Fungal Infections in Solid Organ Transplant Recipients

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					Fungal Infections
in Solid Organ                                                                             Program Three
Transplant Recipients
Post Test
Part A. Multiple-choice questions: There may be more than one correct answer for each question. Please
circle correct answers below and complete the CME Request and Evaluation forms on the reverse side.

1. Which of the following organisms is the most       6. In liver and lung transplant patients, it is
   common cause of post-transplant infection in          advisable to use minimal immunosuppressive
   all solid organ transplant recipients?                therapy early in the transplant period
   a) Aspergillus spp.                                   because:
   b) Candida spp.                                       a) Fungal infections in these patients are not
   c) Cryptococcus neoformans                               seen until a later period
   d) Histoplasma spp.                                   b) Organ rejection does not occur until a
                                                            later period
2. Infection with which type of organism in the          c) Immunosuppressive therapy may
   post-transplant period is associated with the            interfere with wound healing
   highest mortality?                                    d) Using maximal therapy may increase the
   a) Bacterial                                             risk of viral infections
   b) Viral
   c) Fungal                                          7. Current guidelines suggest that patients who
   d) Zygomycetes                                        are seronegative for CMV and receive an
                                                         organ from a seropositive donor be managed
3. Candida infection is most common during               in which of the following manners:
   which post-transplantation period?                    a) Patient should be administered
   a) Pre-transplantation                                   prophylactic doses of ganciclovir or
   b) 0-1 month                                             valganciclovir
   c) 1-6 months                                         b) Patient should receive minimal immuno-
   d) After 6 months                                        suppressive therapy post-transplant
                                                         c) Patient should not receive the infected
4. Which factors affect the net state of immuno-            donor organ
   suppression in solid organ transplant patients?       d) No management decision is required,
   a) Type and duration of immunosuppressive                patient can safely receive the donor organ
   b) Previous and concomitant viral infections       8. The use of immunomodulatory agents (e.g.
   c) Events related to surgery                          G-CSF, IFN-gamma) to support immune
   d) Underlying illness (e.g. diabetes,                 function in post-transplant patients is associ-
      lupus, etc.)                                       ated with which of the following?
   e) All of the above                                   a) Increased risk of neutropenia
                                                         b) Increased risk of rejection of the
5. Prior infection with which virus is associated           transplanted organ
   with increased risk of fungal infection after         c) Increased risk of opportunistic infections
   solid organ transplantation?                          d) None of the above
   a) Human immunodeficiency virus (HIV)
   b) Hepatitis virus C (HVC)
   c) Cytomegalovirus (CMV)
   d) Human papilloma virus (HPV)
9. Which of the following measures can help               b) It most often presents after dissemination
   reduce the risk of fungal infections in post-             to the central nervous system, with
   transplant patients?                                      symptoms of meningitis and/or focal
   a) Minimal use of immunosuppresion when                   lesions detected by MRI
      appropriate                                         c) Pulmonary disease is often asymptomatic,
   b) Careful organ selection, ensuring                      delaying its detection prior to CNS
      appropriate prophylactic measures in                   invasion
      patients receiving viral-infected organs            d) Lumbar puncture is the most important
   c) Careful monitoring and management of                   diagnostic test in these patients
      potential infectious foci (e.g. drains,             e) All of the above are true
      hematomas, fluid collections)
   d) Judicious use of antibiotics                     14. Current guidelines for the treatment of cryp-
   e) All of the above                                     tococcal CNS infection in solid organ
                                                           transplant recipients include:
10. Aspergillus is acquired primarily by:                  a) Amphotericin B plus 5-flucytosine for two
    a) Worker-to-patient contact                              weeks for induction therapy followed by
    b) Inhalation of air-borne conidia                        consolidation therapy with oral
    c) Contaminated organs                                    fluconazole
    d) Blood transfusion received during                   b) Amphotericin B given IV for two weeks
       transplant surgery                                  c) Voriconazole given IV for two weeks
                                                              followed by oral itraconazole indefinitely
11. Invasive aspergillosis has the highest mortality       d) No treatment unless disseminated disease
    rate in which population of transplant patients?          is suspected
    a) Heart and lung transplant patients
    b) Liver and lung transplant patients              15. An important consideration in patients with
    c) Kidney and pancreas transplant patients             solid organ transplants and treatment with
    d) Kidney and lung transplant patients                 the azole class of antifungals is that:
                                                           a) The azoles are renally-metabolized and
12. Which of the following is true of                         thus contribute to significant
    post-transplant patients with suspected pul-              nephrotoxicity
    monary aspergillosis?                                  b) The azoles are bone-marrow suppressive
    a) They may present with fever, cough,                    and increase the risk of fungal infections
       pleuritic pain, and hemoptysis                      c) Infusion reactions are a common
    b) Up to 75% may have a normal chest X-ray                occurrence and pre-medication of patients
    c) Chest X-ray may show a “halo” sign, and                is required prior to administration
       this is tantamount for pulmonary                    d) The azoles inhibit the cytochrome P450
       aspergillosis                                          system and thus interfere with the
    d) All of the above are true                              metabolism of important
    e) Both a and c are true                                  immunosuppressive agents

13. Which of the following is true of Cryptococcus     16. For which of the following indications is the
    infection in solid organ transplant patients?          use of caspofungin approved by the FDA?
    a) It is more common in this patient                   a) Sinus infection with Mucor spp.
       population than in patients receiving               b) Aspergillosis which is refractory to
       hematopoietic stem cell transplantation                conventional therapy
                                                           c) First line treatment of oral candidiasis
                                                           d) Histoplasma infection
Part B. True/False Questions

17. Candida glabrata the most common fungal          19. Bronchopulmonary infection is commonly
    pathogen causing infections in post-transplant       seen in patients from whom Candida spp. is
    patients.                                            isolated in sputum cultures.
    a) True                                              a) True
    b) False                                             b) False

18. Most Candida infections originate from           20. Treatment for zygomycosis should include
    endogenous sources within the patient.               amphotericin B plus flucytosine for
    a) True                                              potentiation of fungal killing.
    b) False                                             a) True
                                                         b) False

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Fungal Infections
in Solid Organ                                                                              Program Three
Transplant Recipients
Evaluation Form
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