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Chapter 7 : Cytomegalovirus Infection in Transplantation
Category: Clinical Microbiology; Bacterial Pathogenesis
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Cytomegalovirus (CMV) latency exists in numerous cells, including leukocytes, endothelial cells, and epithelial cells, among others, which are important reservoirs for the transmission of the virus to susceptible individuals. Likewise, these cells serve as the initial sites of endogenous viral reactivation during critical illness and periods of immune compromise, such as following solid organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT). CMV is the most common viral pathogen that causes clinical infection after transplantation. CMV is described to modulate the immune system and increase the predisposition to develop bacterial and opportunistic fungal infections after transplantation. The major indication for CMV serology in transplantation is in the pretransplant evaluation to assess prior infection among candidates and their donors. Among various anti-CMV prevention strategies, the most common is the use of antiviral drugs as either antiviral prophylaxis or preemptive therapy. There is an ongoing debate about whether antiviral prophylaxis or preemptive therapy is the optimal strategy for preventing CMV disease after transplantation. The rates of virological decline and clinical resolution by the end of a predefined 21-day treatment course and by the end of maintenance valganciclovir treatment were similar between the treatment arms. The results of this study may simplify the current treatment paradigms, as an oral agent is now available for treatment, thereby facilitating outpatient management. The major adverse effects of foscarnet are nephrotoxicity, anemia, hyperphosphatemia, hypophosphatemia, hypercalcemia, hypocalcemia, nausea, vomiting, and seizures.
Histopathologic examination demonstrating CMV-infected cells in a biopsy specimen.