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1.
Adv Exp Med Biol ; 1172: 63-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31628651

RESUMO

The co-stimulation and co-inhibition signal pathways, immune checkpoints, are among the central mechanisms to regulate the T-cell immunity. Optimal signals involve intricate interactions of numerous ligands and receptors. Manipulation of these signals offers great clinical opportunities and has revolutionized the cancer treatment therapies. The 2018 Nobel Prize in Physiology or Medicine was awarded to James P. Allison and Tasuku Honjo in recognition of their discovery of cancer immunotherapy by inhibition of immune checkpoint molecules. Despite the landmark discovery in cancer immunotherapy, the efforts to harness immunity against cancer are also restricted by the limited knowledge on the co-stimulation and co-inhibition signaling networks. Understanding the structures of these molecules, in particular, tackling the interaction paradigms from the structural perspective, help to provide more accurate insights into the signaling mechanisms, which may further facilitate the development of novel biologics and improve the efficacy of the existing biologics against these targets. Here we review our current understanding on the structures of these co-stimulatory and co-inhibitory molecules. Specifically, we focus on the structural basis of several checkpoint molecules among the CD28-B7 family and discuss the therapeutic drugs against these targets for the treatment of human cancers, autoimmune disorders, and transplantation.


Assuntos
Antígenos CD28 , Linfócitos T , Doenças Autoimunes , Antígenos CD28/química , Antígenos CD28/imunologia , Humanos , Imunoterapia , Neoplasias/terapia , Transplante de Órgãos , Transdução de Sinais/imunologia , Linfócitos T/imunologia
3.
N Engl J Med ; 381(12): 1136-1147, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532960

RESUMO

BACKGROUND: Maribavir is a benzimidazole riboside with activity against cytomegalovirus (CMV). The safety and efficacy of maribavir for preemptive treatment of CMV infection in transplant recipients is not known. METHODS: In a phase 2, open-label, maribavir dose-blinded trial, recipients of hematopoietic-cell or solid-organ transplants (≥18 years of age, with CMV reactivation [1000 to 100,000 DNA copies per milliliter]) were randomly assigned to receive maribavir at a dose of 400, 800, or 1200 mg twice daily or the standard dose of valganciclovir for no more than 12 weeks. The primary efficacy end point was the percentage of patients with a response to treatment, defined as confirmed undetectable CMV DNA in plasma, within 3 weeks and 6 weeks after the start of treatment. The primary safety end point was the incidence of adverse events that occurred or worsened during treatment. RESULTS: Of the 161 patients who underwent randomization, 159 received treatment, and 156 had postbaseline data available - 117 in the maribavir group and 39 in the valganciclovir group. The percentage of patients with postbaseline data available who had a response to treatment within 3 weeks was 62% among those who received maribavir and 56% among those who received valganciclovir. Within 6 weeks, 79% and 67% of patients, respectively, had a response (risk ratio, 1.20; 95% confidence interval, 0.95 to 1.51). The percentages of patients with a response to treatment were similar among the maribavir dose groups. Two patients who had a response to treatment had a recurrence of CMV infection within 6 weeks after starting maribavir at a dose of 800 mg twice daily; T409M resistance mutations in CMV UL97 protein kinase developed in both patients. The incidence of serious adverse events that occurred or worsened during treatment was higher in the maribavir group than in the valganciclovir group (52 of 119 patients [44%] vs. 13 of 40 [32%]). A greater percentage of patients in the maribavir group discontinued the trial medication because of an adverse event (27 of 119 [23%] vs. 5 of 40 [12%]). A higher incidence of gastrointestinal adverse events was reported with maribavir, and a higher incidence of neutropenia was reported with valganciclovir. CONCLUSIONS: Maribavir at a dose of at least 400 mg twice daily had efficacy similar to that of valganciclovir for clearing CMV viremia among recipients of hematopoietic-cell or solid-organ transplants. A higher incidence of gastrointestinal adverse events - notably dysgeusia - and a lower incidence of neutropenia were found in the maribavir group. (Funded by ViroPharma/Shire Development; EudraCT number, 2010-024247-32.).


Assuntos
Antivirais/uso terapêutico , Benzimidazóis/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/fisiologia , Ribonucleosídeos/uso terapêutico , Valganciclovir/uso terapêutico , Viremia/tratamento farmacológico , Adulto , Idoso , Aloenxertos , Antivirais/efeitos adversos , Antivirais/farmacologia , Benzimidazóis/efeitos adversos , Benzimidazóis/farmacologia , Citomegalovirus/efeitos dos fármacos , Infecções por Citomegalovirus/virologia , Disgeusia/induzido quimicamente , Feminino , Gastroenteropatias/induzido quimicamente , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Transplante de Órgãos/efeitos adversos , Ribonucleosídeos/efeitos adversos , Ribonucleosídeos/farmacologia , Valganciclovir/efeitos adversos , Valganciclovir/farmacologia , Ativação Viral/efeitos dos fármacos
5.
Expert Opin Drug Saf ; 18(11): 1017-1030, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31478398

RESUMO

Introduction: Human cytomegalovirus (HCMV) is a major contributor of morbidity and mortality, and its management is essential for the successful outcome of solid organ and hematopoietic stem cell transplantation. Areas covered: This review discusses the safety profiles of currently available and emerging antiviral drugs and the other strategies for HCMV prevention and treatment after transplantation. Expert opinion: Strategies for management of HCMV rely largely on the use of antiviral agents that inhibit viral DNA polymerase (ganciclovir/valganciclovir, foscarnet, and cidofovir/brincidofovir) and viral terminase complex (letermovir), with different types and degrees of adverse effects. An investigational agent, maribavir, exerts its anti-CMV effect through UL97 inhibition, and its safety profile is under clinical evaluation. In choosing the antiviral medication to use, it is important to consider these safety profiles in addition to overall efficacy. In addition to antiviral drugs, reduction of immunosuppression is often generally needed in the management of HCMV infection, but with a potential risk of allograft rejection or graft-versus-host disease. The use of HCMV-specific or non-specific intravenous immunoglobulins remains debated, while adoptive HCMV-specific T cell therapy remains investigational, and associated with unique set of adverse effects.


Assuntos
Antivirais/administração & dosagem , Infecções por Citomegalovirus/prevenção & controle , Infecções Oportunistas/prevenção & controle , Antivirais/efeitos adversos , Infecções por Citomegalovirus/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunossupressores/administração & dosagem , Infecções Oportunistas/virologia , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/métodos
6.
Stud Health Technol Inform ; 264: 1851-1852, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438375

RESUMO

The results of Human Leukocyte Antigen (HLA) antigen testing in transplant patients are not generally used to predict future adverse events. In this study, free-text HLA screening results of transplant patients were analyzed and stored in a database, and the frequencies of patients with adverse events according to HLA allele were extracted. Approximately 25% of patients had HLA alleles associated with serious drug side effects.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Antígenos HLA/genética , Transplante de Órgãos , Alelos , Humanos
7.
BJOG ; 126(11): 1310-1319, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31410987

RESUMO

Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.


Assuntos
Sobrevivência de Enxerto/fisiologia , Imunossupressão/métodos , Infertilidade Feminina/cirurgia , Transplante de Órgãos , Doadores de Tecidos , Útero/transplante , Adulto , Feminino , Rejeição de Enxerto , Humanos , Nascimento Vivo , Pessoa de Meia-Idade , Transplante de Órgãos/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
9.
Wiad Lek ; 72(7): 1331-1336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398165

RESUMO

OBJECTIVE: Introduction: The article is devoted to the research of normative regulation of human organs and tissue transplantation in Ukraine and some foreign countries. A considerable part of problem aspects of transplantology in Ukraine is hidden due to the normative and legal base shortcomings, therefore there is a necessity of considering and borrowing foreign experience of legal regulation of this process, a legal regulation of the bases and conditions of providing consent to the removal of organs or refusal of the potential donor and legal consequences of it. The question as for the possibility of consolidating the "consent presumption" on the removal of organs and tissues at the legislative level remains current, but many experts express the idea of inadmissibility of such legislative actions because of the military operations on the territory of Ukraine and the imperfection of state control for the activities of institutions performing transplantation. At the same time, it is obvious that now the legislative regulation of the sphere of transplantology does not meet modern requirements, and creates certain gaps in the Ukrainian legislation. The aim is to determine and concretize problematic issues of legal regulation of the transplantation sphere in Ukraine, to analyze the experience of the successful countries in this direction and to develop an integrated approach to the solution of certain problems. PATIENTS AND METHODS: Materials and methods: During the research, international normative acts, national legislation acts and scientific works of scholars were used. The article is based on the dialectical, legal, historical, comparative, systematic methods of research. RESULTS: Review: The analysis of the current situation of legal regulation of the sphere of transplantology in Ukraine has been carried out, the main problems and gaps, which must be eliminated as soon as possible for the real possibility of organ and tissue transplantation operations, are identified. The experience of the most progressive countries that are leaders in the number of transplantation operations is analyzed and their experience has been taken. CONCLUSION: Conclusions: The solution of this problem is possible only after the transformation of the transplant coordination system, the introduction of the Unified State Information System for transplantation, the training of specialized personnel, the improvement of the technical equipment of medical institutions, and the creation of an effective mechanism for regulating of the human anatomical materials' transplantation.


Assuntos
Transplante de Órgãos , Assistência à Saúde , Humanos , Ucrânia
10.
BMC Infect Dis ; 19(1): 697, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387529

RESUMO

BACKGROUND: S. pneumoniae is the leading cause of community-acquired pneumonia in the solid organ transplant recipient (SOTR); nevertheless, the prevalence of colonization and of the colonizing/infecting serotypes has not been studied in this population. In this context, the aim of the present study was to describe the rate, characteristics, and clinical impact of S. pneumoniae nasopharyngeal carriage. METHODS: A prospective observational cohort of Solid Organ Transplant recipients (SOTR) was held at the University Hospital Virgen del Rocío, Seville, Spain with the aim to evaluate the S. pneumoniae colonization and the serotype prevalence in SOTR. Two different pharyngeal swabs samples from 500 patients were included in two different seasonal periods winter and spring/summer. Optochin and bile solubility tests were performed for the isolation of thew strains. Antimicrobial susceptibility studies (MICs, mg/l) of levofloxacin, trimethoprim-sulfamethoxazole, penicillin, amoxicillin, cefotaxime, ceftriaxone, erythromycin, azithromycin and vancomycin for each isolate were determined by E-test strips. Capsular typing was done by sequential multiplex PCR reactions. A multivariate logistic regression analysis of factors potentially associated with pneumococcal nasopharyngeal carriage and disease was performed. RESULTS: Twenty-six (5.6%) and fifteen (3.2%) patients were colonized in winter and spring/summer periods, respectively. Colonized SOT recipients compared to non-colonized patients were more frequently men (79.5% vs. 63.1%, P < 0.05) and cohabitated regularly with children (59% vs. 32.2%, P < 0.001). The most prevalent serotype in both studied periods was 35B. Forty-five percent of total isolates were included in the pneumococcal vaccine PPV23. Trimethoprim-sulfamethoxazole and macrolides were the less active antibiotics. Three patients had non-bacteremic pneumococcal pneumonia, and two of them died. CONCLUSIONS: Pneumococcal colonization in SOTR is low with the most colonizing serotypes not included in the pneumococcal vaccines.


Assuntos
Nasofaringe/microbiologia , Transplante de Órgãos/efeitos adversos , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Antibacterianos , Criança , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas , Prevalência , Estudos Prospectivos , Sorogrupo , Espanha/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/patogenicidade , Transplantados/estatística & dados numéricos
12.
Nervenarzt ; 90(10): 1021-1030, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31312849

RESUMO

The determination of the irreversible cessation of brain function (ICBF) is conducted in Germany according to the guideline of the German Medical Association, which is currently its fourth update issued in July 2015. This article provides an assessment of the current situation including an international comparison. International case reports with allegedly incorrect ICBF diagnosis are reviewed from the point of view of the German guideline. These case reports underpin the validity of the German guideline, especially its following provisions: (1) in patients with known or suspected adaptation to chronic hypercapnia, apnea cannot be diagnosed as usual; therefore in such a case the proof of cerebral circulatory arrest is mandatory; (2) if perfusion scintigraphy is used for proof of cerebral circulatory arrest, only validated lipophilic radiopharmaceuticals are allowed. This is compatible with new research data which indicate that cellular function can be reactivated for several hours after circulatory arrest but not the brain function. The recently updated recommendations of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) for ancillary testing include editorial adaptations (e.g., the more precise specification of the electrode positions for electroencephalography), standards of display screen with digital electroencephalography and age-related minimum values of mean arterial pressure for Doppler and duplex sonography in children. The novel requirements regarding the institutional organization of ICBF diagnostics in Germany issued in the "Second law on the amendment of transplantation law-improvement of the cooperation and the framework for organ donation" that became effective recently are presented and discussed critically in this review.


Assuntos
Morte Encefálica , Morte Encefálica/diagnóstico , Alemanha , Guias como Assunto , Humanos , Transplante de Órgãos/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
14.
BMC Infect Dis ; 19(1): 573, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269923

RESUMO

BACKGROUND: Solid organ transplantation (SOT) is a well-established and life-saving treatment for patients with end-stage organ failure. Organ rejection and infections are among the main complications to SOT and largely determines the clinical outcome. The correct level of immunosuppression is of major importance to prevent these complications. However, it is a consistent observation that in recipients on the same immunosuppressive regimens the clinical outcome varies, and no reliable marker exists to monitor immune function. METHODS: In a prospective, observational study, we plan to enroll 630 adult patients with a planned organ transplantation at Rigshospitalet, University of Copenhagen, Denmark. Prior to and on different time points up to two years after transplantation we will perform a complete immunological profile on the recipients. This profile will consist of classical descriptive immune phenotyping (flow cytometry and circulating biomarkers) and the functional assay TruCulture®. In TruCulture® whole blood is incubated ex vivo with stimulants imitating bacterial, viral and fungal infections, where after a panel of selected cytokines is quantified. Clinical data from electronic health records will be obtained from the PERSIMUNE (Centre of Excellence for Personalized Medicine of Infections Complications in Immune Deficiency at Rigshospitalet, Copenhagen) data repository, a warehouse of data generated as part of routine care including vital signs, biochemistry, microbiology, pathology as well as medication, demographics, diagnoses, hospital contacts, surgical procedures and mortality. DISCUSSION: This will be the first large scale study to determine several aspects of immune function and perform a complete immunological profiling in SOT recipients. It is expected that knowledge generated will provide information to generate prediction models identifying patients at increased risk of infection and/or rejection. If the study is successful, we will subsequently use the generated prediction models to propose personalized immunosuppressive regimens to be tested in future randomized controlled trials. TRIAL REGISTRATION: This study has been approved by the Regional ethical committee (H-17024315), the Danish Data Protection Agency (RH-2016-47, RH-2015-04, I-Suite 03605) and the Danish National board of Health (3-3013-1060/1). The trial is retrospectively registered at clinicaltrials.gov ( NCT03847285 ) the 20th February 2019.


Assuntos
Infecção/etiologia , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/métodos , Adulto , Biomarcadores/sangue , Citocinas/sangue , Humanos , Tolerância Imunológica , Imunossupressão , Imunossupressores/uso terapêutico , Estudos Observacionais como Assunto , Estudos Prospectivos
15.
Lakartidningen ; 1162019 Mar 19.
Artigo em Sueco | MEDLINE | ID: mdl-31192411

RESUMO

The number of organ donors in Sweden is not enough to cover the need of tissues for transplant purposes. Other sources have to be defined. Young and healthy potential donors can be identified within DFM. Without precise written agreements and a well-educated and trained organization those donations will not be realized. With the purpose to evaluate national efforts to establish close cooperation between tissue establishments and DFM, two surveys were conducted at two time periods, 2011-13 and 2014-16. A total of 2118 pieces of tissue were retrieved within 6 years, 1799 for transplant purposes and 319 for research or education. Most common tissues were heart valves and cornea but also skin and ear bones were collected. 23% of all retrieved tissue from deceased donors in Sweden came from DFM. In the first period 19 % of all transplanted tissue came from DFM and in the latter period it had increased to 26%. Education and national courses for employees in DFM as well as logistic and economical support from national authorities are important factors for building a stable organization and for sustainable progress.


Assuntos
Medicina Legal , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Humanos , Transplante de Órgãos/estatística & dados numéricos , Inquéritos e Questionários , Suécia , Transplante de Tecidos/estatística & dados numéricos
16.
Urologe A ; 58(8): 885-887, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31254014

RESUMO

The number of organ donations in Germany has continuously fallen in recent years. The proposed Transplantation Act stipulates that every German citizen is considered an organ donor if he/she has not objected during his/her lifetime. This proposal has received wide approval, but also much criticism. The German Society for Urology, the German Society for Surgery, the German Society for Nephrology and the German Transplantation Society have all spoken out in press releases in favor of the introduction of an opt out (presumed consent) solution. The German Bundestag will decide on the proposed bill in autumn.


Assuntos
Política de Saúde/legislação & jurisprudência , Legislação Médica , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Feminino , Alemanha , Humanos , Masculino , Nefrologia , Transplante de Órgãos/legislação & jurisprudência , Sociedades Médicas , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
17.
BJOG ; 126(11): 1320-1326, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31215750

RESUMO

Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.


Assuntos
Imunossupressores/uso terapêutico , Infertilidade Feminina , Transplante de Órgãos/métodos , Seleção de Pacientes , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Útero/transplante , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Suécia , Reino Unido , Adulto Jovem
18.
Expert Rev Clin Pharmacol ; 12(8): 781-790, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31242782

RESUMO

Introduction: There is a high incidence of venous thromboembolism (VTE) in solid organ transplant recipients. The safety and efficacy of direct-acting oral anticoagulants (DOAC) have been well established in clinical practice for the prevention and treatment of VTE in broad populations. However, the management of VTE in the setting of solid organ transplantation remains a challenge to clinicians due to limited evidence of DOAC usage with calcineurin inhibitors. Areas covered: The current literature available on the pharmacokinetic-pharmacodynamic interaction between DOACs and calcineurin inhibitors is presented. A comprehensive review was undertaken using PubMed, Embase, drug product labeling, and drug product review conducted by the US Food and Drug Administration using Drugs@FDA. The potential for mitigation strategies and clinical management using extant knowledge is explored. Expert opinion: Immunosuppression therapy is necessary to prevent graft rejection by the host. The sparsity of data together with the lack of well-designed prospective studies of DOAC use in solid organ transplant recipients presents a unique challenge to clinicians in determining the clinical relevance of possible drug interactions. Existing evidence suggests that with attention to concomitant drug use and renal function, the co-administration of DOACs and calcineurin inhibitors is safe and effective.


Assuntos
Anticoagulantes/administração & dosagem , Inibidores de Calcineurina/administração & dosagem , Imunossupressores/administração & dosagem , Administração Oral , Anticoagulantes/efeitos adversos , Inibidores de Calcineurina/efeitos adversos , Interações de Medicamentos , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Transplante de Órgãos/métodos , Projetos de Pesquisa , Tromboembolia Venosa/prevenção & controle
19.
Chirurg ; 90(11): 899-904, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31214724

RESUMO

BACKGROUND: The indications, implementation and reporting of liver biopsies for deceased organ donation are not mandatory or regulated. Reliable data on outcome quality and prognostic relevance are therefore not available. Defined standards are thus required to enable meaningful studies and to ensure high data quality of a national transplantation registry. OBJECTIVE: Presentation of a synopsis of available studies and literature-based recommendations. RESULTS AND CONCLUSION: Against the background of an organ shortage and a growing number of older donors, pretransplantation liver histology is of significant relevance to guide clinical decision making. With the joint recommendations of the German Transplantation Society (DTG), the German Society of Pathology (DGP) and the German Organ Transplantation Foundation (DSO) standardized procedures are defined for the first time.


Assuntos
Transplante de Fígado , Fígado/patologia , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Humanos , Doadores Vivos , Sistema de Registros , Doadores de Tecidos
20.
Internist (Berl) ; 60(7): 678-683, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31089769

RESUMO

Infections in immunosuppressed patients represent a particular challenge in the diagnostics and treatment. They often present with atypical and particularly severe courses, for which rapid diagnostics and treatment are decisive for treatment success. Opportunistic infections with human herpes viruses occur not only more frequently in immunocompromised patients compared to healthy people but also represent a special challenge. In the treatment of immunosuppressed patients, e.g. with human immunodeficiency virus infections and patients with solid organ transplantations, infections with herpes simplex virus, varicella zoster virus, Epstein-Barr virus and cytomegalovirus are particularly important. The symtoms are very variable, ranging from asymptomatic detection of viremia to vital life-threatening organ manifestations. This review article describes the most important clinical presentations of these opportunistic infections. Furthermore, the diagnostic, therapeutic and prophylactic strategies for human herpes viruses are summarized.


Assuntos
Herpes Zoster/diagnóstico , Infecções por Herpesviridae/diagnóstico , Hospedeiro Imunocomprometido/imunologia , Infecções Oportunistas/diagnóstico , Transplante de Órgãos , Transplante/efeitos adversos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Herpes Zoster/tratamento farmacológico , Infecções por Herpesviridae/tratamento farmacológico , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Humanos , Imunossupressão , Infecções Oportunistas/tratamento farmacológico
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