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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.32 no.5 São Paulo Sept./Oct. 1990

http://dx.doi.org/10.1590/S0036-46651990000500005 

ORIGINAL ARTICLES

 

Cytomegalovirus and other herpesviruses infections in heart and bone marrow transplant recipients

 

Infecções causadas por citomegalovírus e outros vírus do grupo herpes em transplantados cardíacos e de medula óssea

 

 

Adriana WeinbergI,II; Lucy S. Vilas BoasI; Olavo FeherIII; Tania M. V. StrabelliIV; Maria Cristina D. S. FinkI; Frederico L. DulleyIII; David E. UipII,IV; Giovani BellottiV; Dalton A. F. ChamoneIII; Vicente Amato NetoII; Cláudio S. PannutiI

IVirology laboratory of the Instituto de Medicina Tropical, São Paulo, HC-LIM-52
IIDivision of Infectious Diseases of the Hospital das Clínicas of the University of São Paulo
IIIDivision of Hematology, HC-FMUSP
IVInfection Control Commitee of the Instituto do Coração of the HC-FMUSP (Incor)
VClinical Division of the Incor

Address for correspondence

 

 


SUMMARY

From January 1988 to January 1989 all the heart transplant and bone marrow recipients at the Instituto do Coração of the Hospital das Clínicas of the University of São Paulo Medical School were studied for the incidence and morbidity associated with herpesviruses infections after transplantation. Five bone marrow and 5 heart transplant recipients were followed for a mean of 4.2 months post-transplantation. All the patients were seropositive for cytomegalovirus (CMV) before admission and 80% experienced one or more recurrences during the observation period. Of the 12 episodes of CMV infection, that were identified in this study, 83% were accompanied by clinical or laboratory abnormalities. However, there was only one case of severe disease. The overall incidence of infection for herpes simplex (HSV) was 50%. Although most of HSV reactivations were oral or genital, one case of HSV hepatitis occurred. One of the 6 episodes of HSV infections that were treated with acyclovir showed an unsatisfactory response and was successfully managed with ganciclovir. All the individuals had anti-varicella zoster virus antibodies, but none of them developed infection. The study emphasizes the importance of active diagnostic surveillance of herpesvirus infections in transplant patients. Both CMV and HSV reactivations showed high incidence and important morbidity and thus, deserve prophylactic therapy.

Key words: Cytomegalovirus infection; Herpesviruses infection; Immunocompro-mised host; Transplantation.


RESUMO

De janeiro de 1988 a janeiro de 1989 todos os pacientes submetidos a transplante de coração ou de medula óssea no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram estudados quanto à incidência e morbidade das infecções pós-transplante causadas por vírus do grupo herpes. Cinco recipientes de medula óssea e 5 transplantados cardíacos foram observados por um período médio de 4.2 meses após o transplante. Todos os pacientes tinham sorologia positiva para citomegalovírus (CMV) antes do transplante e 80% desenvolveram uma ou mais recorrências durante o período de observação. Dos 12 episódios de infecão por CMV detectados neste estudo, 83% foram acompanhados por alterações clínicas ou laboratoriais. Apenas um caso apresentou doença grave. A incidência de infecções causadas por vírus Herpes simplex (HSV), foi de 50%. Apesar da maioria das reativações do HSV fossem representadas por lesões orais ou genitais, houve também um caso de hepatite por HSV. Um dos 6 episódios de infecção, por HSV que foram tratados com aciclovir não respondeu ao tratamento. Posteriormente, o paciente se beneficiou com o uso de ganciclovir. Todos os indivíduos apresentavam antes do transplante anticorpos anti-vírus da varicela zoster. Porém, não houve nenhum caso de reativação. Este estudo realça a importância do controle diagnóstico ativo das infecções por herpes-vírus em pacientes transplantados. Tanto as infecções causadas por CMV como por HSV mostraram alta incidência e grande morbidade indicando a necessidade de quimioprofilaxia.


 

 

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

 

 

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Address for correspondence:
Dr. Claudio Sérgio Pannuti
Instituto de Medicina Tropical de São Paulo, Laboratório de Virologia
Av. Dr. Enéas de Carvalho Aguiar, 470
CEP 05403 São Paulo, SP, Brasil

Recebido para publicação em 23/1/1990
This work was supported by the E. J. Zerbini Foundation and CNPq, grant no. 408741/88.

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