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Chapter 6 : Infections in Organ Transplant Recipients
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Organ transplantation represents a continually expanding field of medicine, and with each innovative method for subverting the natural process of host immunity, new and unusual presentations for virus infections have occurred. With the increasing use of xenotransplantation, the concern about introducing viral zoonoses increases. But from a management standpoint, CMV, EBV, adenovirus (AV), and hepatitis virus infections consume a major focus of attention. However, certain unusual infections such as rabies, West Nile virus, and Creutzfeldt-Jakob disease (CJD) can be a concern after transplantation and are discussed in this chapter. Cytomegalovirus (CMV) produces disease principally in the immunologically impaired individual and, in doing so, demonstrates considerable variability in the types of clinical syndromes that are seen in different at-risk groups. In the transplant population, all aspects of the clinical manifestations of Epstein-Barr virus (EBV) infection can be seen, and for this reason, EBV is among the most important infectious problems after either hematopoietic cell transplantation (HCT) or solidorgan transplantation (SOT). The common respiratory virus infections, i.e., with respiratory syncytial virus, parainfluenza virus, influenza virus, and human metapneumovirus, occur in transplant patients, and except for the potential for serious pulmonary complications, the infections are not qualitatively different from those seen in otherwise healthy populations. The chapter also talks about adenovirus (AV) infection and herpesviruses.
Occurrence of the most frequent virus infections after transplantation. Shown are the times after both SOT and marrow transplantation that recipients present with characteristic types of virus infections, ranging from HSV at the earliest time to CMV, EBV, and HHV-6 at 1 to 3 months after transplantation and AV, VZV, polyomavirus, and hepatitis viruses at later times.
Risk factors for CMV complications in the transplant recipient
CMV prophylaxis in transplant recipients a