Diagnostic microbiology of the immunocompromised host by Randall T Hayden; et al

By Randall T Hayden; et al

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These agents are usually combined with corticosteroids and MMF. A large European randomized multicenter trial comparing the efficacies of tacrolimus plus lowdose corticosteroids and a conventional multidrug cyclosporine-based regimen (corticosteroids plus azathioprine) to prevent allograft rejection in liver transplant recipients revealed similar incidences of infection in patients receiving the tacrolimus- and cyclosporine-based regimens (206). The incidence of sepsis was approximately 20% for both groups, and the incidence of CMV infection ranged from 15 to 25%, with a lower incidence for the tacrolimustreated patients.

The disease manifestations include a mononucleosis-like syndrome with fever and neutropenia, aplastic anemia, oral hairy leukoplakia, and PTLD. The patients at highest risk for PTLD include those patients who have received an allogeneic transplant from a matched unrelated, mismatched, or T-cell-depleted donor, have chronic GVHD, and have received antilymphocyte antibody therapy for GVHD prophylaxis (148). Patients may also lose B-cell-specific immunity to measles, mumps, rubella, parvovirus B19, and the polyomaviruses JC virus and BK virus (168).

Patients with a well-functioning allograft on minimal maintenance immunosuppressive therapy are at risk for the usual community-acquired infections, primarily respiratory infections. Patients maintained on higher doses of immunosuppressive agents because of recurrent or chronic rejection remain at risk for opportunistic infections with the pathogens described above. Those patients chronically infected with the immunomodulating viruses remain at significant risk for secondary infections as well as for the virus-associated malignancies (263).

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