VA Morning Report Pearls 8.31

Shout out to Anna and Alayn for teaching us so much this morning – here are just a couple of the take-aways:

  1. Hollander’s Framework for considering the Transplant Patient courtesy of Geoff Stetson:
    1. Infection (think of each category: bacterial, fungal, viral, mycobacterial, parasites)
    2. Rejection (often requires pathological diagnosis b/c clinically can present very similarly to infection)
    3. Recurrence of underlying disease process that caused their organ failure leading to transplant
    4. Medication effect, especially immunosuppressive agents
    5. Post-transplant lymphoproliferative disorder (PTLD)
  2. When thinking about infection – remember that there is a great figure from NEJM called: “Changing Timeline of Infection after Organ Transplantation” which can help you think about what could be going on based on how far out the patient is from transplant. (see below)
  3. Hyperthermia – most define as 104F or above has its own differential including
    1. Severe infx such as meningitis, encephalitis, malaria, tetanus
    2. Hypothalamic strokes, seizures, brain bleeds
    3. Exposure (high temp and humidity)
    4. Thyroid storm, pheo
    5. Leukemia/Lymphoma
    6. DRUGS- don’t forget about NMS, serotonin syndrome, malignant hyperthermia, cocaine etc

nejmTRNSPLT

Ref: Fishman J. Infection in Solid-Organ Transplant Recipients N Engl J Med 2007;357:2601-14

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