Infection in the Transplant Recipient

Nancy L. Stitt, RN, BSN

April 03, 2003

Community-acquired Respiratory Viruses

Important community-acquired respiratory virus infections in the immunocompromised host include influenza virus types A and B; respiratory syncytial virus; parainfluenza viruses 1, 2, and 3; adenoviruses; and, possibly, rhinoviruses. Transmission is via contact for all viruses except influenza, which is transmitted by respiratory droplets. Common respiratory virus syndromes include the common cold, upper respiratory tract infection, pharyngitis, laryngitis, tracheobronchitis, influenza-like syndromes, bronchiolitis, and pneumonia. In the immunocompromised host, viral shedding may persist for months vs days in the immunocompetent host. The diagnosis and treatment of community-acquired respiratory viruses have been previously reviewed on Medscape Transplantation.^[31,44]

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Table 1. Table 1. Treatment Regimens for HSV Infection in Transplant Recipients[29]
Indication	Drug and Dosage
Initial genital infection	Acyclovir 400 mg PO 5 times daily or valacyclovir 1 g PO 3 times daily, for 10 days
Recurrent genital infection	Acyclovir 400 mg PO 5 times daily or valacyclovir 1 g PO 2 times daily, for 5 days
Suppression of recurrent genital infection	Acyclovir 400 mg PO 2 or 3 times daily or valacyclovir 1 g PO once daily
Herpes labialis	Penciclovir 1% topically every 2 h for 4 days or acyclovir 400 mg PO 5 times daily for 5 days
Encephalitis	Acyclovir 10-15 mg/kg IV every 8 h for 14-21 days

Table 2. Treatment Regimens for Varicella Infection in Transplant Recipients ^[29]
Indication	Drug and Dosage
Varicella	Acyclovir 10 mg/kg IV every 8 h for 7-10 days
Zoster	Valacyclovir 1 g PO 3 times daily or acyclovir 800 mg PO 5 times daily for 7 days or acyclovir 10 mg/kg IV every 8 h for 7 days

Table 3. Treatment Regimens for CMV Infection in Transplant Recipients[29]
Indication	Drug and Dosage
Prophylaxis	Ganciclovir, 5 mg/kg IV 2 times daily, then 1 g 3 times daily to complete 3 months; valacyclovir 2 g PO 4 times daily for 3 months
Treatment	Ganciclovir 5 mg/kg IV 2 times daily for 14 days, then 1 g 3 times daily to complete 6 weeks

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Infection in the Transplant Recipient

Community-acquired Respiratory Viruses

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