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Infections usually result from viruses that come to life after lying inactive (dormant) in your body or your new liver. Most of these infections would not harm anyone in good health but they can cause problems for people who are immunosuppressed.

Infections can be viral, bacterial or fungal. You are most likely to pick up an infection in the first few months after your transplant when doses of immunosuppressants are higher, but it is sensible for you to remain aware of infection risks in the long term.

Common infections following transplantation

Cytomegalovirus (CMV) is a type of herpes and a very common infection – more than 60% of all people are exposed to it at some point in their lives. CMV usually occurs during the first months after transplantation. Symptoms include headaches, nausea, sore throat, high temperature, fatigue and aching joints, although it is also possible not to have these signs. Doctors can diagnose the virus using a sensitive laboratory test such as the polymerase chain reaction test (PCR).

To treat the virus you will be given antiviral medication (ganciclovir) in either oral or intravenous form for several weeks. To protect against CMV occurring (prophylactic treatment or ‘prophylaxis’), doctors may prescribe antiviral drugs immediately after transplantation.

Herpes Simplex viruses (HSV) are two types of cold sore virus affecting the skin. Type 1 causes cold sores and blisters around the mouth, while type 2 causes genital herpes. After the first infection HSV lays dormant in the body until reactivated. Infection with HSV was more common after transplantation until prophylactic treatment with acyclovir (Zovirax) became routine.

HSV viruses are highly contagious and easily passed from close contact. If you have sore areas, keep them as clean and dry as possible; wash your hands with soap and water after touching them. Avoid kissing or having oral sex with someone who has a cold sore. If you are prone to cold sores, keep acyclovir cream handy and use as soon as you think a sore is developing. There is no need to check with medical staff before using acyclovir.

Varicella–zoster virus (VZV) belongs to the same herpesvirus group as HSV and causes two fairly well-known diseases, chickenpox (varicella) and shingles (herpes zoster).

Chickenpox is a contagious disease more often seen in children. It usually appears as a rash or in small blisters. If you have been in contact with someone who has chickenpox, contact your transplantteam immediately.

Shingles is caused by a much later reactivation of VZV in your body following chickenpox. There is a vaccine for shingles but it is unsuitable for immunosuppressed people as it contains live particles of the virus. Shingles appears as a rash or small water blisters, usually on the chest, back or hips. If you think you have this kind of rash, contact your transplant team.

Candida (yeast) is the most common fungal infection after liver transplantation. It usually starts in the mouth or throat but may also occur in the oesophagus (gullet), genital and urinary organs. An infectionin the mouth, throat or vagina is called thrush. It appears as a patchy white coating on the tongue causing it to feel painful and tender. This can lead to difficulty in swallowing if it spreads to the throat. Vaginal infections usually cause a whitish discharge.

Fungal infections are treated with the drugs amphoteracin or fluconazole (Fungilin), given either intravenously or as oral medication.

How do I know I have an infection?

A quick checklist of common signs to look for are:

  • raised body temperature or fever (pyrexia)
  • tiredness or fatigue
  • diarrhoea or vomiting
  • redness or discharge around your operation scar, bile or tube site
  • a cough or sore throat.

To determine the nature of the infection doctors may take blood, urine and mucus samples, as well as samples from areas outside of the body such as the operation scar and drainage site.

What can I do to prevent infection?

There are a number of fairly simple precautions you can take to stayhealthy. In short, it is advisable for you to:

  • avoid close contact with adults and children carrying infections –
  • from the common cold to chicken pox
  • have a flu vaccination each year
  • have a pneumococcal vaccination for lifelong protection against the
  • pneumococcus bacterium (it causes pneumonia, meningitis and other infections)
  • avoid inhaling dust, particles or smoke
  • keep good standards of hygiene – for example, washing your hands after going to the toilet or changing a baby’s nappy
  • brush your teeth after every meal and floss daily
  • visit the dentist every 6 months and do not have dental work for the first six months after transplant (without seeking further advice from your transplant team)
  • keep toenails and fingernails clean and trimmed
  • thoroughly clean all cuts and grazes before applying a clean, dry dressing or plaster and keep an eye on them
  • do not clean out the cat litter or bird cages, or go near animal excrement, without gloves
  • for women, use only small tampons, change frequently and do not use overnight
  • keep up-to-date with vaccines (see below).

What vaccines should I be given?

Routine vaccines such as those against flu and pneumococcal infection are important. However, you will be advised to avoid ‘live’ vaccines that contain tiny amounts of a particular disease. Live vaccines given in the UK include measles, mumps and rubella (MMR), TB (BCG vaccine), yellow fever, and the oral typhoid vaccine.

It is also important that no-one in your household receives live vaccines either. Your doctor can advise on how you can protect yourself and order the necessary non-live vaccines for you and your household.

How can I avoid food poisoning infections?

Particularly during the first three months after your transplant, it is important that you avoid eating foods that may contain bacteria such as listeria, salmonella or E.coli. You might be more vulnerable to foodpoisoning and there can be problems whilst you are on high doses of anti-rejection drugs.

Foods that could contain listeria and other bacteria include:

  • unpasturised milk
  • unpasturised cheese and soft cheese such as feta, Brie, Camembert and blue vein cheese
  • Pâté
  • live yoghurt
  • food that contains raw egg, such as home made mayonnaise
  • soft serve ice creams
  • refrigerated smoked seafood and fish
  • shellfish
  • unwashed salads
  • Deli meats

Can I take antibiotics for my infection?

Most antibiotics are safe for you to take although some common antibiotics, such as clarithromycin and erythromycin, can interfere with cyclosporin and tacrolimus. Always ask your GP or medical staffwhether the antibiotics you have been prescribed are safe to take with your immunosuppressant medication before starting your course.