Aspergillus Nocardia spp. During the first 6 months after transplantation, due to high levels of immunosuppression, transplant patients are at increased risk for many opportunistic infections. Common viral infections include HSV, CMV, EBV, varicella-zoster, influenza, respiratory syncytial virus and adenoviruses. Also on the differential are nocardia, Listeria monocytogenes , and mycobacteria. Fungal infections include Pneumocystis carinii and Candida spp.
Parasitic infections encountered in the United States include toxoplasmosis and strongyloidiasis.
Many of the previously noted organisms can cause myopericardial inflammation and with the paucity of laboratory information presented, it would be difficult to narrow it down to one organism. In the setting of recent CMV infection, certainly recurrent disease is possible in the setting of continued immune suppression, ineffective drug levels or the emergence of resistant CMV organisms. Clinically, the patient's symptoms had improved and his CMV antigenemia, which had been positive a month earlier, was undetectable in peripheral blood, making the diagnosis of CMV less likely. Infection with CMV has increasingly been recognized as immunosuppressing in and of itself. Infection with a second opportunistic pathogen following CMV disease is a classic clinical scenario in transplant patients.