Darrigo Luiz Guilherme, de Sant'Anna Carvalho Alexandre Machado, Machado Clarisse Martins
Bone Marrow Transplant Unit - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Virology Laboratory - Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - 2nd floor, São Paulo, SP, 05403-000, Brazil.
Curr Infect Dis Rep. 2018 Mar 17;20(4):5. doi: 10.1007/s11908-018-0612-2.
Describe the characteristics of chikungunya, dengue, and Zika in transplant recipients and immunocompromised hosts.
Stem cell/bone marrow grafts, organs, and blood transfusions can transmit CHIKV/DENV/ZIKV infections, which are clinically similar, resembling influenza-like illness. Laboratory confirmation is necessary. In the acute phase, RT-PCR is preferred. DENV and ZIKV serology may cross-react. Delayed engraftment and extended viruria is observed in ZIKV+/HSCT recipients, while longer viremia is observed in DENV+/HSCT patients. Arbovirus persistence in organ tissues is generally unknown. Vaccine development is in early stages for CHIKV/ZIKV. No data is available to recommend the licensed DENV vaccine in transplant recipients. In endemic areas, the assessment of epidemiological risk is mandatory. Donor deferral for 120 days in suspected or confirmed ZIKV+ has been recommended, while CHIKV+ donors should wait 30 days. No deferral is recommended for DENV+ donors. CHIKV/DENV/ZIKV tests should be included in the differential of febrile neutropenia and other transplant syndromes. Reassessment of DENV serology is urgently needed. Prospective studies are necessary to determine the impact of CHIKV/DENV/ZIKV in this special population.
描述基孔肯雅病毒、登革热病毒和寨卡病毒在移植受者和免疫功能低下宿主中的特征。
干细胞/骨髓移植、器官移植及输血可传播基孔肯雅病毒/登革热病毒/寨卡病毒感染，这些感染在临床上相似，类似流感样疾病。实验室确诊很有必要。急性期，逆转录聚合酶链反应（RT-PCR）为首选检测方法。登革热病毒和寨卡病毒血清学检测可能会出现交叉反应。寨卡病毒阳性的造血干细胞移植（HSCT）受者中观察到植入延迟和病毒尿期延长，而登革热病毒阳性的HSCT患者中观察到病毒血症持续时间更长。虫媒病毒在器官组织中的持续存在情况通常未知。基孔肯雅病毒/寨卡病毒的疫苗研发尚处于早期阶段。尚无数据支持在移植受者中推荐使用已获许可的登革热疫苗。在流行地区，必须评估流行病学风险。对于疑似或确诊寨卡病毒阳性的供者，建议推迟120天，而基孔肯雅病毒阳性的供者应等待30天。对于登革热病毒阳性的供者，不建议推迟。基孔肯雅病毒/登革热病毒/寨卡病毒检测应纳入发热性中性粒细胞减少症及其他移植综合征的鉴别诊断。迫切需要重新评估登革热病毒血清学。有必要开展前瞻性研究以确定基孔肯雅病毒/登革热病毒/寨卡病毒对这一特殊人群的影响。
