Parasitic Infections

Pneumocystis carinii pneumonia (PCP) occurs in 5 to 10 percent of renal transplant patients not receiving prophylactic therapy. Risk factors include recent increases in the level of immunosuppression and concurrent CMV infections. PCP most often presents during the first 6 months posttransplant with fever, dry cough, dyspnea on exertion, and interstitial pulmonary infiltrates. Diagnosis is based on recovery of the organism on bronchoalveolar lavage or lung biopsy. Ireatment is with high-dose intravenous IMP-SMX or pentamidine.

Toxoplasma gondii affects cardiac more often than renal transplant patients. Infection results in meningitis, brain abscess, pneumonia, myocarditis, endocarditis, and choriorentinitis. Diagnosis is based on histologic demonstration of trophozoites in a biopsy specimen. Ireatment is with pyrimethamine with folinic acid in combination with sulfadiazine or clindamycin.

Strongyloidiasis can result in a hyperinfection syndrome of the gastrointestinal tract from Strongyloides stercoralis. Symptoms are usually limited to the gastrointestinal tract, with diarrhea and abdominal pain. With increased immunosuppression, strongyloidiasis can flare, producing hemorrhagic enterocolitis and pneumonia. Diagnosis is often first suspected by eosinophilia and confirmed by finding larvae in stool, body fluids, and tissue specimens. Strongyloidiasis is treated with thiabendazole.

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