Table 1.
Rare and Emerging Viral Infections in the Transplant Population: Case Series or Multiple Cases Reported
| Virus | Virus Family | Transplant | Clinical Manifestations | Comments |
|---|---|---|---|---|
| HTLV-1 | Retroviridae | SOT and HSCT; donor-derived infections reported | Adult T-cell leukemia and HTLV-1–associated myelopathy | Associated with lower survival after HSCT from HTLV-1+ donor |
| HEV | Hepeviridae | SOT predominantly; case report in HSCT | Chronic viremia, elevated LFTs, cirrhosis; rare reports of neurological complications | Typically de novo infections; treatment possible with reduced immunosuppression, peg-interferon, or ribavirin |
| Rabies | Rhabdoviridae | SOT, ileac artery graft, cornea transplants; all cases donor derived | Fatal encephalitis; cornea transplants present with pain in eye with graft | Survivors reported cornea transplant with immediate PEP; liver transplant 20 y after vaccination |
| LCMV and novel arenavirus | Arenaviridae | SOT; all reported cases donor derived | Fever, abdominal pain, nausea, vomiting, diarrhea, altered mental status; often peri-incisional rash and tenderness | 14 of 17 patients died; ribavirin employed but effect unclear; 3 cornea transplants unaffected |
| Measles | Paramyxoviridae | SOT and HSCT | Occasional clinical measles; SME (afebrile, altered mental status, intractable seizures); interstitial pneumonia | SME fatal in 4 of 6 transplant patients; case series suggest severe measles represents minority of cases in transplant recipients |
| Mumps | Paramyxoviridae | SOT and HSCT | Parotitis, orchitis, vestibular neuronitis, and renal allograft involvement (SOT); fatal encephalitis (HSCT) | 3 cases in SOT, all renal transplant patients and all survived; 2 encephalitis cases peri- and post-HSCT |
| Dengue | Flaviviridae | SOT and HSCT | Dengue fever; severe dengue, including hemorrhagic fever and shock | Dengue shock associated with high mortality; rates of severe dengue differ in case series |
| Orf | Poxviridae | SOT; contact with infected sheep | Giant and recurrent skin lesions on hands and forearms | Often misdiagnosed and treated with excision or amputation; case reports document responses to cryotherapy, cidofovir cream, or imiquimod |
| HCoV-HKU1 and -NL63 | Coronaviridae | SOT and HSCT | Cases of fatal LRTI, predominantly in SOT; increased risk of lung transplant rejection | Novel beta HCoV identified in 2012 with high rate of fatalities; no reported cases in transplant |
Abbreviations: HCoV-HKU1, human coronavirus HKU1; HEV, hepatitis E virus; HSCT, hematopoietic stem cell transplantation; HTLV-1, human T-cell leukemia virus type 1; LCMV, lymphocytic choriomeningitis virus; LFTs, liver function tests; LRTI, lower-respiratory-tract infection ; NL63, human coronavirus NL63; PEP, postexposure prophylaxis; SME, subacute measles encephalitis; SOT, solid organ transplant.