Table 2.

Emerging infections in transplant recipients

Pathogen	Mode of transmission	Usual time of presentation	Presenting features	Diagnosis	Treatment
HHV-6	Reactivation of latent infection	Commonest in first 2–4 weeks, may occur up to 2 years	Fever, rash, myelosuppression, hepatitis, pneumonitis, encephalitis ↑ risk of CMV and opportunistic infections	PCR	Ganciclovir
HHV-7	Transmission from donor			Histopathology	Cidofovir Foscarnate
Adenovirus	Reactivation, nosocomial transmission	Commonest in first 3 months, may occur until several years	Interstitial nephritis, hemorrhagic cystitis, pneumonitis	Immunohistochemistry PCR in plasma	IVIG Cidofovir
West Nile virus	Transmission from donor,blood transfusion, environmental exposure		Fever, meningoencephalitis,hyporeflexic paralysis	PCR (short viremic phase)Serology (may be delayed) IgM antibody in CSF	IVIG
LCM	Transmission from donor,	First 4 weeks	Fever, diarrhea, asepticmeningitis, interstitial pneumonia, hepatitis, multisystem failure	Cerebrospinal fluid PCR, serology
Parainfluenza and metapneumovirus	Environmental and nosocomial transmission	After 1 year illness, pneumonia	Fever, upper respiratory	PCR Antigen detection on respiratory secretions	Ribavirin
Parvovirus B19	Transmission from donor	First year	Fever, joint pain, pure redcell aplasia, hepatitis, pneumonitis	PCR Bone marrow examination	IVIG
Respiratory syncytial virus	Nosocomial transmission	Any time	Upper respiratory tract infection, interstitial pneumonia	PCR Antigen testing on respiratory secretions	Ribacirin IVIG
Rotavirus	Environmental transmission	Any time	Self-limiting diarrhea, lowergastrointestinal bleeding		None

HHV: human herpesvirus; LCM: lymphocyte choriomeningitis virus, CSF: cerebrospinal fl uid, IVIG: intravenous immunoglobulin; PCR: polymerase chain reaction