Tan Hiok-Hee, Goh Chee-Leok
National Skin Centre, Singapore.
Am J Clin Dermatol. 2006;7(1):13-29. doi: 10.2165/00128071-200607010-00003.
Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surveillance, sun avoidance, and patient education are important aspects of the management strategy.
病毒性皮肤感染是器官移植受者的常见表现。最重要的病原体是人类疱疹病毒（HHV）、人乳头瘤病毒（HPV）和传染性软疣病毒。在这类患者中重要的HHV包括1型和2型单纯疱疹病毒（HSV）、水痘带状疱疹病毒（VZV）、巨细胞病毒（CMV）、爱泼斯坦-巴尔病毒（EBV）、HHV-6和-7，以及引起卡波西肉瘤（KS）的HHV-8。HSV感染的特点是能够建立潜伏状态，随后在日后重新激活。器官移植受者中HSV感染最常见的表现是口咽或生殖器区域的黏膜皮肤病变。治疗通常使用阿昔洛韦、伐昔洛韦或泛昔洛韦。尽管大多数耐阿昔洛韦菌株是从艾滋病患者而非器官移植受者中分离出来的，但仍可能出现阿昔洛韦耐药情况。在这种情况下，可能不得不考虑使用膦甲酸钠、西多福韦或曲氟尿苷等替代药物。VZV可引起水痘以及带状疱疹。在器官移植受者中，可出现复发性带状疱疹。器官移植患者的急性水痘应使用静脉注射阿昔洛韦进行治疗。CMV感染发生在所有移植受者中的比例为20%至60%。皮肤表现包括非特异性斑疹、溃疡、紫癜性皮疹和水疱大疱性病变，在10%至20%的全身感染患者中可见，提示预后不良。目前治疗的金标准是更昔洛韦，但诸如缬更昔洛韦等新药似乎很有前景。EBV与一些移植后淋巴细胞增生性疾病病例有关，这是移植受者中严重EBV疾病的最大风险。HHV-6和HHV-7是两种相对较新发现的病毒，目前，关于这两种病原体的信息仍然相当有限。KS由HHV-8引起，HHV-8是最近发现的嗜淋巴细胞性HHV。医源性KS见于实体器官移植受者，根据患者的原籍国不同，患病率为0.5%至5%。HPV普遍存在，器官移植受者可能永远无法完全清除HPV感染，HPV感染是肾移植受者中最常见的复发性感染。移植受者中的HPV感染很重要，因为它与某些皮肤癌尤其是鳞状细胞癌的发生有关。定期监测、避免日晒和患者教育是管理策略的重要方面。
