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Human herpesviruses (HHV)-6, HHV-7, and HHV-8 were identified as causes of infection in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients nearly three decades ago. HHV-6 infection occurs early posttransplant and may cause fever of unknown origin, diarrhea, rash, pneumonitis, and encephalitis. Chromosomal integration of HHV-6 can complicate diagnostic testing for HHV-6, as these patients have markedly elevated HHV-6 DNA levels due to the presence of HHV-6...
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Influenza virus is a common respiratory virus in solid organ and stem cell transplant recipients. Influenza infection in immunocompromised hosts can result in severe disease, as compared to general population. Risk factors for severe influenza infection in transplant recipients include treatment with antilymphocyte globulin, presence of lower respiratory disease, and infection early after transplantation. Transplant programs should act to optimize prevention, early diagnosis, and treatment of...
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Human herpesvirus 5, better known as cytomegalovirus (CMV), infects 50–90% of the adult population worldwide and is the most common opportunistic infection in allogeneic hematopoietic stem cell transplant (HSCT) recipients, causing significant morbidity and mortality [1–6]. Without prophylaxis, CMV reactivation occurs in up to 70–80% of CMV-seropositive individuals [6–9]. This chapter will review the current understanding of CMV infection in HSCT recipients focusing on emerging concepts and...
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Hepatitis A (HAV) is vaccine-preventable disease with an ongoing burden of disease nationally and worldwide. It is caused by a non-enveloped RNA virus with predominantly fecal-oral spread. It does not cause chronic disease and symptomatic infection increases with age. Fulminant disease and death are more common in the elderly and comorbid, particularly those with underlying chronic liver disease. Immunity to HAV infection occurs after infection or vaccination, with antibody levels indicating...
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Herpes Simplex Virus (HSV) 1 and 2 and Varicella Zoster Virus (VZV) are ubiquitous alpha-herpes viruses that establish lifelong latency in nerve root ganglia. They are characterized by clinical and subclinical reactivation which can lead to significant morbidity in the transplant population. Primary infection after transplant can also be highly morbid, potentially fatal. Despite significant advances in screening, diagnosis, treatment and prevention, there are further gains to be made in...
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The hepatitis E virus (HEV) is one of the main causative agents of acute viral hepatitis worldwide. Over the past decade, HEV genotypes 3 and 4 have been responsible for chronic infections in immunocompromised patients, especially solid organ transplant recipients. A rapid progression of liver fibrosis and the development of HEV-related cirrhosis have been documented in this specific population. HEV infections have also been associated with extrahepatic manifestations such as neurological...
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Solid organ and hematopoietic stem cell transplant recipients are at high risk of contracting infectious diseases, including vaccine-preventable illnesses, in the post-transplant period. Given the high degree of immunosuppression immediately post-transplant, infection in the transplant patient results in higher morbidity and mortality than in the general population. Thus, it is the responsibility of the care team to ensure appropriate vaccines are given in an attempt to mitigate this risk....
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Hepatitis B virus (HBV) and hepatitis D virus (HDV) are hepatotropic viruses that can have a significant impact on patients undergoing solid organ and hematopoietic stem cell transplants. In the setting of transplant immunosuppression, patients with HBV or HDV coinfection can have acceleration in the natural history of their liver diseases with increased risk of developing cirrhosis, decompensation, and hepatocellular carcinoma. Immunosuppression can also reactivate HBV in patients with...
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Infections due to adenoviruses confer significant morbidity and mortality in immunocompromised hosts. Manifestations of disease in the setting of hematopoietic stem cell and solid organ transplantation may range from asymptomatic shedding or viremia to localized infection and disseminated disease. In solid organ transplant recipients, adenoviral disease often involves the allograft and can lead to graft dysfunction and/or graft loss. Several diagnostic methods are available for adenovirus...
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Respiratory syncytial virus (RSV) causes significant morbidity and mortality in immunocompromised hosts with particular burden among allogeneic hematopoietic stem cell transplant and lung transplant recipients. Affected patients have a substantial risk of secondary infection, ICU admission, or death. Improved diagnostic testing with better sensitivity has given new insights into the epidemiology of disease. In particular, it has highlighted the issue of nosocomial transmission and hospital...
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Polyomavirus-associated nephropathy (PyVAN) and hemorrhagic cystitis (PyVHC) occur almost exclusively after kidney transplantation (KT) and allogeneic hematopoietic stem cell transplantation (HSCT), respectively. In addition, PyV-associated urothelial cancer (PyVUC) is emerging after KT. These diseases are attributed to BK polyomavirus (BKPyV), a small non-enveloped, doublestranded DNA virus infecting >90% of the general population followed by renal persistence. PyVAN causes premature...
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Respiratory viruses are among the most common causes of infection among solid organ and hematopoietic stem cell transplant recipients. Respiratory viruses, such as influenza and respiratory syncytial virus, can cause a range of disease from asymptomatic shedding, upper respiratory infections, to life threatening pneumonia. In addition, respiratory viruses may be associated with chronic sequelae, including devasting late complications such as chronic rejection in lung transplant recipients and...
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The purpose of this review is to describe the characteristics of dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) in transplant recipients. The majority of reported cases were transmitted by mosquito bite, but blood and graft transmission may occur. These arbovirus infections are clinically similar, resembling influenza-like illness or frequent transplant syndromes. Therefore, laboratory confirmation is necessary. In the acute phase, nucleic acid tests are preferred. DENV and ZIKV serology...
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ORGANISMS
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VIRUSES
- Adenovirus (1)
- Arboviruses (1)
- CMV (1)
- Hepatitis A (1)
- Hepatitis B (2)
- Hepatitis D (1)
- Hepatitis E (1)
- HHV-6 (1)
- HHV-8 (1)
- HSV (1)
- Influenza (1)
- Polyomaviruses (1)
- Respiratory Viruses (1)
- RSV (1)
- VZV (2)
PREVENTION
- Travel (1)
- Vaccination (1)