Your immune system is the part of your body that is responsible for fighting infection. When this system is weakened by the immunosuppressive drugs used to prevent rejection of the transplanted lung(s), you become more susceptible to infections.

Your susceptibility to infection is directly related to the amount of immunosuppression that you are receiving at any given time.

The highest level of immunosuppression is immediately after the transplant operation, and isolation precautions are most strict at that time. Everyone who comes into your room will be required to wash their hands thoroughly in order to prevent transfer of bacteria, viruses, and other infection-causing microorganisms to you.

Your level of immunosuppression is also very high after you receive therapy for rejection.

Common Infections

After transplant, you are susceptible to the same types of infections that people around you have. These infections include upper respiratory infections (colds and flu) and stomach bugs.

Common infection can quickly become severe and perhaps even life-threatening because of your weakened immune system. Because of this, notify your transplant coordinator if common cold symptoms linger or if a stomach virus is causing you to be unable to take your medications.

Remember to always notify your transplant coordinator if you develop a fever higher than 100 degrees Fahrenheit.

Cytomegalovirus (CMV) Infection

Cytomegalovirus (CMV) is a virus that is very common in the general population. It does not usually cause problems in healthy people, but can cause very serious illness in transplant patients whose immune systems are weakened by immunosuppressive drugs.

The risk of CMV infection is especially high during the first few weeks after transplantation and after treatment for rejection, when larger doses of immunosuppressants are needed. Most patients will be given ganciclovirduring at this time to try and prevent CMV infection.

CMV infection can occur at any time after transplantation and is easily treated if detected early. For this reason, it is important for you to be able to recognize possible signs and symptoms of a CMV infection. These include:

• Fever (may be low-grade and cyclical; e.g. fever in the morning that is gone by afternoon)
• Shortness of breath
• Decreased FEV1 and FVC
• Extreme fatigue
• Muscle and joint aches
• Decreased white blood cell count

Often, CMV infection will occur without any symptoms that you can detect. For this reason, we will routinely check for CMV infection with a blood test when you come to clinic.

Treatment of CMV infection usually consists of a 14- to 21-day course of gancyclovir, given intravenously once or twice a day, depending upon your kidney function. We will usually arrange for you to receive this treatment at home with the assistance of a home care company. Gancyclovir capsules (known as "Valcyte") may be used in some circumstances.

Skin Infections

Some transplant patients will develop a skin infection known as shingles, which is also caused by a virus.

Shingles generally looks like small red blisters on your skin that are often grouped together in a line. The blisters may be itchy, tingly, and quite painful. Notify your local doctor or transplant coordinator if you think you may have shingles.

If a diagnosis of shingles is confirmed, it is often treated with a medication called Valtrex that can be called in to your pharmacy. If left untreated, shingles can spread to all parts of your body and become very serious. Shingles is also contagious to others until all the blisters have dried up.

Other types of skin infections, as well as skin cancers, occur more often in transplant patients due to their weakened immune systems. Always contact your doctor to examine any unusual skin or mouth lesions. As always, earlier detection and treatment can prevent a condition from becoming serious or even life-threatening.

Fungus Infections

Transplant patients are also more likely to develop fungus infections than the general population. Fungus infections can occur in almost any part of the body, including skin, nails, and your new lung(s), and can be difficult to treat.

Fungus is located in damp areas as well as dusty areas, so avoid being in areas where there is mold, mildew, dust, and dirt whenever possible.

While most fungus infections are usually treatable, the drugs used to treat fungus are generally very expensive, and treatment lasts a long time. Most drugs used to treat fungus infections also interact with anti-rejection drugs.

Your transplant coordinator will adjust your anti-rejection drug doses and monitor you closely while you are being treated for a fungus infection.