ABSTRACT
Viral infections are increasingly recognized as a serious problem in lungtransplant recipients. In addition to their direct effects of tissue injury and clinical illness, they produce indirect effects that may lead to long-term adverse sequelae in the lung allograft. The herpesviruses, which include cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus 1 and 2 (HSV-1 and –2), varicella-zoster virus (VZV), and human herpesvirus 6, 7, and 8 (HHV-6, -7, and -8) have important immunomodulatory effects in addition to their direct infectious effects. The community-acquired respiratory viruses (CARV), such as respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza A and B, adenovirus, and rhinovirus, are increasingly recognized as important pathogens in lung-transplant recipients. Newly described viruses, such as human metapneumovirus (hMPV), or emerging viruses, such as West Nile virus (WNV) or severe acute respiratory syndrome coronavirus (SARS-CoV), are being reported in increasing frequency in transplant recipients. Development of potent oral antiviral agents, molecular techniques for the detection of infection, and its response to therapy and the emergence of isolates with antiviral resistance have had significant impacts on the approach to viral infections in these patients. This chapter discusses the individual pathogens, prevention strategies in the era
PART VII: INFECTIOUS COMPLICATIONS
of potent oral antiviral agents, the role of new diagnostic techniques, treatment regimens for established viral infection or disease, and their potential impact on the indirect effects of these viruses on long-term allograft function, and the incidence, risk factors, and impact of antiviral resistance. Understanding the pleiotropic effects of these viruses is important for the development of comprehensive management strategies for viral infections following lung transplantation.
