Anderson D J, Jordan M C
Department of Medicine, University of Minnesota Medical School, Minneapolis.
Semin Respir Infect. 1990 Mar;5(1):38-49.
Viral pulmonary infections are a major cause of morbidity and mortality in solid organ transplant recipients. The herpes viruses-cytomegalovirus, herpes simplex virus, varicella zoster virus, and Epstein-Barr virus--cause most of the viral infections in this population. Respiratory syncytial virus, adenovirus, and human immunodeficiency virus also cause pneumonitis in the transplant recipient. Differences in the clinical and laboratory presentation of pneumonitis due to the various viral agents can provide clues to the etiology. However, definitive diagnosis requires laboratory identification of the virus or appropriate serologic changes. With cytomegalovirus, herpes simplex virus, Epstein-Barr virus, and adenovirus, one must take care to distinguish between asymptomatic shedding of the virus and disease produced by the virus. Advances in diagnostic techniques such as rapid antigen detection, nucleic acid hybridization, and gene amplification may allow an earlier diagnosis of viral pneumonia. Advances in risk reduction with appropriate pairing of donors and recipients, improved immunosuppressive regimens, vaccination, and prophylactic administration of antiviral agents may reduce the incidence of viral infection. Finally, advances in anti-viral therapy have made possible the successful treatment of pneumonia due to some of the viral agents.
病毒性肺部感染是实体器官移植受者发病和死亡的主要原因。疱疹病毒——巨细胞病毒、单纯疱疹病毒、水痘带状疱疹病毒和爱泼斯坦-巴尔病毒——导致该人群中的大多数病毒感染。呼吸道合胞病毒、腺病毒和人类免疫缺陷病毒也会在移植受者中引起肺炎。由各种病毒病原体引起的肺炎在临床和实验室表现上的差异可为病因提供线索。然而，明确诊断需要对病毒进行实验室鉴定或出现适当的血清学变化。对于巨细胞病毒、单纯疱疹病毒、爱泼斯坦-巴尔病毒和腺病毒，必须注意区分病毒的无症状排出和由病毒引起的疾病。快速抗原检测、核酸杂交和基因扩增等诊断技术的进步可能使病毒性肺炎的早期诊断成为可能。通过适当匹配供体和受体、改进免疫抑制方案、接种疫苗以及预防性使用抗病毒药物来降低风险方面的进展可能会降低病毒感染的发生率。最后，抗病毒治疗的进展使得成功治疗某些病毒病原体引起的肺炎成为可能。
