Transplant Support- Lung, Heart/Lung, Heart

DANGER!!!!

Post Transplant Dangers that you may hear from other patients, other transplant centers, or you read about.

Listed below are a collection of what some dangers may be. As to wether you need to follow these precautions.... only YOUR transplant center can decide that. You must be compliant with your center, so PLEASE ask them the rules that they request you follow.

Birds: Due to the possibility of Cryptococcus neoformans and Mycobacterum avium immune suppressed persons are regularly told that pet birds should be avoided. C.neoformans may be found in the droppings of wild birds, especially pigeons, but not often in pet bird droppings. Transplant recipients should avoid areas of pigeon droppings. M.avium can develop in pet birds and should be avoided. Avoid handling any wild birds because they can shed Campylobacter spp, and Salmonella. Due to the possibility of inhaling bird droppings, avoid all bird droppings.

Cryptococcus: Cryptococcus Neoformans, is a fungus that rarely makes healthy people sick, but it is a major threat to people with weak immune systems. Cryptococcus is found in soil, and researchers have known for nearly 50 years that it is also teeming in the droppings of many birds, including canaries, pigeons, parakeets and parrots. A teaspoon of droppings can harbor as many as 300 million organisms. The fungus does not make the birds, sick, but birds have long been suspected of transmitting it to people through droppings, which can be stirred into a cloud of particles and inhaled. Healthy persons need not get rid of birds, but people with impaired immune systems, transplant patients or AIDS or lymphoma patients, they're suseptible, and they need to think twice.

Fish: If you have fish, have someone else clean the tanks. Fish can carry parasites.

Wear gloves when cleaning the tank or when handling a fish and always wash your hands thoroughly after touching a fish.
Be extra careful if you have cuts or sores on your hands

Dogs & Cats: Stay away from dog and cat feces. Your center, may or may not allow your to have cats. Some only allow if cat is indoor and you do not change the litter box and have been checked thoroughly by a vet before you arrive home from the hospital. Toxoplamosis in regular people can mimic a cold or mono. The illness is caused by the spores of the fungus which are in the cat's feces and thus in the litter box dust. Cat Scratch Fever a scratch from a cat can cause this which has the symptoms of low-grade fever, headache, fatigue and swollen lymph nodes. Call your physician immediately as this can be fatal. The basic suggestion is that do not let your cat or dog lick your hands and face. And always wash your hands after handling either.

Cats kept indoors are preferred since they are exposed to fewer diseases. Be sure your veterinarian checks your cat for the Feline Leukemia Virus and Feline Immunodeficiency Virus. It's important to take precautions around the litter box:

Keep the litter box away from the kitchen and eating areas
Change the litter box and its disposable plastic liner daily ( It is urged have someone who's not at risk to do the changing)
Don't dump the litter as the dust could infect you.
Disinfect the litter box at least once a month by filling it with boiling water and letting it stand for 5 minutes
Wear disposable glove for extra protection and a mask. Wash your hands after cleaning the litter box.

Rabbits and Rodents: Zoonoses transmitted by pet rabbits, mice, guinea pigs, hamsters or gerbilis are quite rare. The most common problems usually come from reactions to rabbit scratches or infections from rabbit or rodent bites.

Reptiles: Frogs, lizards and turtles live in slimy, stagnant ponds, frogs are covered with salmonella and fecal bacteria.
Smallpox: Transplant recipients and family members are being urged not to seek vacination for small pox because a live vaccine virus similiar to smallpox which can cause large, oozing lesions spreading from the site of the vacccine especially in people with immune system problems or severe skin problems, could be life threatening. It was stressed that no one who lives with a person at high risk will should be vaccinated.

Hantavirus - A deadly virus associatted with rodent droppings can be a danger to those post lung transplant. Hantavirus, an often-fatal respiratory disease linked to exposure to infected mice. It was first identified in 1993 in the Southwest corner of the United States. Hantavirus is contracted mainly by breathing tiny, airborne liquid beads from droppings, urine or saliva left by infected rodents. The virus causes arteries to close down, bringing about complete respiratory failure. The symptoms include fatigue, fever, muscle aches, headaches, dizziness and abdominal problems. It progresses rapidly to include coughing and shortness of breath and most victims require hospitalization within 24 hours.

The most at risk for contracting hantavirus are people whose activities put them in contact with rodent droppings, urine or nesting material. They include:

Hikers and campers who use infestted trail shelters or camp in rodent habitats.
Construction and utility workers who have to work in crawl spaces under houses or in vacant buildings that may have rodents.
Those who have to open up cabins and sheds or clean outbuildings like barns and garages that have been closed during the winter.
You can also put yourself at risk cleaning your home if mice have moved in, which is common when the weathe turns cold.

What to Do - Only a small number of rodents carry the hantavirus, but it's impossible to know which ones. So treat the rodent droppings with care. If you find any, resist the urge to reach for a broom or a vacuum. That just makes the potentially deadly virus airborne. Instead, air out the area for about an hour, then spray with a solution of one gallan water and 1.5 cups of bleach. Wear rubber gloves and double-bag when cleaning up droppings or disposing of dead rodents.

Fish Tanks May Pose M. marinum Infection Risk

Reuters Health Information 2003. � 2003 Reuters Ltd.
NEW YORK (Reuters Health) Sept 01 - Individuals with open skin lesions and those who are immunosuppressed may be susceptible to infection with Mycobacterium marinum and should therefore avoid cutaneous contact with fish tanks, according to investigators at the Dartmouth-Hitchcock Medical Center.First identified in dead aquarium fish in 1926, M. marinum was recognized as a human pathogen in 1951 after being isolated from granulomatous skin lesions, Dr. C. Fordham von Reyn and colleagues in Lebanon, New Hampshire report in the August 1st issue of Clinical Infectious Diseases. Because chlorination has "drastically reduced" the number of cases acquired from swimming pools, most reported cutaneous cases are associated with contact with fish tanks. Dr. von Reyn and colleagues describe the features and treatment of eight such cases.The patients ranged in age from 25 to 59 years old; four cases were in men and four in women. Most patients presented with sporotrichoid lesions on the arm. Six of the eight patients had positive M. marinum cultures, and all eight had a history of cutaneous exposure to fish tanks. Of the seven patients tested, all had tuberculin test reactions of 10 mm or larger.Six patients with infections limited to the skin responded completely to a two-drug treatment regimen, which included clarithromycin, ethambutol or rifampin. "Optimal treatment should include two drugs for 1 to 2 months after resolution of lesions, typically 3 to 4 months in total," the authors note.Two patients developed deep infections. One patient, who had diabetes mellitus, developed tenosynovitis of the right index finger. This patient responded to treatment with clarithromycin and ethambutol.The other patient, who had psoriasis, melanoma and was on prednisone therapy, had extensive infection, including osteomyelitis. This patient's infection failed to resolve after about 2 years of drug treatment with clarithromycin, ethambutol and rifabutin, and multiple excisions."Fish-tank exposure is the source of most cases of cutaneous M. marinum infections and may be preventable through the use of waterproof gloves for persons with acute or chronic open skin lesions," Dr. von Reyn's group concludes.They also note that tuberculin skin test reactivity is common with M. marinum and should therefore "not generally be attributed to tuberculosis."Finally, they conclude that "treatment with a two-drug regimen that includes a macrolide should be successful in most patients with disease limited to the skin."Clin Infect Dis 2003;37:390-397.

Shelf-Life of Food in Cupboard Is Long but Still Limited

BLACKSBURG -- Since you are not old Mother Hubbard, chances are your cabinets are full of food. Being familiar with the recommended shelf life of various foods, helps you be sure that the food you are eating is safe. "Knowing how to store food properly and how long it will keep means fewer food dollars wasted," said Tim Roberts, Virginia Cooperative Extension food safety specialist at Virginia Tech. "When we store food, we want it to retain all of the nutrients it had when we purchased it." Non-perishable food items such as cereals, snack foods, and dry-packaged foods, such as rice, retain quality best in dry relatively cool environments. Cabinets over the range, near the dishwasher, or by the refrigerator exhaust may be too warm for food. Warm temperatures may affect the nutritional quality of the food and allow microorganisms to grow causing food spoilage.

While canned foods have a long shelf life, Roberts recommended that you try not to keep canned foods for more than one year. The color, flavor, texture, and nutritive value may have deteriorated in old canned goods. Canned goods should be stored at an optimum temperature of 70 degrees F and no higher than 95 F. Looking at the condition of the can is one indicator of how safe the food is inside the can. Discard bulging cans because the food inside may be spoiled. Avoid buying cans with dents on the side seams or around the top and bottom rim seams. If a can is leaky, throw it away. Check for leakage in rusty cans. The rust may have penetrated the can and contaminated the food inside.

Bread stays fresh longer if stored in a cool, dry place. "Refrigeration hastens staling of bread by retarding mold growth," said Roberts. High moisture breads such as English muffins and brown-and-serve breads should be stored in the refrigerator. Hard-crust breads, such as French bread, should be stored at room temperature and used within one or two days of purchase. Freeze fresh bread if you want to store it for a longer time. Flour should be kept in an airtight container. In hot and humid weather, flour may draw moisture permitting the growth of microorganisms. Whole wheat flour should be kept refrigerated year round because the natural oils in the flour may become rancid quickly if stored at room temperature.

Vegetables such as dry onions, potatoes, rutabagas, and winter squash keep best in cool dark places. Most fruits and vegetables should be ripened at room temperature and then refrigerated until ready to use. Cereals, crackers, and snacks should be consumed by the "best if consumed by date" or "use by date," Roberts suggested. Normally, if ready-to-eat cereal is opened, it can be kept for two to three months provided the package liner is tightly refolded after opening. Coffee in cans can be stored for one year if unopened and for two weeks if opened. Unopened instant coffee can be stored for six months and for two weeks if opened. Cornmeal, grits, honey, jellies and jams, and unopened molasses all have a shelf life of one year. Spaghetti, macaroni, and other pastas keep for two years if stored in airtight containers. An unopened bottle of salad dressing can be stored for ten to twelve months. Once opened, however, it should be refrigerated and can be kept for three months. Solid shortenings do not require refrigeration and can be kept for eight months. Biscuit, brownie, cake, and muffin mixes can be stored for nine months if kept cool and dry. The shelf life of crackers is three months. Pudding mixes and soup mixes both keep for one year. Unopened catsup and chili sauce can be stored for one year; if opened, one month. Mustard may be stored for two years if unopened and for six to eight months if opened. Parmesan cheese can be kept for twelve months if unopened and for two months if opened. Peanut butter can be stored for six to nine months if unopened and for two months if opened. If stored in the refrigerator, peanut butter keeps longer. For additional information on safe food storage, contact your local VCE office. The office is listed in the government offices section of the telephone directory. (Source: Contact: Tim Roberts, Extension specialist, food safety
Department of Human Nutrition, Foods, and Exercise Virginia Tech (540) 231-3464 Writer: Marcia Carter Elliott ARE Communications intern, Virginia Tech (540) 231-6975 email: jnayram@vt.edu