritis in a heart transplant recipient. Hum. Pathol., 17, 1072PubMedCrossRefGoogle Scholar
  46. 46.
    Simon, H.B. (1981). Mycobacterial and nocardial infections in the compromised host. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 229. (New York: Plenum)Google Scholar
  47. 47.
    Rand, K.H., Pollard, R.B. and Merigan, T.C. (1978). Increased pulmonary superinfections in cardiac transplant patients undergoing primary cytomegalovirus infection. N. Engl. J. Med., 298, 951PubMedCrossRefGoogle Scholar
  48. 48.
    Chou, S. (1987). Cytomegalovirus infection and reinfection transmitted by heart transplantation. J. Infect. Dis., 155, 1054PubMedCrossRefGoogle Scholar
  49. 49.
    Icenogle, T.B., Peterson, E., Ray, G., Minnich, L. and Copeland, J.G. (1987). DHPG effectively treats CMV infection in heart and heart—lung transplant patients: a preliminary report. J. Heart Transplant., 6, 199PubMedGoogle Scholar
  50. 50.
    Min, K.W., Wickemeyer, WJ., Chandran, P, Shadur, C, Gervich, D, Phillips, S.J., Zeff, R.H. and Song, J. (1986). Fatal cytomegalovirus infection and coronary arterial thromboses after heart transplantation: a case report. J. Heart Transplant., 5, 375Google Scholar
  51. 51.
    Havel, M., Laczkovics, A., Laufer, G., Spiss, C., Muller, M.M. and Wolner, E. (1986). Cytomegalovirus hyperimmunoglobulin prophylaxis after heart transplantation. J. Heart Transplant., 5, 398Google Scholar
  52. 52.
    Schulman, L.L. (1987). Cytomegalovirus pneumonitis and lobar consolidation. Chest, 91, 558PubMedCrossRefGoogle Scholar
  53. 53.
    Tobin, J.O.H. (1983). Virus infections in the immunocompromised. In Waterson, A.P. (ed.) Recent Advance in Clinical Virology. No. 3. p. 1. (Edinburgh: Churchill Livingstone)Google Scholar
  54. 54.
    Watson, F.S., O’Connell, J.B., Amber, I.J., Renlund, D.G. and Bristow, M.R. (1986). Treatment of cytomegalovirus pneumonia in heart transplant recipients with DHPG. J. Heart Transplant., 5, 390Google Scholar
  55. 55.
    Locke, T.J., Odom, N.J., Tapson, J.S., Freeman, R. and McGregor, C.G.A. (1987). Successful treatment with trisodium phosphonoformate for primary cytomegalovirus infection after heart transplantation. J. Heart Transplant., 6, 120PubMedGoogle Scholar
  56. 56.
    Uys, C.J., Rose, A.G. and Barnard, C.N. (1979). The pathology of human cardiac transplantation. S. Afr. Med. J., 56, 887PubMedGoogle Scholar
  57. 57.
    Alford, C.A. (1982). Acyclovir treatment of herpes virus infections in immunocompromised humans. Am. J. Med., 73 (Suppl.), 225PubMedCrossRefGoogle Scholar
  58. 58.
    Armstrong, D. (1981). Fungal infections in the compromised host. In Rubin, R.H. and Young, L.S. (eds.) Clinical Approach to Infection in the Compromised Host. p. 195. (New York: Plenum)Google Scholar
  59. 59.
    Kerkering, T.M., Duma, RJ. and Shadomy, S. (1981). The evolution of pulmonary cryptococcosis. Clinical implications from a study of 41 patients with and without compromising host factors. Ann. Intern. Med., 94, 611PubMedGoogle Scholar
  60. 60.
    Butler, W.T., Ailing, D.W., Spickard, A., and Utz, J.P. (1964). Diagnostic and prognostic value of clinical and laboratory findings in cryptococcal meningitis. A follow-up study of 40 patients. N. Engl. J. Med., 59, 270Google Scholar
  61. 61.
    Hammerman, K.J., Powell, K.E., Christianson, C.S., Huggin, P.M., Larsh, H.W., Vivas, J.R. and Tosh, F.E. (1973). Pulmonary cryptococcosis: clinical forms and treatment. A center for disease control cooperative mycoses study. Am. Rev. Respir. Dis., 108, 1116PubMedGoogle Scholar
  62. 62.
    Medoff, G. and Kobayashi, G.S. (1980). Strategies in the treatment of systemic fungal infections. N. Engl. J. Med., 302, 45CrossRefGoogle Scholar
  63. 63.
    Edwards, J.E., Lehrer, R.I., Stiehm, E.R., Fischer, T.J. and Young, L.S. (1978). Severe candidal infections. Clinical perspective, immune defense mechanisms, and current concepts of therapy. Ann. Intern. Med., 89, 91PubMedGoogle Scholar
  64. 64.
    Walker, D.H., Adamec, T. and Krigman, M. (1978). Disseminated petriellidosis (Allescheriosis). Arch. Pathol. Lab. Med., 102, 158PubMedGoogle Scholar
  65. 65.
    Murray-Leisure, K.A., Aber, R.C., Rowley, L.J., Applebaum, P.C., Wisman, C.B., Pennock, J.L. and Pierce, W.S. (1986). Disseminated Trichosporon beigelii (cutaneum) infection in an artificial heart recipient. J. Am. Med. Assoc., 256, 2995CrossRefGoogle Scholar
  66. 66.
    Walzer, P.D., Perl, D.P., Krogstad, D.J., Rawson, P.G. and Schultz, M.G. (1974). Pneumocystis carinii pneumonia in the United States: epidemiologic, diagnostic and clinical features. Ann. Intern. Med., 80, 83PubMedGoogle Scholar
  67. 67.
    Winston, D.J, Lau, W.K., Gale, R.P. and Young, L.S. (1980). Trimetho-primsulphamethoxazole for the treatment of Pneumocystis carinii pneumonia. Ann. Intern. Med., 92, 762PubMedGoogle Scholar
  68. 68.
    Luce, J.M. (1986). Sputum induction in the acquired immunodeficiency syndrome. Am. Rev. Respir. Dis., 133, 513PubMedGoogle Scholar
  69. 69.
    Debs, R.J, Straubinger, R.M, Brunette, E.N, Lin, J.M, Lin, E.J, Montgomery, A.B., Friend, D.S. and Papahadjopoulos, D.P. (1987). Selective enhancement of pentamidine uptake in the lung by aerosolization and delivery in liposomes. Am. Rev. Respir. Dis., 135, 731PubMedGoogle Scholar
  70. 70.
    Hughes, W.T, Kuhn, S, Chaudhary, S, Feldman, S, Verzosa, M, Aur, R.J.A, Pratt, C. and George, S.L. (1977). Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. N. Engl. J. Med., 297, 1419PubMedCrossRefGoogle Scholar
  71. 71.
    Rose, A.G, Uys, C.J, Novitzky, D, Cooper, D.K.C. and Barnard, C.N. (1983). Toxoplasmosis of donor and recipient heart after heterotopic cardiac transplantation. Arch. Pathol. Lab. Med., 197, 368Google Scholar
  72. 72.
    Potasman, I, Araujo, F.G, Desmonts, G. and Remington, J.S. (1986). Analysis of Toxoplasma gondii antigens recognized by human sera obtained before and after acute infection. J. Infect. Dis., 154, 650PubMedCrossRefGoogle Scholar
  73. 73.
    Jones, R.J. (1981). Vaccines and antisera against Gram-negative bacilli. J. Hosp. Infect., 2, 105PubMedCrossRefGoogle Scholar
  74. 74.
    Gaffin, S.L. (1982). Control of septic shock — present day concept. S. Afr. J. Hosp. Med., 8, 4Google Scholar

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© Kluwer Academic Publishers 1990

Authors and Affiliations

  • E. D. Bateman
  • A. A. Forder

There are no affiliations available

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