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2015 ; 70
(7
): 515-23
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Cytomegalovirus infection in transplant recipients
#MMPMID26222822
Azevedo LS
; Pierrotti LC
; Abdala E
; Costa SF
; Strabelli TM
; Campos SV
; Ramos JF
; Latif AZ
; Litvinov N
; Maluf NZ
; Caiaffa Filho HH
; Pannuti CS
; Lopes MH
; Santos VA
; Linardi Cda C
; Yasuda MA
; Marques HH
Clinics (Sao Paulo)
2015[Jul]; 70
(7
): 515-23
PMID26222822
show ga
Cytomegalovirus infection is a frequent complication after transplantation. This
infection occurs due to transmission from the transplanted organ, due to
reactivation of latent infection, or after a primary infection in seronegative
patients and can be defined as follows: latent infection, active infection, viral
syndrome or invasive disease. This condition occurs mainly between 30 and 90 days
after transplantation. In hematopoietic stem cell transplantation in particular,
infection usually occurs within the first 30 days after transplantation and in
the presence of graft-versus-host disease. The major risk factors are when the
recipient is cytomegalovirus seronegative and the donor is seropositive as well
as when lymphocyte-depleting antibodies are used. There are two methods for the
diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase
chain reaction. Serology has no value for the diagnosis of active disease,
whereas histology of the affected tissue and bronchoalveolar lavage analysis are
useful in the diagnosis of invasive disease. Cytomegalovirus disease can be
prevented by prophylaxis (the administration of antiviral drugs to all or to a
subgroup of patients who are at higher risk of viral replication) or by
preemptive therapy (the early diagnosis of viral replication before development
of the disease and prescription of antiviral treatment to prevent the appearance
of clinical disease). The drug used is intravenous or oral ganciclovir; oral
valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue
for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and
the gold-standard drug is intravenous ganciclovir. Treatment should be given for
2 to 3 weeks and should be continued for an additional 7 days after the first
negative result for viremia.
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