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Chapter 40 : Viral Infections in Transplant Recipients
Category: Clinical Microbiology; Bacterial Pathogenesis
This chapter discusses the role of nucleic acid tests in the diagnosis and management of herpes simplex virus (HSV), varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), parvovirus (erythrovirus) B19, and adenovirus in hematopoietic and solid-organ transplant recipients. HSV most commonly causes reactivation of oral or genital mucocutaneous lesions in transplant recipients. The majority of transplant recipients are VZV seropositive pretransplantation, and at risk for VZV reactivation, most commonly in the form of zoster. Due to the severity of primary VZV infection in transplant recipients, solid-organ transplant candidates should be screened for antibody to VZV prior to transplantation, and consideration should be given to administration of the varicella vaccine prior to transplantation to solid-organ transplant candidates who have no history of prior VZV disease and are VZV seronegative. To complicate the matter, some pediatric liver and heart transplant recipients may exhibit chronic high EBV viral loads. Molecular diagnostics play a paramount role in the diagnosis and management of transplant recipients with infections caused by viruses. These methods have greatly enhanced diagnosis of viral infections due to the increase in speed and sensitivity compared to traditional antigen detection or culture methods. In addition, routine monitoring of transplant recipients for CMV, EBV, and BKV viremia using these methods has become the standard of care at many transplant centers, and this monitoring has facilitated earlier clinical interventions that have dramatically reduced morbidity caused by these viruses.
Infections associated with adenovirus subgroups and serotypes a