Monitored for Infection
The first four weeks after your child's transplant at the risk is highest for infection because their white blood cell count is very low. Even organisms that are normally harmless in your child's body can cause infections after transplant.
Several measures are taken to reduce the risk of infection:
- The air in your child's hospital room is filtered to lower the risk of airborne infections.
- Your child will wear a special mask when out of their room, after they're discharged from the hospital, when coming to the clinic or when in crowds. This will decrease your child's exposure to infections. Your child's nurse coordinator or physician will indicate when a mask is recommended and for how long.
- Your child will be tested for infections frequently during the high-risk period.
- Your child will be asked to take a bath or shower regularly and to clean their mouth four times a day.
- For some patients, growth factor injections or IV infusions will be used to speed the production of white blood cells.
- Visitors and staff members must wash their hands before entering your child's room.
- Visitors and staff members may not visit if they have a fever. Visitors must also notify the nurse prior to visiting if they are experiencing other symptoms of infection, such as a cold or rash or diarrhea.
- Visitors will be told not to bring any plants. Molds and fungi commonly found on houseplants and flowers can be dangerous for your child as they recover from BMT.
The most common infections after a BMT are from bacteria, primarily living in your child's own body. When white blood cells are suppressed, some of these bacteria can grow and become a problem. Bacterial infections typically develop around your child's central venous catheter or in their mouth, lungs, or digestive tract.
Signs of bacterial infection include:
- Chills, even without fever
- Redness, tenderness, or drainage around the central venous catheter site
- A general achy feeling
Bacterial infections usually respond well to antibiotics. Different antibiotics can be used depending on the type of infection and your child's history of allergies or reactions to specific medications. Antibiotics are given orally or through your child's central venous catheter to prevent and treat certain infections.
Fungi and yeasts normally live all around us without causing problems. But when the immune system is suppressed, a fungus or yeast can grow more than it should. For example, candida, a yeast commonly found in the mouth, intestines, and vagina, can cause sores in the mouth (called thrush) as well as more serious widespread infections. Good oral hygiene (mouth care) and antifungal medications can help prevent and treat oral candida infections.
Similarly, aspergillus is a common mold found in many places, often in dust. When it invades the body, it often affects the sinuses or lungs and causes a serious kind of pneumonia.
Patients with weakened immune systems are especially prone to Pneumocystis pneumonia, but specific antibiotic medications are very effective in preventing it. Most patients take this medication twice a day on Monday and Tuesday for about a year after the transplant.
Your child may be exposed to viruses while their immune system is suppressed, or a viral infection your child had earlier may recur. Viral infections are most common during the first year after a BMT. The most common viruses that affect people after a BMT are cytomegalovirus, herpes simplex, and varicella zoster (shingles).
Cytomegalovirus (CMV) often occurs in people without causing serious disease. Your child may have had it without knowing it. In a person with a healthy immune system, CMV may cause a fever, flulike symptoms, or no symptoms at all. But after a BMT, when your child's immune system is suppressed, it can cause more serious illness such as pneumonia or hepatitis.
A blood test will be done before your child's transplant to see if they have been exposed to CMV. If your child or your donor have been exposed to CMV, they will be given antiviral drugs to decrease the risk that CMV could become active after the transplant.
Herpes Simplex Virus
Herpes simplex virus is the virus that causes cold sores and genital herpes. Patients may have had the virus many years earlier, but it can be dormant for a long time. Herpes can recur with stress, illness, or a suppressed immune system. The mouth sores that are common after transplant will likely be worse if patients also have a herpes simplex infection. A blood test will be done before a patients transplant to see whether they have been exposed to herpes simplex. If they have, they will be given antiviral drugs to prevent the infection from coming back.
Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox. Shingles produces painful or itchy sores on the skin, usually on just one side of the back and flank of the body. Early symptoms include burning, itching, and pain in a localized area of the body. Usually within a few days of these symptoms, small blisters will form.
Treating shingles as soon as possible is important to prevent the spread of the infection. Antiviral drugs taken by mouth or intravenously can usually heal the infection quickly. Sometimes the shingles site can be painful (stinging or burning) long after the infection is healed. Prompt treatment can help prevent this long-lasting pain.