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Purpose of Review The goal of this review is to summarize the current knowledge of the epidemiology, clinical manifestations, diagnosis, and treatment of cutaneous, mucosal, and visceral leishmaniasis. We will describe the most recent findings and suggest areas of further research in the leishmaniasis field. Recent Findings This article reviews newer leishmaniasis tests (including rapid diagnostic tests using rK39 antibodies), vaccine candidates, and updated treatment recommendations. Summary While leishmaniasis is a complex disease, learning the prominent clinical manifestations and major parasite species can guide the recommendations for diagnosis and treatment.

Splenic complications of acuteBabesia microtiinfection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

Liver abscess associated with suppurative portal vein thrombosis (pylephlebitis) secondary to Fusobacterium necrophorum has been rarely reported. It is considered to be an abdominal variant of Lemierre’s syndrome associated with significant morbidity and mortality. We report a case of 69-year-old man who developed liver abscess and pylephlebitis due to F. necrophorum with an unclear source of infection. We discuss the pathogenesis, diagnosis, and treatment strategy for this entity, with a review of previously published cases of pyelephlebitis due to F. necrophorum in regard to their clinical presentation and outcome.

Chagas disease (CD) is the third most common parasitic infection globally and can cause cardiac and gastrointestinal complications. Around 300,000 carriers of CD live in the U.S., with about 3000 of those in Colorado. We described our experience in diagnosing CD at a Colorado teaching hospital to revise screening eligibility criteria. From 2006 to 2020, we reviewed Trypanosoma cruzi (TC) IgG serology results for 1156 patients in our institution. We identified 23 patients (1.99%) who had a positive test. A total of 14/23 (60%) of positive serologies never had confirmatory testing, and 7 of them were lost to follow up. Confirmatory testing, performed in 9 patients, resulted in being positive in 3. One additional case of CD was identified by positive tissue pathology. All four confirmed cases were among patients born in Latin America. While most of the testing for CD at our institution is part of the pretransplant screening, no confirmed cases of CD derived from this strategy. Exposure risk in this population is not always documented, and initial positive results from screening are not always confirmed. The lack of standardized screening protocols for CD in our institution contributes to underdiagnosis locally and in health systems nationwide. Given a large number of individuals in the U.S. with chronic CD, improved screening is warranted.

Patient: Male, 28-year-old Final Diagnosis: Kaposi sarcoma inflammatory cytokine syndrome (KICS) Symptoms: Abdominal pain • anemia • dyspnea • fever • shock • thrombocytopenia Medication: — Clinical Procedure: Skin biopsy Specialty: Infectious Diseases Objective: Unusual clinical course Background: Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS) is a relatively new syndrome described in patients co-infected with Human Immunodeficiency Virus (HIV) and Kaposi Sarcoma (KS) Herpes Virus (KSHV). KICS clinically resembles Multicentric Castleman disease (MCD) and both present with various degrees of lymphadenopathy, pancytopenia, HIV and KSHV viremia, and signs of systemic inflammatory syndrome (SIRS). KICS has higher mortality than MCD and is rarely recognized. Lymph node, bone marrow, or splenic biopsy can help differentiate between the 2 entities. Case Report: We present a case of a 28-year-old African American man with advanced acquired immunodeficiency syndrome (AIDS) who was diagnosed with disseminated pulmonary and cutaneous KS. Following initiation of combined antiretroviral therapy (cART), rapid immunologic recovery occurred followed by rapid clinical deterioration (IRIS) with multiorgan failure, overwhelming SIRS, and ultimately death. The patient’s symptoms, signs, and laboratory findings during this episode could not be solely explained by KS-IRIS, and MCD versus KICS was diagnosed. Conclusions: SIRS in patients with uncontrolled HIV viremia and CD4 lymphopenia has a broad differential diagnosis, including infectious and noninfectious causes. It encompasses sepsis due to common bacterial pathogens, various HIV-specific opportunistic infections, immunological conditions such as hemophagocytic lymphohistiocytosis (HLH), and IRIS, malignancies such as primary effusion lymphoma (PEL) and MCD, and finally KCIS. Clinicians involved in treatment of these patients should have a high index of suspicion for less-known and recently described syndromes such as KICS to recognize it early and initiate timely treatment, which might improve the high mortality associated with KICS.

We present a case of Cryptococcus neoformans pericarditis in a cardiac transplant recipient. This article reviews the diagnosis, treatment, and complications of cryptococcosis specifically in transplant patients. While pericarditis is a rare manifestation of Cryptococcus infection, this case highlights that cryptococcosis should be considered in the differential diagnosis for solid organ transplant and immunocompromised patients presenting with pericardial effusions.

Cytomegalovirus (CMV) is a DNA virus of the Herpesviridae family and is estimated to affect 15%-30% of high-risk solid organ transplant recipients. Typical manifestations of CMV end-organ disease in this population include colitis, esophagitis, and pneumonitis, and myocarditis is a rarely reported manifestation. We describe two cases of CMV myocarditis in solid organ transplant recipients and review the literature regarding previously published cases of CMV myocarditis.

The risk of toxoplasmosis in high-risk cardiac transplant recipients is well recognized prompting universal donor and candidate screening with administration of targeted post-transplant chemoprophylaxis in high-risk (D+/R-) cardiac transplant patients. In contrast, until recently, there have been neither well-defined recommendations nor consensus regarding toxoplasmosis preventive strategies among non-cardiac solid organ transplant recipients. We report 3 cases of post-transplant toxoplasmosis in non-cardiac transplant recipients (one lung and two liver); all 3 infections presumed to be donor-derived. Not surprisingly, pre-transplant Toxoplasma serology was negative in all the patients. None of the patients were on trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis of toxoplasmosis. The median time from transplant to onset of infection was 90 days (range: 30-120 days). Clinical presentations included cerebral (n = 1) and disseminated infections (n = 2). Two of the 3 patients, both with disseminated infection died (mortality ~ 67%).

This article reviews the current diagnostic approaches, both serologic and molecular, for the detection of fungi associated with pulmonary disease. Classic serologic techniques, including immunodiffusion and complement fixation, both of which remain a cornerstone for fungal diagnostic testing, are reviewed and their performance characteristics presented. More recent advances in this field, including novel lateral-flow assays for fungal antigen detection, are also described. Molecular techniques for fungal identification both from culture and directly from patient specimens, including nucleic acid probes, mass spectrometry-based methods, nucleic acid amplification testing, and traditional and broad-range sequencing, are discussed and their performance evaluated.

A patient with asplenia and multiple red blood cell transfusions acquired babesiosis infection with Babesia divergens-like/MO-1 organisms and not Babesia microti, the common United States species. He had no known tick exposure. This is believed to be the first transfusion-transmitted case and the fifth documented case of B. divergens-like/MO-1 infection.

A real-time RT-PCR assay was designed to detect and differentiate norovirus genogroups I (GI) and II (GII), with primers and probes targeting the nonstructural polyprotein gene. Stool samples (n = 100) submitted for routine testing by the BioFire FilmArray® GI panel were also tested by the norovirus GI/GII real-time PCR assays. When compared to the FilmArray GI panel, the norovirus real-time PCR assay demonstrated a sensitivity of 77.5% (62/80) and specificity of 95% (19/20). Specimens yielding discordant results (n = 19) were tested at two outside laboratories for adjudication. Following discordant resolution, the adjusted sensitivity and specificity of the norovirus real-time PCR assays were 96.9% (63/65) and 100% (35/35), respectively. These results suggest that the real-time PCR assays are able to accurately detect and differentiate norovirus GI/GII from clinical stool specimens. Furthermore, our report highlights a potential issue with the specificity of the BioFire FilmArray® norovirus assay, which warrants additional investigation.

Patient: Female, 79 Final Diagnosis: Splenic rupture due to babesia microti infection Symptoms: Abdominal discomfort • chest pain • fever • tachycardia Medication: — Clinical Procedure: Splenectomy Specialty: Infectious Diseases Objective: Rare disease Background: Babesiosis is an emerging, tick-borne zoonosis caused by intraerythrocytic protozoa of the genus Babesia. Babesia microti is the main pathogen causing human disease and is endemic in the northeastern and upper midwestern parts of the USA. Severity of infection ranges from mild, self-limited, febrile viral-like illness accompanied by nonspecific symptoms to life-threatening infection complicated by severe hemolytic anemia, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and renal or/and hepatic failure. Splenic rupture (SR) is a very rare but life-threatening complication of severe B. microti infection. Case Report: A 79-year-old female farmer from Wisconsin, USA was admitted during summer with hemorrhagic shock secondary to spontaneous splenic rupture. She was transfused with 3 units of packed red blood cells (PRBC) and underwent emergent splenectomy. Postoperatively, she recovered well and was discharged on postoperative day 4. However, she was re-admitted on postoperative day 10 for febrile hemolytic anemia. Further exposure history was obtained and was significant for multiple tick bites 8 weeks preceding the index hospitalization. She was promptly diagnosed with babesiosis and Lyme disease co-infection. She responded favorably to 10 days of azithromycin and atovaquone and 21 days of oral doxycycline. Conclusions: Despite its rare occurrence, SR due to B. microti infection is a dreaded complication that can rapidly progress to hemorrhagic shock and death. In contrast to other complications of babesiosis, SR is not correlated with parasite burden or immune status of the affected host. Babesiosis should be considered as part of the differential diagnosis in patients from endemic areas presenting with atraumatic splenic rupture.

SUMMARY The recent development of commercial panel-based molecular diagnostics for the rapid detection of pathogens in positive blood culture bottles, respiratory specimens, stool, and cerebrospinal fluid has resulted in a paradigm shift in clinical microbiology and clinical practice. This review focuses on U.S. Food and Drug Administration (FDA)-approved/cleared multiplex molecular panels with more than five targets designed to assist in the diagnosis of bloodstream, respiratory tract, gastrointestinal, or central nervous system infections. While these panel-based assays have the clear advantages of a rapid turnaround time and the detection of a large number of microorganisms and promise to improve health care, they present certain challenges, including cost and the definition of ideal test utilization strategies (i.e., optimal ordering) and test interpretation.

This article reviews the current diagnostic approaches, both serologic and molecular, for the detection of fungi associated with pulmonary disease. Classic serologic techniques, including immunodiffusion and complement fixation, both of which remain a cornerstone for fungal diagnostic testing, are reviewed and their performance characteristics presented. More recent advances in this field, including novel lateral-flow assays for fungal antigen detection, are also described. Molecular techniques for fungal identification both from culture and directly from patient specimens, including nucleic acid probes, mass spectrometry-based methods, nucleic acid amplification testing, and traditional and broad-range sequencing, are discussed and their performance evaluated.

Campylobacter fetusis a zoonotic pathogen that occasionally causes serious, relapsing, invasive disease, especially in immunocompromised hosts. We report a case of relapsingC. fetusdiarrheal illness in a 75-year-old woman which resulted in secondary bacteremia and seeding of the left knee prosthetic joint. Patient responded favorably to debridement and retention of prosthesis in addition to six weeks of meropenem followed by chronic oral doxycycline suppressive therapy.

Cytomegalovirus (CMV) is a common opportunistic infection that contributes to poor outcomes in hematopoietic stem cell transplant (HSCT) recipients. Prevention of CMV end-organ disease in allogeneic HSCT recipients is commonly achieved by preemptive antiviral therapy of asymptomatic CMV reactivation that is detected by serial nucleic acid testing (NAT). However, there was no standardized CMV NAT until the development of the World Health Organization (WHO) International Standard. Areas covered: This article provides a comprehensive review on COBAS AmpliPrep/TaqMan (CAP/CTM) CMV assay (Roche) and emphasizes the limitations in the clinical use of CMV NAT in HSCT recipients. Expert commentary: The CAP/CTM CMV Test is the first US FDA approved commercial quantitative NAT for CMV viral load monitoring of plasma samples in solid organ transplant and HSCT recipients. The CAP/CTM assay has wide linear range of DNA quantification and demonstrates colinearity to the WHO International Standard. Studies of CAP/CTM CMV assay in HSCT recipients are still limited, but are now being reported to define viral thresholds for diagnosis, surveillance and monitoring. Results from these early studies in HSCT recipients suggest that, while the WHO IS has improved the inter-laboratory result variances, there are still important factors that continue to contribute to assay variability. This lack of harmony among NAT highlights the need for further standardization.

Microsporidia are highly specialized obligate intracellular organisms that are closely related to fungi. Although traditionally associated with diarrheal illness in patients with AIDS, extraintestinal infections involving various organs have been reported with increasing frequency in the past decade, particularly in immunocompromised hosts. Diagnosis is usually accomplished by light microscopic identification of spores in body fluids and tissues, using a variety of stains. Transmission electron microscopy, immunofluorescence assays, or molecular methods are necessary for identification to the genus and species level. Early diagnosis is essential for preventing the significant associated morbidity and mortality of extraintestinal microsporidiosis.

Clinical disease due to human T cell lymphotropic virus type 1 (HTLV-1), a retrovirus endemic in certain regions of the world, is rarely reported after solid organ transplantation. In 2009, universal deceased donor organ screening for HTLV-1 was discontinued in the United States. We report the first case of donor-derived HTLV-1-associated myelopathy in a kidney transplant recipient from the United States. The patient, who was HTLV-1-seronegative prior to transplantation, likely acquired HTLV-1 infection from a seropositive organ donor. In this era when screening of donors and recipients for HTLV infection is not mandatory, clinicians should be vigilant in recognizing the risk and potential occurrence of this donor-derived infection in recipients with epidemiologic exposures.

Rothia spp. are Gram-positive cocco-bacilli that cause a wide range of serious infections, especially in immunocompromised hosts. Risk factors for Rothia mucilaginosa (previously known as Stomatococcus mucilaginosus ) bacteremia include prolonged and profound neutropenia, malignancy, and an indwelling vascular foreign body. Here, we describe 67 adults at the Mayo Clinic in Rochester, MN, from 2002 to 2012 with blood cultures positive for Rothia . Twenty-five of these patients had multiple positive blood cultures, indicating true clinical infection. Among these, 88% (22/25) were neutropenic, and 76% (19/25) had leukemia. Common sources of bacteremia were presumed gut translocation, mucositis, and catheter-related infection. One patient died with Rothia infection. Neutropenic patients were less likely to have a single positive blood culture than were nonneutropenic patients. Antimicrobial susceptibility testing was performed on 21% of the isolates. All of the tested isolates were susceptible to vancomycin and most beta-lactams; however, four of six tested isolates were resistant to oxacillin. There was no difference between the neutropenic and nonneutropenic patients in need of intensive care unit care, mortality, or attributable mortality.

Acute transverse myelitis (ATM) is a rare, potentially devastating neurological syndrome that has variety of causes, infectious being one of them. Lyme disease (LD) is the most common vector borne zoonosis in the United States (U.S.). While neurologic complications of LD are common, acute transverse myelitis is an exceedingly rare complication. We present a case of a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis and clinical features of transverse myelitis including bilateral lower extremity motor and sensory deficits manifesting as weakness and numbness, urinary retention and constipation. Despite negative serum antibodies against Borrelia burgdoferi, cerebrospinal fluid (CSF) was positive for Borrelia burgdorferi PCR. Following treatment with methylprednisolone and ceftriaxone, he attained complete recovery apart from neurogenic bladder necessitating intermittent self-catheterization. We report rare manifestation of a common disease and emphasize the importance of considering LD in the differential diagnosis of acute transverse myelitis, particularly in residents of endemic areas.

Anisakidosis is a parasitic infection caused by anisakid nematodes in the genera Anisakis and Pseudoterranova . Infection is not uncommon in the United States due to increased raw seafood consumption. We report the first known case of parametrial anisakidosis in a 42-year-old woman and review existing literature.

We present a case of JC polyomavirus (JCV)-associated nephropathy (PyVAN) in an asymptomatic deceased-donor kidney transplant recipient. Despite the presence of viral cytopathic effect in the kidney biopsy and positive BK polyomavirus (BKV) in situ hybridization (ISH), BKV real-time polymerase chain reaction (PCR) results of plasma and urine were negative. JCV ISH was performed and was found to be positive. JCV real-time PCR on urine, plasma, and the kidney biopsy tissue was positive. Reduction in immunosuppression resulted in resolution of JCV viremia. This case highlights that JC-PyVAN is a distinct clinical entity and is likely to have a better clinical outcome than BK-PyVAN. Concurrent infection with BKV and JCV may occur, but may be difficult to confirm owing to the potential for cross reactivity between BKV and JCV IHS stains. This article is protected by copyright. All rights reserved.

Answer: Invasive fungal infection of the right paranasal sinus demonstrating two distinct, adjacent morphologies consistent with a Mucorales (Zygomycetes) mold and a narrow, septate hyaline mold. Fungal culture of the debrided right paranasal sinus tissue grew Fusarium and Rhizopus species

A 54-year-old male from South Dakota with recently diagnosed acute myelogenous leukemia (AML) presented with right-sided facial pain associated with right periorbital swelling, diplopia, and bloody nasal discharge. He had received standard induction chemotherapy with cytarabine and idarubicin during

The epidemiology of infection after liver transplantation for hilar cholangiocarcinoma has not been systematically investigated. In this study of 124 patients, 255 infections occurred in 105 patients during the median follow-up of 4.2 years. The median time to first infection was 15.1 weeks (IQR 1.6 – 62.6). The most common sites were the abdomen, bloodstream and musculoskeletal system. Risk factors for any post-transplant infection were pre-transplant VRE colonization (Hazard Ratio [HR] 1.9, p=0.002), living donor transplantation (HR 6.6, p

Background The BACTEC Myco/F Lytic bottle (Becton Dickinson), along with the Wampole Isolator lysis centrifugation tube (Alere) are used to enhance recovery of fungal and mycobacterial organisms from blood. At our institution, one Isolator tube and two Myco/F Lytic bottles are inoculated for each suspected case of fungemia or mycobacteremia. A retrospective analysis of 7518 cultures over 6 years was performed to determine whether one or twoMyco/F Lytic bottles were required for optimal recovery of these organisms. Methods Blood was collected by a phlebotomy team and distributed into three blood culture receptacles: 2 Myco/F Lytic bottles each with 4 mL of blood and one Isolator tube with 8 mL of blood. The sediment from the processed Isolator tube was inoculated onto Inhibitory Mold Agar, Emmons Sabouraud Dextrose Agar, and Middlebrook 7H11/7H11 Selective Agar. The Myco/F Lytic bottles were incubated for 42 days on the BACTEC FX instrument and the plated media was incubated for 30 days. We compared the recovery of fungal and mycobacterial organisms from one vs. two Myco/F Lytic bottles at our institution from April, 2004 through October, 2010. Myco/F Lytic bottles were randomly assigned as the first or second bottles and additional culture positivity results for the second bottle was compared with that of the first bottle and the Isolator tube together. Results 171 (2.3%) cultures were positive with fungal or mycobacterial isolates from a total of 7518 cultures. Among 171 positive cultures, 28 (16.4%) grew only in the second Myco/F Lytic bottle. Among these, 20 were fungi (Histoplasma capsulatum, n = 7, Candida sp., n = 7, filamentous fungi, n = 4, Cryptococcus neoformans, n = 1, other yeast, n = 1), 7 were mycobacterial species (Mycobacterium avium complex, n = 7) and 1 was an aerobic actinomycete (Streptomyces sp). 7/45 (15.6%) of H. capsulatum isolates, 7/18 (38.9%) of M.avium complex isolates and 1/17 (5.9%) of C.neoformans isolates grew in the second Myco/F Lytic bottle only. Conclusion The use of two Myco/F Lytic bottles increases the recovery of certain fungal and mycobacterial organisms from blood as compared with one Myco/F Lytic bottle. Disclosures All authors: No reported disclosures.

Histoplasma urine antigen (UAg) detection is an important biomarker for histoplasmosis. The clinical significance of low-positive (Histoplasma infection. UAg results from 12/25 (48%) patients were considered falsely positive, suggesting that low-positive UAg values should be interpreted cautiously.

Gordonia species are ubiquitous aerobic actinomycetes that rarely cause infection in humans. We report the second known case of Gordonia otitidis catheter-related bacteremia in an immunocompromised patient and review four additional cases of Gordonia bacteremia seen at our institution over the past 14 years. In addition, the existing literature on Gordonia infections is reviewed.

Elizabethkingia species are environmental bacteria that rarely cause infection in neonates and immunocompromised adults, usually as part of nosocomial outbreaks. We report an isolated fatal case of disseminated Elizabethkingia species infection in a lung transplant recipient and review the literature of this bacterial infection in transplant recipients.

Rhodococcus species are environmental organisms that predominantly cause opportunistic infections in immunocompromised hosts. Rhodococcus equi is the most common species associated with human infections, but there are uncommon but increasing number of cases of infections caused by non-equi Rhodococcus species. We report a case of Rhodococcus globerulus bacteremia in an allogeneic hematopoietic stem cell transplant recipient, who presented with subacute systemic illness accompanied by severe hepatitis. In the context of this case, we review the literature on Rhodococcus species infections in transplant recipients.

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Keywords: clinical research/practice; infectious disease; infection and infectious agents; viral: human T-lymphotropic virus (HTLV); infection and infectious agents; viral

Background: LT patients are at higher risk of CDI compared to other hospitalized patients. Since LT patients with CCA often require antibacterial therapy for various infections, they may be at increased risk of CDI. However, the epidemiology, risk factors and impact of CDI in LT recipients with CCA have not been studied. Objectives: We describe the epidemiology and risk factors for CDI and assess its impact on patient outcomes among LT patients with CCA. Methods: We conducted a retrospective cohort study of patients who underwent neoadjuvant chemo-radiotherapy followed by LT for CCA during 20042013 at a single tertiary referral center. Results: The population consisted of 124 patients who were followed for median duration of 4.2 years (interquartile range (IQR) 1.5-6.7 years). 15.9% developed CDI within 9.3 years post-transplant (19 episodes in 15 patients).10 (67%) were male. Thirteen (68%) were community-onset CDI. Initial treatment regimen consisted of oral metronidazole in 11 (58%) and oral vancomycin in 8 (42%) episodes. 4 patients developed recurrent CDI. Recurrent CDI was treated with oral metronidazole (50%) and oral vancomycin (50%). No patient died from CDI and none developed toxic megacolon or required surgical intervention. On univariable analysis, LT patients with history of a pre-transplant infection (within 6 months pretransplant) had lower risk of post-transplant CDI (HR 0.3 (0.1-0.9); P=0.04). Post-transplant CDI was associated with higher mortality when adjusted for recurrent CCA (HR 4.6 (1.4-15.2); P=0.01). Conclusion: CDI is a common infectious complication after LT for CCA, and is associated with a higher risk of mortality. Its prevention, through antimicrobial stewardship, may improve the outcomes of LT patients with CCA.  A single-center, retrospective cohort study of adult patients who underwent liver transplantation for biopsy proven hilar CCA at the Mayo Clinic Rochester between 2004 and 2012.  Patients’ demographic and clinical data was extracted from the electronic medical records.  All patient records were reviewed from six months prior to liver transplantation until the last date of follow up.  Descriptive statistical analysis was performed. Background Hilar cholangiocarcinoma (CCA) is an aggressive cancer and is the second most common primary hepatobiliary cancer. The annual incidence of CCA in the USA is rising and is currently estimated at 1.2/100,000 in the United States. Many patients present with unresectable, locally advanced disease at the time of diagnosis. Early experiences with liver transplantation for CCA were disappointing due to high tumor recurrence rates and poor patient survival. However, the Mayo Clinic, in 1993, developed a protocol using neoadjuvant chemoradiation and staging abdominal exploration before liver transplantation for selected patients and this has shown encouraging results. Mayo Clinic has the largest cohort of patients with CCA who have undergone liver transplantation. CCA has re-emerged as an indication for liver transplantation. However, data regarding the epidemiology of Clostridium difficile infections in this specific patient cohort and their impact on patient and graft survival are non-existent. We believe that patients with CCA who undergo liver transplantation have unique characteristics that make them more vulnerable to infections when compared with other liver transplant recipients. These include background disease (Primary sclerosing cholangitis), protocol effects, higher rates of living donor liver transplantation and Roux en Y anastomosis. Aims:  To describe the epidemiology of Clostridium difficile infections in LT recipients with biopsy proven CCA.  To assess the risk factors for Clostridium difficile infections in LT recipients with biopsy proven CCA.  To assess the impact of Clostridium difficile infections on patient and allograft survival in LT recipients with biopsy proven CCA. Objectives

Cytomegalovirus (CMV) continues to have a tremendous impact in solid organ transplantation despite remarkable advances in its diagnosis, prevention and treatment. It can affect allograft function and increase patient morbidity and mortality through a number of direct and indirect effects. Patients may develop asymptomatic viremia, CMV syndrome or tissue-invasive disease. Late-onset CMV disease continues to be a major problem in high-risk patients after completion of antiviral prophylaxis. Emerging data suggests that immunologic monitoring may be useful in predicting the risk of late onset CMV disease. There is now increasing interest in the development of an effective vaccine for prevention. Novel antiviral drugs with unique mechanisms of action and lesser toxicity are being developed. Viral load quantification is now undergoing standardization, and this will permit the generation of clinically relevant viral thresholds for the management of patients. This article provides a brief overview of the contemporary epidemiology, clinical presentation, diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients.