Infections in the Immunosuppressed Patient

An Illustrated Case-Based Approach

Edited by Pranatharthi H. Chandrasekar

81 illustrated cases of infection diagnosis and management across five types of immunosuppressed patients
Cases drawn from leading medical centers and experts from multiple specialties
References for each case offer additional resources for users
Highly navigable, with short cases organized by immunosuppression type
Includes specifications of immune deficit leading to the infection for each case

Infections in the Immunosuppressed Patient

An Illustrated Case-Based Approach

Edited by Pranatharthi H. Chandrasekar

Description

Infections in the Immunosuppressed Patient offers an illustrated, case-based matrix for treatment of infections across all types of immunosuppressed patients. As the challenges of managing these infections continues to evolve, this collection offers lucid, authoritative guidance to diagnosing and treating these infections effectively.

Comprising 81 cases from leading experts across specialties, this collection offers a guide to both common and uncommon presentations of infections in:

· Cancer patients
· Solid-organ transplant recipients
· Stem-cell recipients
· Patients on immunosuppressive drugs
· Patients with other immunosuppressive conditions

Supplemented with rich color illustrations and insights from more than 100 experts, Infections in the Immunosuppressed Patient is the new benchmark reference work for treatment of these difficult cases.

Infections in the Immunosuppressed Patient

An Illustrated Case-Based Approach

Edited by Pranatharthi H. Chandrasekar

Preface
Section 1: Infections in Cancer Patients
Section Editor
Alison G. Freifeld
Introduction to Section One
Alison G. Freifeld
Case 1.1: Leg Edema Woes
Edwin C. Pereira
Case 1.2: Doctor, I'm Sick Again and Again
Patrick Tang and R. Gregory Bociek
Case 1.3: What's Lurking Beyond the Barricade?
Allison L. Nazinitsky and Steven J. Lawrence
Case 1.4: Alimentary Antimicrobial Apocalypse
Kate Mullane
Case 1.5: Not Appendicitis in a Neutropenic Host
Kari Neemann
Case 1.6: Lung Lesions, Skin Lesions, Brain Lesions...Oh My
Patrick Tang and R. Gregory Bociek
Case 1.7: Lung Mass in a Neutropenic Patient with Leukemia: Beyond Aspergillosis
Michael J. Satlin, Stephen Castro, and Thomas J. Walsh
Case 1.8: When An Uncommon Atypical Bacillus Goes Mainstream
Jackrapong Bruminhent, Nancy L. Wengenack, and Raymund R. Razonable
Case 1.9: What's Wrong With My Right Side, Doc?
Susan Seo
Case 1.10: A Budding Headache in a Patient With Hematological Malignancy
Samantha E. Jacobs, Rosemary Soave, Audrey N. Schuetz, and Thomas J. Walsh
Case 1.11: Shocking Revenge of the Weak Gram Positive Cocci
Elena Beam
Raymund R. Razonable
Case 1.12: Upper Respiratory Symptoms During Febrile Neutropenia
Michael G. Ison
Case 1.13: Multiple Skin Lesions in a Neutropenic Patient with Leukemia: Connecting the Dots
Matthew McCarthy, Audrey N. Schuetz, and Thomas J. Walsh
Case 1.14: The New "Red Tide": Multidrug Resistant Gram-Negative Infections in the Compromised Host
Rahul Sampath, Raymund R. Razonable, and Shawn Vasoo
Case 1.15: Cough and Dyspnea in a Sarcoma Patient: Appetite for Infection
David Crockett and Nicole Shonka
Case 1.16: Breaking Bad: Breakthrough Fungemia
Jamie S. Green
Case 1.17: Painful Sores All Over My Body
Kailash Mosalpuria and Sara Bares
Case 1.18: Wounds in Cancer Patients: Watch for the Drugs!
Pavan Kumar Tandra and Nicole Shonka
Case 1.19: The Dangers of Dirt: Pulmonary Infiltrates and Skin Ulcers in a Farmer
Paul J. Deziel and Raymund R. Razonable
Case 1.20: A Red Hot Mess
Robbe Peetz and Alison G. Freifeld
Section 2: Infections in Solid Organ Transplant Recipients
Section Editors
Ajit P. Limaye and Lynne Strasfeld
Introduction to Section Two
Ajit P. Limaye and Lynne Strasfeld
Case 2.1: Breathless in Seattle
Erika D. Lease
Case 2.2: Red Snapper Cough
Robert M. Rakita
Case 2.3: Spots on the Lung
Joshua A. Hill
Case 2.4: Spots on the Brain
Elizabeth Ann Misch
Case 2.5: A Purplish Skin Lump
Christine M. Durand and Kieren Marr
Case 2.6: To Accept or Not to Accept
Ignacio A. Echenique and Michael G. Ison
Case 2.7: Fuzzy Vision and Balance Problems
Yuki Aoyagi and Richard A. Zuckerman
Case 2.8: More Than a Green Thumb
Jasmin Chaudhary
Case 2.9: Oh My Aching Head
Graeme N Forrest
Case 2.10: It's That Time of Year Again
Morgan Hakki
Case 2.11: How Low did the Hemoglobin Go?
Morgan Hakki
Case 2.12: The "Achilles' Heel" of Liver Transplantation
Janice Jou and Christopher D. Pfeiffer
Case 2.13: The Troll of Transplantation Rears its Head
Katie A. Sharff
Case 2.14: Sometimes it's the Drug, Rather Than the Bug
Lynne Strasfeld
Case 2.15: While the T cells Were Sleeping
Lynne Strasfeld
Case 2.16: An Ounce of Prevention
Jason Van Winkle
Case 2.17: Cruise Ship Souvenir
Robert M. Rakita
Section 3: Infections in Hematopoietic Stem Cell Transplant (HSCT) Recipients
Section Editor
John R. Wingard
Introduction to Section Three
John R. Winegard
Case 3.1: A Bad Case of the Trots: Diarrhea Early in the Course of Transplantation
Jack Hsu
Case 3.2: An Unexpected Trouble
Maxim Norkin
Case 3.3: A Swollen Eye
John R. Wingard
Case 3.4: Breathless in the Transplant Unit
John R. Wingard
Case 3.5: Learning from our Failures: Stubborn Aspergillosis That Does Not Get Better
John R. Wingard
Case 3.6: Mr. Sniffles Strikes Again
Gaurav Trikha
Case 3.7: Mucormycosis: An Uncommon But Deadly Foe
Maxim Norkin
Case 3.8: Something's in the Air
Gaurav Trikha
Case 3.9: Take My Breath Away
Gaurav Trikha
Case 3.10: Unfinished Business: Prior Aspergillosis
John R. Wingard
Case 3.11: When the Levee Breaks
Maxim Norkin
Case 3.12: A Bump in the Night
Jack Hsu
Case 3.13: A Really Bad Yeast Infection
John R. Wingard
Case 3.14: Proceed or Not to Proceed: Evaluation of the Transplant Candidate with Prior Hepatitis
Jack Hsu
Case 3.15: An All Too Common Abdominal Catastrophe in the Transplant Patient
Gaurav Trikha
Case 3.16: Female Troubles After Transplantation
Jack Hsu
Case 3.17: If at First you Do Not Succeed, Try, Try, Again
John R. Wingard
Case 3.18: An Enemy Awakened
Maxim Norkin
Case 3.19: A Heat Wave
John R. Wingard
Case 3.20: A Bellyache Seven Months After Transplant
John R. Wingard
Section 4: Infections in Patients Receiving Immunosuppressive Drugs
Section editor
Emily A. Blumberg
Introduction to Section Four
Emily A. Blumberg
Case 4.1: Consternation about Induration
Ryan McConnell and Naasha J. Talati
Case 4.2: Game of Cat and Mouse
Ambar Haleem and Bryan Steussy
Case 4.3: Beware the Fish Tank
Dilek Ince
Case 4.4: The Perils of Processed Foods
Jessie Torgersen and Todd Barton
Case 4.5: When the Dust Settles
Jennifer M. Babik
Case 4.6: A Tough Pill to Swallow
Matthew Whitson and Vandana Khungar
Case 4.7: A Construction Hazard
Rachel Miller
Case 4.8: The Dyspneic Diplomat
Ige Abraham George and Glenn Eiger
Case 4.9: Take One's Breath Away
Dana D. Byrne, Misha Rosenbach and Keith Hamilton
Case 4.10: Wielding a Double Edged Sword
Charitha Gowda and Melissa A. Grilliot
Case 4.11: Don't Judge a Book By Its Cover
Deborah Kahal and Faten Aberra
Case 4.12: Hitting the Bull's eye: Target Lesions
Rachel Gormley and Misha Rosenbach
Case 4.13: Multiple Sclerosis Treatments: Friend and Foe
David Holtzman and Amy Pruitt
Case 4.14: "B" Prepared When Using Biologic Agents
Charitha Gowda and Karen Krok
Case 4.15: Can We Inject to Protect?
Cristina Brickman
Section 5: Infections in Patients with Immunosuppression Due to Miscellaneous Conditions
Section Editors
George J. Alangaden
Prantharthi H. Chandrasekar
Case 5.1: Why Won't My "Infection" Go Away?
George J. Alangaden
Case 5.2: Why Do I Have a Groin Lump?
Priscilla Rupali
Case 5.3: Driveline Infection, Pocket Infection or Endocarditis?
George J. Alangaden
Case 5.4: Delirium During Treatment for Pneumonia
Murat Gonulalan
Case 5.5: Construction of a Bone Marrow Transplant Unit
George J. Alangaden
Case 5.6: C. difficile Keeps Coming Back: Liver Transplant Recipient
George J. Alangaden
Case 5.7: Idiopathic CD4+ Lymphocytopenia: Dizziness and Headaches
Ashish Bhargava
Case 5.8: Confused: A Patient With Melanoma
Maha Alhusseini, Deepak Garg, and Marwan Al-Hajeili
Case 5.9: Infected Donor - What Do I Do?
Ashish Bhargava
Index

Infections in the Immunosuppressed Patient

An Illustrated Case-Based Approach

Edited by Pranatharthi H. Chandrasekar

Author Information

Edited by Pranatharthi H. Chandrasekar, Professor of Medicine and Chief of Infectious Diseases, Karmanos Cancer Institute, Wayne State University School of Medicine

Pranatharthi H. Chandrasekar, MD, is Professor of Internal Medicine at Wayne State University. His major professional interest is management of infections in the immunocompromised host.

Contributors:

Faten Aberra, M.D., M.S.C.E.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

George J. Alangaden, M.D.
Henry Ford Hospital, Detroit, MI

Maha Alhusseini, M.D.
Wayne State University, Detroit, MI

Marwan Al-Hajeili, M.D.
Karmanos Cancer Institute, Wayne State University, Detroit, MI

Yuki Aoyagi, M.D., M.P.H., M.A.
Geisel School of Medicine at Dartmouth, NH

Jennifer M. Babik, M.D., Ph.D.
University of California, San Francisco, CA

Sara Bares, M.D.
University of Nebraska Medical Center, Omaha, NE

Todd Barton, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Elena Beam, M.D.
Mayo Clinic, Rochester, MN

Ashish Bhargava, M.D.
Wayne State University, Detroit, MI

Emily A. Blumberg, M.D.
Professor of Medicine, Division of Infectious Diseases
University of Pennsylvania, Philadelphia, PA

R. Gregory Bociek, M.D.
University of Nebraska Medical Center, Omaha, NE

Cristina Brickman, M.D.
University of California, San Francisco, CA

Jackrapong Bruminhent, M.D.
Mayo Clinic, Rochester, MN

Dana D. Byrne, M.D.
Cooper Medical School of Rowan University, Camden, NJ

Stephen Castro, M.D.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Jasmin Chaudhary, M.D.
Oregon Health and Science University, Portland, OR

David Crockett, M.D.
University of Nebraska Medical Center, Omaha, NE

Paul J. Deziel, PA-C
Mayo Clinic, Rochester, NY

Christine M. Durand, M.D.
Johns Hopkins University, Baltimore, M.D.

Ignacio A. Echenique, M.D.
Northwestern University, Chicago, IL

Glenn Eiger, M.D.
Einstein Medical Center, Philadelphia, PA

Graeme N Forrest, M.B.B.S.
Oregon Health and Science University, Portland VA Medical Center, Portland, OR

Alison G. Freifeld, M.D.
Professor, Internal Medicine, Infectious Diseases Section
University of Nebraska Medical Center, Omaha, NE

Deepak Garg, M.D.
St. John Hospital and Medical Center, Detroit, MI

Ige Abraham George, M.D.
Washington University School of Medicine, St. Louis, MO

Murat Gonulalan, M.D.
Henry Ford Hospital, Detroit, MI

Rachel Gormley, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Charitha Gowda, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Jamie S. Green, M.D.
University of California San Diego, La Jolla, CA

Melissa A. Grilliot, M.D.
Miami Valley Hospital, Wright State University School of Medicine, Dayton, OH

Ambar Haleem, M.D.
University of Iowa Hospital and Clinics, Iowa City, IA

Morgan Hakki, M.D.
Oregon Health and Science University, Portland, OR

Keith Hamilton, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Joshua A. Hill, M.D.
Fred Hutchinson Cancer Research Center & University of Washington, Seattle, WA

David Holtzman, M.D.
Global Health Corps Physician, Baylor International Pediatric AIDS Initiative, Houston, TX

Jack Hsu, M.D. />University of Florida, College of Medicine, Gainseville, FL

Dilek Ince, M.D.
University of Iowa Carver College of Medicine, Iowa City, IA

Michael G. Ison, M.D., M.S.
Northwestern University Feinberg Schoolo of Medicine, Chicago, IL

Samantha E. Jacobs, M.D.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Janice Jou, M.D., M.H.S.
Oregon Health and Science University, Portland VA Medical Center, Portland, OR

Deborah Kahal, M.D., M.P.H.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Vandana Khungar, M.D., M.Sc.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Karen Krok, M.D.
Penn State Hershey Medical Center and Penn State College of Medicine, Hershey, PA

Steven J. Lawrence, M.D., MSC
Washington University, St. Louis, MO

Erika D. Lease, M.D.
University of Washington, Seattle, WA

Ajit P. Limaye, M.D.
Professor, Division of Infectious Diseases
University of Washington, Seattle, Washington

Kieren Marr, M.D.
Johns Hopkins University, Baltimore, M.D.

Matthew McCarthy, M.D.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Ryan McConnell, M.D.
University of California, San Francisco, CA

Rachel Miller, M.D.
University of Iowa, Carver College of Medicine, Iowa City, IA

Elizabeth Ann Misch, M.D.
University of Washington, Seattle, WA

Kailash Mosalpuria, M.D.
University of Nebraska Medical Center, Omaha, NE

Kate Mullane, D.O., Pharm.D.
University of Chicago Medical Center, Chicago, IL

Allison L. Nazinitsky, M.D.
Washington University, St. Louis, MO

Kari Neemann, M.D.
University of Nebraska Medical Center, Omaha, NE

Maxim Norkin, M.D.
University of Florida, College of Medicine, Gainseville, FL

Robbe Peetz, P.A.
University of Nebraska Medical Center, Omaha, NE

Edwin C. Pereira, M.D.
University of Minnesota, Minneapolis, MN

Christopher D. Pfeiffer, M.D., M.H.S.
Oregon Health and Science University, Portland VA Medical Center, Portland, OR

Amy Pruitt, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Robert M. Rakita, M.D.
University of Washington, Seattle, WA

Raymund R. Razonable, M.D.
Mayo Clinic, Rochester, MN

Misha Rosenbach, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Priscilla Rupali, M.D., D.T.M. & H.
Christian Medical College and Hospital, Vellore, South India

Rahul Sampath, M.D.
Baylor, College of Medicine

Michael J. Satlin, M.D., M.S.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Audrey N. Schuetz, M.D., M.P.H.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Susan Seo, M.D.
Memorial Sloan Kettering Cancer Center, New York, NY

Katie A. Sharff, M.D.
Oregon Health and Science University, Portland, OR

Nicole Shonka, M.D.
University of Nebraska Medical Center, Omaha, N E

Rosemary Soave, M.D.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Bryan Steussy, M.D.
University of Iowa, Carver College of Medicine, Iowa City, IA

Lynne Strasfeld, M.D.
Oregon Health and Science University, Portland, OR

Naasha J. Talati, M.D., M.S.C.R.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Pavan Kumar Tandra, M.D.
University of Nebraska Medical Center, Omaha, NE

Patrick Tang, M.D.
University of Nebraska Medical Center, Omaha, NE

Jessie Torgersen M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Gaurav Trikha, M.D.
University of Florida, College of Medicine, Gainseville, FL

Shawn Vasoo, M.D.
Mayo Clinic, Rochester, MN

Jason Van Winkle, M.D.
Oregon Health and Science University, Portland, OR

Thomas J. Walsh, M.D.
New York Presbyterian-Weill Cornell Medical Center, New York, NY

Nancy L. Wengenack, Ph.D.
Mayo Clinic, Rochester, MN

Matthew Whitson, M.D.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

John R. Wingard, M.D.
University of Florida, College of Medicine, Gainseville, FL

Richard A. Zuckerman, M.D., M.P.H.
Geisel School of Medicine at Dartmouth, NH