Q35-38: Infection

Question 35: Did the recipient have a history of clinically significant fungal infection (documented or suspected) in the 6 months prior to the start of the preparative regimen?

Fungal infections play a major role in the clinical outcome of a transplant recipient. The intent of this question is to identify serious fungal infection(s) that might have an effect on the outcome of the HCT. For the purposes of this manual, the term “clinically significant” refers to conditions that are treated at the time of pre-HCT evaluation, or that have affected the recipient’s medical history, that might cause complications post-HCT.

Examples of fungal infections include, but are not limited to the following: invasive aspergillosis (infection codes 210-213, 219), zygomycosis (infection code 240) and other molds (infection codes 230, 240, 242, 261), invasive candidiasis (infection codes 200-209), cryptococcosis (infection code 220), endemic mycosis (infection code 241), other yeasts (infection code 250), and pneumocystsis (PCP/PJP) (infection code 260). Include any fungal abscesses of the lungs, sinuses, liver, or spleen.

If the recipient has a history of clinically significant fungal infection in the 6 months prior to this HCT event, check “yes” and continue with question 36. For a subsequent HCT, report any documented significant fungal infections in the recipient’s medical history, between the start of the preparative regimen of the previous HCT to just prior to the preparative regimen for the current HCT.

If the recipient does not have a history of clinically significant fungal infection in the 6 months prior to this HCT event, check “no” and continue with question 38. For assistance with reporting fungal infections, consult with a transplant physician.

Question 36: Select organism:

From the list of “Codes for Commonly Reported Fungal Organisms,” select the code corresponding to the identified or suspected fungus. A fungal infection form (Form 2046) must be completed for all organisms.

Question 37: Date of diagnosis

Enter the date of diagnosis of the fungal infection. For suspected fungal infections, enter the date of a radiology test or date treatment was started as the date of diagnosis.

Fungal Infection Diagnosis Reporting Scenario
p((. A recipient has a CT scan on 4/1/2015 due to a persistent cough. The CT scan documents multiple nodules. An Aspergillus galactomannan was drawn in the blood on 4/2/2015 and the patient underwent a bronchoscopy on 4/3/2015. Fluid from the bronchoaveolar lavage was stained for fungal elements and submitted for culture. The stain was positive for fungal elements and the culture grew Aspergillus The blood galactomannan was also positive.
p((. * The date of diagnosis of infection will be 4/2/2015. This is the date the galactomannan was obtained and positive.
p((. * If galactomannan was negative and the BAL negative, the date of infection would be 4/1/2015 (the date of the CT scan).

Question 38: Testing for evidence of prior viral exposure/infection: (check all that apply)

Indicate if the recipient was positive for any of the viral exposure or infections listed below. Do not select the viral exposure or infection if the test was performed and the results were negative.

If testing for evidence of prior viral exposure / infection was not performed, select “not done.”

Select “not applicable” if testing for evidence of prior viral exposure / infection was performed and all of the results were negative.

HTLV1 antibody: Human T-Lymphotropic virus I/II (HTLV I/II) is a retrovirus in the same class as HIV. HTLV I/II is associated with certain leukemias and lymphomas, as well as demyelinating diseases such as multiple sclerosis.

Anti-EBV (Epstein-Barr virus antibody): Epstein-Barr Virus (EBV) is a common virus of the herpes family. It can cause infectious mononucleosis, but in most cases is asymptomatic. EBV establishes a lifelong dormant infection in some cells of the body’s immune system. Serious post-transplant complications related to EBV include EBV viremia (reactivation) and post-transplant lymphoproliferative disease (PTLD).

Hepatitis B surface antibody: Hepatitis B is caused by the hepatitis B virus (HBV). Infection with this virus can cause scarring of the liver, liver failure, liver cancer, and even death. Hepatitis B is spread through infected blood and other body fluids. Acute hepatitis B infection does not usually require treatment because most adults clear the infection. Treatment of chronic infection may be necessary to reduce the risk of cirrhosis and liver cancer.

The hepatitis B surface antibody test reveals the presence of hepatitis B antibodies, indicating previous exposure to HBV (or successful vaccination), but the virus is no longer present, and the person cannot pass on the virus.

A Hepatitis insert (Form 2047) is not required for a positive result.

Anti-HBc (hepatitis B core antibody): The enzyme-linked immunosorbent assay (ELISA) technique tests for the antibody directed against the hepatitis B virus core proteins. The hepatitis B core antibody test can indicate previous HBV infection. Currently there is no licensed confirmatory test for Anti-HBc. If the screening test is reactive, a second Anti-HBc test is performed using a different manufacturer’s test kit.