Journal Information
Vol. 35. Issue 2.
Pages 117-125 (January 2011)
Share
Share
Download PDF
More article options
Vol. 35. Issue 2.
Pages 117-125 (January 2011)
Full text access
Role of viral infections in immunosuppressed patients
Papel de las infecciones víricas en pacientes inmunodeprimidos
Visits
748
M. Salaverta, R. Granadab, A. Díazc, R. Zaragozad,
Corresponding author
raf@gva.es

Corresponding author.
a Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain
c Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
d Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
This item has received
Article information
Abstract

Being a solid organ and hematopoietic stem cell transplant recipient as well as receiving chemotherapy for a malignant hematological disease clearly predispose the subject to a variety of viral infections, both common and opportunistic diseases. The patient may have acquired these infections from the community as well as from the donor organ (donor-derived infections) and/or from reactivation of an endogenous latent virus. Herpes viruses and especially the cytomegalovirus and Epstein-Barr virus are among the most common of the opportunistic viral pathogens affecting these patients, in addition to respiratory viruses. Treatment consists in antiviral drug therapies combined with the reduction in the degree of the induced immunosuppression. A review of the literature has been performed in order to update the epidemiology, pathogenesis, clinical manifestations and therapeutic approach of the viral infections in these immunocompromised patients.

Keywords:
Viral infection
Cytomegalovirus
Respiratory viruses
Immunodepressed patients
Transplant
Resumen

Ser receptor de un trasplante de órgano sólido, así como recibir tratamiento quimioterápico para una enfermedad hematológica maligna, predispone claramente a padecer infecciones virales tanto comunes como oportunistas, de origen tanto comunitario como procedentes del donante de órganos y/o de una reactivación de un virus latente endógeno. Herpes virus y más especialmente citomegalovirus y virus de Epstein-Barr son los que con más frecuencia afectan a estos enfermos, así como los virus respiratorios. El tratamiento consiste en la combinación de reducir la inmunodepresión inducida junto con tratamiento antiviral. Se ha realizado una revisión de la literatura pormenorizada y actualizada de la epidemiología, la patogenia, las manifestaciones clínicas y la aproximación terapéutica de las infecciones virales en estos enfermos.

Palabras clave:
Infección viral
Citomegalovirus
Virus respiratorios
Pacientes inmunodeprimidos
Trasplante
Full text is only aviable in PDF
References
[1.]
P.K. Linden.
Approach to the immunocompromised host with infection in the intensive care unit.
Infect Dis Clin North Am, 23 (2009), pp. 535-556
[2.]
R.R. Razonable, A.J. Eid.
Viral infections in transplant recipients.
Minerva Med, 100 (2009), pp. 479-501
[3.]
J.J. Castón, J.M. Cisneros, J. Torre-Cisneros.
Effects of viral infection on transplant recipients.
Enferm Infecc Microbiol Clin, 25 (2007), pp. 535-548
[4.]
M.J. Pérez-Sola, J.J. Castón, R. Solana, A. Rivero, J. Torre-Cisneros.
[Indirect effects of cytomegalovirus infection in solid organ transplant recipients].
Enferm Infecc Microbiol Clin, 26 (2008), pp. 38-47
[5.]
R. San Juan, J.M. Aguado, C. Lumbreras, J. Fortun, P. Muñoz, J. Gavalda, RESITRA Network of the Spanish Study Group of Infection in Transplantation, et al.
Impact of current transplantation management on the development of cytomegalovirus disease after renal transplantation.
Clin Infect Dis, 47 (2008), pp. 875-882
[6.]
J.A. Fishman, V. Emery, R. Freeman, M. Pascual, L. Rostaing, H.J. Schlitt, et al.
Cytomegalovirus in transplantation −challenging the status quo.
Clin Transplant, 21 (2007), pp. 149-158
[7.]
R. Dolcetti.
B lymphocytes and Epstein-Barr virus: the lesson of post-transplant lymphoproliferative disorders.
Autoimmun Rev, 7 (2007), pp. 96-101
[8.]
J.M. Smith, R.A. McDonald.
Emerging viral infections in transplantation.
Pediatr Transplant, 10 (2006), pp. 838-843
[9.]
S.A. Fischer.
Emerging viruses in transplantation: there is more to infection after transplant than CMV and EBV.
Transplantation, 86 (2008), pp. 1327-1339
[10.]
N.C. Issa, J.A. Fishman.
Infectious complications of antilymphocyte therapies in solid organ transplantation.
Clin Infect Dis, 48 (2009), pp. 772-786
[11.]
M. Blanes, D. Gómez, M.J. Giménez, M. Salavert.
Evaluación de la infección en el donante y en el receptor de trasplante de órgano sólido y de progenitores hematopoyéticos.
Infecciones en pacientes trasplantados, 3rd ed, pp. p131-p158
[12.]
G. Opelz, V. Daniel, C. Naujokat, B. Döhler.
Epidemiology of pretransplant EBV and CMV serostatus in relation to posttransplant non-Hodgkin lymphoma.
Transplantation, 88 (2009), pp. 962-967
[13.]
M. Slifkin, S. Doron, D.R. Snydman.
Viral prophylaxis in organ transplant patients.
Drugs, 64 (2004), pp. 2763-2792
[14.]
O.J. Benmarzouk-Hidalgo, E. Cordero, A. Martín-Peña, E. García-Prado, M.A. Gentil, M.A. Gomez-Bravo, et al.
Prevention of cytomegalovirus disease using pre-emptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection.
Antivir Ther, 14 (2009), pp. 641-647
[15.]
R. San Juan, M. Yebra, C. Lumbreras, F. López-Medrano, M. Lizasoain, J.C. Meneu, et al.
A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R−) solid organ transplant recipients.
Clin Transplant, 23 (2009), pp. 666-671
[16.]
J.A. Fishman.
Infection in solid-organ transplant recipients.
N Engl J Med, 357 (2007), pp. 2601-2614
[17.]
R.A. Fisher.
Cytomegalovirus infection and disease in the new era of immunosuppression following solid organ transplantation.
Transpl Infect Dis, 11 (2009), pp. 195-202
[18.]
P. Ljungman, N. Singh.
Human herpesvirus-6 infection in solid organ and stem cell transplant recipients.
J Clin Virol, 37 (2006), pp. S87-S91
[19.]
O. Len, J. Gavaldà, J.M. Aguado, N. Borrell, C. Cervera, J.M. Cisneros, et al.
RESITRA. Valganciclovir as treatment for cytomegalovirus disease in solid organ transplant recipients.
Clin Infect Dis, 46 (2008), pp. 20-27
[20.]
M. Hidalgo, C. Lumbreras, J.M. Aguado.
[Lymphoproliferative syndromes associated to the Epstein Barr virus in organ transplants].
Med Clin (Barc), 107 (1996), pp. 310-316
[21.]
H.E. Heslop.
How I treat EBV lymphoproliferation.
Blood, 114 (2009), pp. 4002-4008
[22.]
E. Ramos, C.B. Drachenberg, R. Wali, H.H. Hirsch.
The decade of polyomavirus BK-associated nephropathy: state of affairs.
Transplantation, 87 (2009), pp. 621-630
[23.]
H.H. Hirsch.
BK virus: opportunity makes a pathogen.
Clin Infect Dis, 41 (2005), pp. 354-360
[24.]
A.J. Eid, R.A. Brown, R. Patel, R.R. Razonable.
Parvovirus B19 infection after transplantation: a review of 98 cases.
Clin Infect Dis, 43 (2006), pp. 40-48
[25.]
K. Watt, B. Veldt, M. Charlton.
A practical guide to the management of HCV infection following liver transplantation.
Am J Transplant, 9 (2009), pp. 1707-1713
[26.]
M. Berenguer, V. Aguilera, M. Prieto, C. Ortiz, M. Rodríguez, F. Gentili, et al.
Worse recent efficacy of antiviral therapy in liver transplant recipients with recurrent hepatitis C: impact of donor age and baseline cirrhosis.
Liver Transpl, 15 (2009), pp. 738-746
[27.]
M. Berenguer.
Systematic review of the treatment of established recurrent hepatitis C with pegylated interferon in combination with ribavirin.
J Hepatol, 49 (2008), pp. 274-287
[28.]
M. Berenguer.
Recurrent allograft disease: viral hepatitis.
Acta Gastroenterol Belg, 68 (2005), pp. 337-346
[29.]
J.M. Miró, J. Torre-Cisneros, A. Moreno, M. Tuset, C. Quereda, M. Laguno, et al.
[GESIDA/GESITRA-SEIMC PNS and ONT consensus document on solid organ transplant (SOT) in HIVinfected patients in Spain (March, 2005)].
Enferm Infecc Microbiol Clin, 23 (2005), pp. 353-362
[30.]
A.K. Singal, B.S. Anand.
Management of hepatitis C virus infection in HIV/HCV co-infected patients: clinical review.
World J Gastroenterol, 15 (2009), pp. 3713-3724
[31.]
J.M. Miro, F. Aguero, M. Laguno, M. Tuset, C. Cervera, A. Moreno, Hospital Clinic OLT in HIV Working Group, et al.
Liver transplantation in HIV/hepatitis co-infection.
J HIV Ther, 12 (2007), pp. 24-35
[32.]
J. Torre-Cisneros, J. Fortún, J.M. Aguado, R. De la Cámara, J.M. Cisneros, J. Gavaldá, et al.
[Consensus document from GESITRA-SEIMC on the prevention and treatment of cytomegalovirus infection in transplanted patients].
Enferm Infecc Microbiol Clin, 23 (2005), pp. 424-437
[33.]
G. Torres-Madriz, H.W. Boucher.
Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients.
Clin Infect Dis, 47 (2008), pp. 702-711
[34.]
M.C. Mateos, J.M. Arguiñano, M.A. Ardaiz, F.J. Oyarzábal.
[Infections in non-transplanted oncohaematological patiens].
An Sist Sanit Navar, 28 (2005), pp. 59-81
[35.]
J.-A. Van Burik, D. Weisdorf.
Infecciones en los receptores de trasplante de células madre hematopoyéticas.
Enfermedades infecciosas. Principios y práctica, 6th ed, pp. 3486-3501
[36.]
C.A. Dykewicz.
Sumary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.
Clin Infect Dis, 2 (2001), pp. 139-144
[37.]
M. Boeckh, W. Leiserin, S.R. Bowden, R.A. Huang, D. Myerson, et al.
Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity.
Blood, 101 (2003), pp. 407-414
[38.]
R. De la Cámara.
[Viral infections in hematologic patients: prevention, diagnosis and treatment].
Haematologica (ed. esp.), 87 (2002), pp. 221-226
[39.]
T. Jancel, S.R. Penzak.
[Antiviral therapy in patients with hematologic malignancies, transplantation, and aplastic anemia].
Semin Hematol, 46 (2009), pp. 230-247
[40.]
A.E. Broers, R. Van Der Holt, J.W. Van Esser, J.W. Gratama, S. Henzen-Logmans, V. Kuenen-Boumeester, et al.
Increased transplantrelated morbidity and mortality in CMV-seropositive patients despite highly effective prevention of CMV disease after allogeneic T-cell-depleted stem cell transplantation.
Blood, 95 (2000), pp. 2240-2245
[41.]
Q. Nguyen, E. Estey, I. Raad, K. Rolston, H. Kantarjian, K. Jacobson, et al.
Cytomegalovirus pneumonia in adults with leukemia: an emerging problem.
Clin Infect Dis, 32 (2001), pp. 539-545
[42.]
P. Ljungman, P. Griffiths, C. Paya.
Definitions of cytomegalovirus infection and disease in transplant recipients.
Clin Infect Dis, 34 (2002), pp. 1094-1097
[43.]
M. Boeckh.
The challenge of respiratory virus infections in hematopoietic cell transplant recipients.
Br J Haematol, 143 (2008), pp. 455-467
[44.]
M. Robin, S. Marque-Juillet, C. Scieux, R. Peffault de Latour, C. Ferry, V. Rocha, et al.
Disseminated adenovirus infections after allogeneic hematopoietic stem cell transplantation: incidence, risk factors and outcome.
Haematologica, 92 (2007), pp. 1254-1257
[45.]
T. Willians, J. Roach, T. Rugg, L. Brettman.
Frequency of cytomegalovirus pneumonia following Alemtuzumab. Treatment in lymphoid malignancies: Rewiew of 1,538 patients.
Blood, 98 (2001), pp. 4923
[46.]
S.L. Goldberg, A.L. Pecora, R.S. Alter, M.S. Kroll, S.D. Rowley, S.E. Waintraub, et al.
Unusual viral infections (progressive multifocal leukoencephalopathy and cytomegalovirus disease) after high-dose chemotherapy with autologous blood stem rescue and peritransplantation rituximab.
Blood, 99 (2002), pp. 1486-1488
Copyright © 2011. Elsevier y Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias
Idiomas
Medicina Intensiva (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?