Ask the Experts - Isolation Policies for Renal Transplantation?
I would like information on appropriate isolation policies for renal transplant patients who present with fever, pulmonary infection (of unknown origin), septicemia, and/or rejection. Do such conditions indicate isolation precautions?

Muhammad Redha M. Yousuf, MBBS, DTM

We usually do not use routine isolation in kidney transplant recipients with such presentation. Sepsis is not an indication for isolation practices. Even in the case of neutropenia, this is controversial because most investigators believe that the main source of infection in this condition is the patient's own bacterial flora. There were isolated reports claiming transmission of Pneumocystis carinii pneumonia (PCP) between patients, but routine respiratory isolation in PCP is not recommended.

The exception would be when there is clinical suspicion of a communicable infection such as tuberculosis or measles. In the case that tuberculosis (TB) is a possibility, the patient is kept in respiratory isolation until this is ruled out. We usually obtain 3 sputum smears for acid-fast stain, and if they are negative, the patient is taken off isolation. Obviously, when the clinician highly suspects TB (like in the case of a known hospital epidemic), the patient is kept in respiratory isolation.