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4 : Changing Patterns of Respiratory Viral Infections in Transplant Recipients
Category: Clinical Microbiology
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Advances in the care of immunocompromised hosts have been driven by the development of a variety of increasingly potent immunosuppressive agents for use in solid-organ and hematopoietic stem cell transplant recipients. Routine prophylaxis with trimethoprim-sulfamethoxazole and antiviral agents has reduced the incidence of Pneumocystis pneumonia, nocardiosis, and respiratory, urinary, and gastrointestinal infections due to susceptible pathogens and cytomegalovirus (CMV) infection. Data from retrospective studies allow some generalizations about respiratory viral infections in transplant recipients. Direct detection of viral antigens in respiratory tract specimens using monoclonal antibodies may have increased sensitivity compared with the rapid, commercially available methods. The possibility that immune status plays a pivotal role in the transmission of severe acute respiratory syndrome (SARS) was suggested by the identification of individuals who appeared to be “super spreaders” of infection. Adenoviral disease is best described in pediatric liver transplant recipients but is also described in individuals following kidney, small bowel, lung, and heart transplantation. Vaccination is recommended annually, as much of the burden of influenza is related to secondary superinfections, graft rejection (in lung transplant recipients), or graft-versus-host disease (in HSCT recipients). Respiratory viral infections are a risk factor for graft rejection, particularly chronic graft rejection in lung transplant recipients.
Adenovirus pneumonia in a hematopoietic stem cell transplant recipient. Nasal swabs and sputum were negative for adenovirus. (Top) Chest computed tomography scans reveal patchy consolidation and diffuse tree-in-bud opacities consistent with diffuse pneumonia. (Bottom) Severe bronchitis with pseudomembrane formation was observed on bronchoscopic examination with direct fluorescence of respiratory specimens positive for adenovirus serotype 4. Blood cultures and blood PCR were also positive for adenovirus.
Estimated annual incidences of respiratory viral infections in transplant recipients a
Available agents with activity against adenovirus