After transplantation, your immune system is weak and you are at risk for infection. Unfortunately, the same medications that help prevent transplant rejection also cause you to be more susceptible to infections, particulary infections of the lungs and urinary tract. You are extremely vulnerable to illness right after your transplant when the level of immunosuppressive drugs are at thier highest. Even though your white blood cell count may be "normal", infections can still occur. Because the risk for infection continues long after you are discharged from the hospital, it is important to take steps to prevent infection at home.

Both physical barriers and the immune system defend the body against organisms that can cause infection. Physical barriers include the skin, teardrops, earwax, mucus (for example, in the nose), and stomach acid. Also, the normal flow of urine washes out organisms that ascend the urinary tract. The immune system, which is complex and sophisticated, is made up of, among other components, white blood cells and antibodies that identify and eliminate organisms. A wide variety of diseases, drugs, and other treatments can cause a breakdown in the body's natural defenses. Such a breakdown may result in infections, which may be caused by organisms that normally live harmlessly on or in the body. Remember to wear your mask when you go to hospital or crowded places, and avoid people who are ill, prevention does not mean you have to live in a bubble, but you have to take all precautions. After all, your life is the most important thing.

The medications given to prevent your immune cells from attacking and killing your new organs also prevent your immune cells from attacking other foreign objects in your body. We call these medications that suppress or block your immune cells Immunosuppressive drugs. The commonly used Immunosuppressive drugs at Columbia are cyclosporine, prograf, prednisone, imuran and cellcept. Because they block the ability of your immune cells to attack foreign objects in your body, these same drugs put you at risk for developing infections caused by foreign bodies like viruses, fungi and bacteria.
The infection problem is worse when you are on high doses of the immunosuppressive drugs. You will be on high doses of the drugs right after you have transplant surgery and during times of rejection. As the doses of immunosuppressive drugs are lowered your chances of getting an infection are also lowered. This does not mean however, that you can stop worrying. Being on these drugs no matter what the dose makes you prone to developing infections.

Organ transplant recipients are susceptible to infection due to their generalized immunosuppressed state.

 

Warning signs of infection:

• Fever over 100°F (38°C)
• Sweats or chills
• Skin rash
• Pain, tenderness, redness or swelling
• Wound or cut that won't heal
• Red, warm or draining sore
• Sore throat, scratchy throat or pain when swallowing
• Sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones
• Persistent dry or moist cough that last more than two days
• White patches in your mouth or on your tongue
• Nausea, vomiting or diarrhea
• Flu-like symptoms (chills, aches, headache or fatigue) or generally feeling "lousy"
• Trouble urinating: pain or burning, constant urge or frequent urination
• Bloody, cloudy or foul-smelling urine

  If you have any of these symptoms, notify your health care provider right away.

Glossary

Antibody: Protein molecule that is part of the immune system. Antibodies are produced in response to substances, usually foreign, known as antigens. Antibodies to transplantation antigens can lead to organ rejection.
Antiviral medicines: Drugs that attack a virus at its source in the body, rather than treating the symptoms of a disease. Unlike vaccines, antiviral medicines do not prevent infection.
Bacteria: Tiny, singlecelled microorganisms. Some bacteria, called pathogens, cause disease.
Compliance: Following a disease treatment, including drug and nondrug therapies, prescribed by a healthcare practitioner in the amounts needed and for the time required.
Diphtheria: Highly contagious childhood disease caused by particular bacteria.
Dormant: An infection that is currently not active.
Epidemic: Sudden increase in occurrence of a disease beyond a normal level in a particular population; for example, in a specific geographic area.
Hepatitis viruses: Hepatitis B - Infections from hepatitis viruses cause inflammation of the liver. Hepatitis B (serum hepatitis) is caused by hepatitis B virus, which is transmitted through body fluids.
Herpes zoster: See Varicella-zoster virus.
Human herpes viruses: A group of viruses with sometimes overlapping symptoms and with common traits: an initial, or primary, infection; a period of dormancy in the body; finally, reactivation of infection, often associated with recurrent disease.
Immune system: The organs, tissues, cells, and cell products in our body that work to find and neutralize foreign substances, including bacteria, viruses, and transplanted organs.
Immunosuppression: Medical therapy to reduce the strength of the immune response so that your body does not reject your new organ.
Incubation: Period of time, from a few days to a few weeks, between when an infectious organism enters the body and when symptoms occur.
Influenza: Acute, or intense, viral infection of the respiratory tract caused by one of three strains of virus:A, B, or C.
Latency: When a virus is not making copies of itself in the body, but is still alive and making certain proteins in the infected cells. It can go into a “sleeping” state, or dormancy, for months or years before reactivation due to injury, stress, or a weakened immune system.
Meningitis: Inflammation of the membranes that surround and protect the spinal cord and brain; usually caused by a bacterial infection (lifethreatening) or by a viral infection (milder).
Mononucleosis: Infection caused by a virus that invades a type of white blood cell called a monocyte, causing fever, sore throat, and swollen lymph nodes.
Mutation: A change in the genetic information contained in viral cells, often enabling the virus to grow stronger.
Opportunistic infections: Infections that are usually harmless, but can cause disease in a person with a weakened immune system.
Papillomaviruses: A majority of this family of more than 60 viruses cause warts on the hands, fingers, and the face. However, other viruses in this group are sexually transmitted, causing genital warts that raise the risk for contracting cervical cancer.
Pneumococcal: Referring to the bacterium that causes pneumonia and certain other diseases.
Pneumonia: An inflammation of the lungs due to a bacterial or viral infection, which causes fever, shortness of breath, and the coughing up of phlegm.
Polyoma viruses: Infections from this family of viruses occur in early childhood and can go into latency within the kidney. Reactivation may occur in transplant patients as a result of immunosuppression, or infection can be transmitted by a donor kidney.
Reactivation: When an infection reappears after a period of latency, usually due to stress, injury, or a weakened immune system. See Opportunistic infections.
Resistance: The ability of a virus to fight off the effects of treatment because the information contained in its cells has changed. It can be the result of not taking the right amount of medicine on a regular basis needed to keep the virus to a level below its ability to cause disease.
Roseola: A common disease in young children characterized by a sudden fever and rash.
Shingles: See Varicellazoster virus.
Tetanus: An often fatal disease affecting the brain and spinal cord.Tetanus shots are given regularly to prevent infection that can lead to disease after a cut or puncture wound caused by an object soiled with dirt or manure.
Vaccine: Protects an individual against infection and/or disease from a microorganism. Prepared from killed or weakened microorganisms and administered to stimulate an immune response and create resistance to a certain disease.
Varicella-zoster virus: Medical name for the virus that causes chickenpox and shingles.
Viruses: Very small disease-causing microorganisms. Viruses are very simple in structure and can only multiply when they are inside the cell of another organism.

 

Prevention

• Visitors: 1. Limit visitors at first. 2. If visitors have cold or flu symptoms ask them to return when they are feeling well. 3. Before visiting with an infant or child, check with the Transplant Team.
• Environment: 1. Keep your house clean and free from excess dust. 2. Do not work in or visit any form of construction site. Dust can be harmful. If you absolutely must go near this type of area, wear a mask provided by the Transplant Team.
• Activities and Exercise: 1. Enjoy the out-of-doors, but always wear gloves when gardening. Soil has many molds and fungi that can be sources of infection. In addition, do not mow the lawn yourself and avoid areas where people are mowing. A lawn mower blows bacteria from the grass wich can cause an infection. 2. Exercise! Walking helps to expand the lungs and strenghten your body. Ride an exercise bike if you have one at home. Check with the Transplant Team before doing any advanced exercising such as aerobics and weight lifting. 3. Enjoy spending time with your pets, but decrease close exposure to them. Have other family members or friends clean the litter box, cage or yard. In addition, do not add any new pets to your home, especially birds. 4.Ask your health care provider when you can safely return to work or school.
• Diet: 1. Try to eat a balanced diet. Good nutrition is important to help the body resist infection. Eat foods from all the food groups. 2. Drink plenty of fluids. Water, juices and sport drinks are the best.

Daily Hygiene

1. Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes.
2. Shower or bathe daily, using a mild soap.
3. If you have a dry skin, apply a mild skin lotion after bathing.
4. Examine your mouth and gums daily. Brush your teeth and gums thoroughly after each meal. Be sure to have a routine check-up and cleaning by your dentist at least every six months.
5. Protect your skin from scratches, sores and other irritations that might lead to infection.

With your immune system suppressed from the anti-rejection drugs, you can get infections easier now. Protect yourself all you can:
- Wash your hands often, especially after being around children and pets.
- Avoid being in large crowds the first few weeks after transplant.
- Drink water and eat food you know is safe.
- Don't travel outside your country without talking to your transplant team.
- Avoid contact with an animal's bodily waste, especially bird droppings and kitty litter, which can be harmful to you.
- Ask people who are sick to stay away until they are well.
- Call your transplant team before getting any dental work done, because you could get an infection. You'll need to start an antibiotic before the dental work begins.
- Call your transplant team if you or someone close to you is getting vaccinated.
- Practice safe sex.

Medical Precautions

1. Record your temperature once a day. If your temperature is over 100°F, call your health care provider, since fever is an early sign of infection.
2. Check your neck, armpits and groin area for lumps or new growths. Report signs of these to your doctor.
3. Get the pneumonia vaccine if you have not had it.
4. Women should perform monthly breast self-exams. Women should also have a pelvic exam with pap smear and a mammogram every year, regardless of age.
5. Men should have their PSA (prostate-specific antigen) and prostate checked every year.
6. Get a flu shot every year. You cannot get the flu from receiving the shot itself.
7. Do not go into crowded areas for three months. If you cannot control how far away you can stay from other people, it is probably a crowd.
8. Do not use hot tubs, whirlpools, saunas or steam baths. Germs tend to multiply in these.
9. Stay out of the sun, unless you are wearing sunscreen. We reccomend that you use a lotion with a SPF rating of 15 or above.

Physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis. Physical activity also helps the body use calories more efficiently, thereby helping in weight loss and maintenance. It can increase basal metabolic rate, reduces appetite, and helps in the reduction of body fat.

Call your doctor if you experience any of the warning signs of an infection.

 

Created and maintained by Andrei Mihail © 2002