But when you can take steps to prevent infections: Practice good hygiene. Wash your hands with mild soap after using the toilet and before eating.
Take care of your teeth. Brush your teeth at least twice a day. Eat right. A healthy, balanced diet can help prevent infections. Be physically active. Staying fit is important to your overall health. Ask your doctor what activities are appropriate for you. Get enough sleep. Try to go to sleep and get up at the same time daily and get the same number of hours of sleep every night. Manage stress. Some studies suggest that stress can hamper your immune system.
Schutta feel your first line of defense should be doing everything you can to avoid exposure and infection. Porter also cautions that people should keep taking their immune-suppressing medications. Porter says you should have a conversation with your health care provider. Get information on a variety of health conditions, disease prevention, and our services and programs. It's advice from our physicians delivered to you on your time. Sign up for the Health and Wellness Newsletter.
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Date published Tuesday, 19 January, Post-transplantation infections are divided into 3 major categories based on the postsurgical time period Fishman ; de Pauw and Rubin ; Rubin ; Rubin et. In the first period, the first month post-transplant, the majority of infections are similar to those in any postsurgical patient. In the second time period, the period from the second until the sixth month post-transplant, opportunistic infections predominate. The third time period, 6 months or more post-transplant, is characterised by infections similar to those in an immunocompetent individual.
However, a continuing requirement for high dose pharmacological immunosuppression or the presence of graft versus host disease will substantially alter these timelines. Most early postoperative infections in solid organ transplant recipients are similar to those occurring in immunocompetent patients; however, their clinical course may be much more severe. Surgical wound and IV catheter infections, urinary tract infections, and pneumonia are typical. Pathogens responsible for these infections are typically nosocomial in origin and will carry resistance patterns endemic to ICU organisms.
The majority of remaining early post-transplant infections are caused by reactivation of latent or subclinical infections that were present in the recipient before transplantation. Reactivation is triggered by perioperative nonspecific insults and intense immunosuppression.
Typical organisms include HSV, Mycobacterium tuberculosis, geographically restricted mycoses Histoplasma capsulatum and Coccidioides immitis and, occasionally, Strongyloides stercoralis and Toxoplasmosis gondii. Opportunistic pathogens do not normally present in this early postoperative period, since they require a prolonged period of immunosuppression to manifest. Following the first month post-transplantation, defects of cellular immunity due to pharmacological intervention begin to have a greater impact on the nature of infections.
The risk for infections is maximal between 1 and 6 months with serious life-threatening infections occurring at 3 to 4 months after transplantation. Normally, at 6 months post-transplantation pharmacological immunosuppression is minimised and graft function is optimal. At this point most infections in graft recipients are similar to those of immunocompetent individuals. The actual organ transplanted is crucial to determining the risk of infection especially in the first three months.
For example, lung transplant recipients tend to exhibit recurrent pneumonias, involving both standard bacterial pathogens and opportunistic organisms. Liver transplant recipients exhibit biliary sepsis with increased frequency. Renal transplants are often complicated by recurrent urinary tract infection. Three broad time periods corresponding to the nature of infectious risk have been defined for bone marrow recipients.
The first encompasses the pre-engraftment period occurring from bone marrow ablation until 30 days post-transplant. The second time period, the post-engraftment period lasts from 30 days to days post-transplant. The third time period, the late post-trans plantation period, begins days post-transplant Rubin et.
In the first time period, infections are primarily related to the severe neutropenia and mucositis caused by the cytotoxic conditioning regimen given for the transplant. Clinical disease and treatment are therefore similar to those for other febrile neutropenic patients. Various prophylactic regimens to prevent infectious complications may be given in this period.
These can influence predominant pathogens, shifting bacterial species to more resistant gram negatives, and increasing the incidence of colonisation with fluconazole-resistant Candida species. The most common pathogens in this time period include HSV and human metapneumovirus. The second time period, 30 days to days post-transplant includes infection risk due to antirejection immunosuppressive regimen leading to depressed cell-mediated immunity.
However, immune dysfunction caused by the bone marrow ablating conditioning regimen as well as graft versus host disease, may contribute to the increased infection risk during this period. Since allogeneic transplants require greater immunosuppression, they tend to have higher rates of infection than autologous transplants.
Because cell-mediated immunity is predominantly affected, infections in this period involve pathogens similar to those seen in organ transplant recipients. During the third time period, after days post-transplant, VZV reactivation and viral respiratory infections become more common.
Potential causes of viral respiratory tract infections in the late post-transplant period include respiratory syncytial virus and parainfluenza. They are the most common causes of viral pneumonia in this population and carry a high mortality rate.
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