Discussion on varicella-zoster virus infection after solid organ transplantation
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摘要: 实体器官移植术后的相关感染是移植科医师在移植受体术后管理中所面临的重大挑战之一, 也是影响器官移植受体术后恢复的重要因素。水痘-带状疱疹病毒(VZV)在正常人群中有较高的感染率, 但其发病往往是亚临床、自愈性的。而在实体器官移植受体中, 其临床症状表现明显, 可导致受体生活质量降低、再入院率及经济压力增加、甚至影响移植物功能, 严重时可导致死亡。本文回顾国内外相关文献, 就VZV感染的流行病学特点及其发病风险因素, 器官移植后VZV感染的临床表现、诊断、治疗及预防做一综述, 以期为临床工作提供参考。
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表 1 VZV的实验室检测方法
Table 1. Laboratory testing methods of VZV
检测方法 优点 缺点 灵敏度 直接抗体荧光检测 快速、病毒特异性较高 灵敏度较低、需要细胞染色 82% VZV病毒PCR检测 灵敏度较高、各种标本均可检测 检测费用较高、检测技术要求高 95% 血清病毒培养 可检测病毒亚群、能够同时检测药物敏感性 培养耗时长、标本的储存及运输会影响结果 20% Tzanck涂片检查 快速、直接、可视 需要在新鲜病灶中取材、技术要求高、不能与疱疹病毒区别 低 病理学活组织检查 明确组织病变 有创操作、耗时长 48% 血清学检测 术前检测可明确移植术后感染风险 移植术后无检测意义 无 
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[1] COHEN JI.The varicella-zoster virus genome[J].Curr Top Microbiol Immunol, 2010, 342:1-14.DOI: 10.1007/82_2010_10. [2] COHRS RJ, HURLEY MP, GILDEN DH.Array analysis of viral gene transcription during lytic infection of cells in tissue culture with varicella-zoster virus[J].J Virol, 2003, 77(21):11718-11732. doi: 10.1128/JVI.77.21.11718-11732.2003 [3] SUENAGA T, SATOH T, SOMBOONTHUM P, et al.Myelin-associated glycoprotein mediates membrane fusion and entry of neurotropic herpesviruses[J].Proc Natl Acad Sci U S A, 2010, 107(2):866-871.DOI: 10.1073/pnas.0913351107. [4] METTENLEITER TC.Budding events in herpesvirus morphogenesis[J].Virus Res, 2004, 106(2):167-180. doi: 10.1016/j.virusres.2004.08.013 [5] SKRIPULETZ T, PARS K, SCHULTE A, et al.Varicella zoster virus infections in neurological patients:a clinical study[J].BMC Infect Dis, 2018, 18(1):238.DOI: 10.1186/s12879-018-3137-2. [6] MARIN M, GÜRIS D, CHAVES SS, et al.Prevention of varicella:recommendations of the Advisory Committee on Immunization Practices (ACIP)[J].MMWR Recomm Rep, 2007, 56(RR-4):1-40. https://www.ncbi.nlm.nih.gov/pubmed/8668119 [7] GOURISHANKAR S, MCDERMID JC, JHANGRI GS, et al.Herpes zoster infection following solid organ transplantation:incidence, risk factors and outcomes in the current immunosuppressive era[J].Am J Transplant, 2004, 4(1):108-115. doi: 10.1046/j.1600-6143.2003.00287.x [8] KIRNAP M, AKDUR A, AYVAZOĞLU SOY HE, et al.Prevalence and outcome of herpes zoster infection in renal transplant recipients[J].Exp Clin Transplant, 2015, 13 (Suppl 1):280-283. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=JJ0225070085 [9] 贺腾辉, 钱叶勇, 范宇, 等.单中心肾移植术后带状疱疹的相关危险因素分析[J].器官移植, 2017, 8(3):215-219.DOI: 10.3969/j.issn.1674-7445.2017.03.008.HE TH, QIAN YY, FAN Y, et al.Analysis of risk factors of herpes zoster after renal transplantation in a single center[J].Organ Transplant, 2017, 8(3):215-219.DOI: 10.3969/j.issn.1674-7445.2017.03.008. [10] PERGAM SA, FORSBERG CW, BOECKH MJ, et al.Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients[J].Transpl Infect Dis, 2011, 13(1):15-23.DOI: 10.1111/j.1399-3062.2010.00547.x. [11] MANUEL O, KUMAR D, SINGER LG, et al.Incidence and clinical characteristics of herpes zoster after lung transplantation[J].J Heart Lung Transplant, 2008, 27(1):11-16.DOI: 10.1016/j.healun.2007.09.028. [12] ARNESS T, PEDERSEN R, DIERKHISING R, et al.Varicella zoster virus-associated disease in adult kidney transplant recipients:incidence and risk-factor analysis[J].Transpl Infect Dis, 2008, 10(4):260-268. doi: 10.1111/tid.2008.10.issue-4 [13] ARVIN AM.Humoral and cellular immunity to varicella-zoster virus:an overview[J].J Infect Dis, 2008, 197(Suppl 2):S58-S60.DOI: 10.1086/522123. [14] LAUZURICA R, BAYÉS B, FRÍAS C, et al.Disseminated varicella infection in adult renal allograft recipients:role of mycophenolate mofetil[J].Transplant Proc, 2003, 35(5):1758-1759. doi: 10.1016/S0041-1345(03)00684-5 [15] LEUNG AK, KAO CP, SAUVE RS.Scarring resulting from chickenpox[J].Pediatr Dermatol, 2001, 18(5):378-380. doi: 10.1046/j.1525-1470.2001.01975.x [16] ROMMELAERE M, MARÉCHAL C, YOMBI JC, et al.Disseminated varicella zoster virus infection in adult renal transplant recipients:outcome and risk factors[J].Transplant Proc, 2012, 44(9):2814-2817.DOI: 10.1016/j.transproceed.2012.09.090. [17] JANTSCH J, SCHMIDT B, BARDUTZKY J, et al.Lethal varicella-zoster virus reactivation without skin lesions following renal transplantation[J].Nephrol Dial Transplant, 2011, 26(1):365-368.DOI: 10.1093/ndt/gfq542. [18] HOVENS MM, VAESSEN N, SIJPKENS YW, et al.Unusual presentation of central nervous system manifestations of varicella zoster virus vasculopathy in renal transplant recipients[J].Transpl Infect Dis, 2007, 9(3):237-240. doi: 10.1111/tid.2007.9.issue-3 [19] MIROUSE A, VIGNON P, PIRON P, et al.Severe varicella-zoster virus pneumonia:a multicenter cohort study[J].Crit Care, 2017, 21(1):137.DOI: 10.1186/s13054-017-1731-0. [20] GILDEN D, COHRS RJ, MAHALINGAM R, et al.Varicella zoster virus vasculopathies:diverse clinical manifestations, laboratory features, pathogenesis, and treatment[J].Lancet Neurol, 2009, 8(8):731-740.DOI: 10.1016/S1474-4422(09)70134-6. [21] PAPANICOLAOU GA, MEYERS BR, FUCHS WS, et al.Infectious ocular complications in orthotopic liver transplant patients[J].Clin Infect Dis, 1997, 24(6):1172-1177. doi: 10.1086/cid.1997.24.issue-6 [22] SAITOH H, TAKAHASHI N, NANJO H, et al.Varicella-zoster virus-associated fulminant hepatitis following allogeneic hematopoietic stem cell transplantation for multiple myeloma[J].Intern Med, 2013, 52(15):1727-1730. doi: 10.2169/internalmedicine.52.0118 [23] CHHABRA P, RANJAN P, BHASIN DK.Simultaneous occurrence of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient:a case report and review of literature[J].Perm J, 2017, 21.DOI: 10.7812/TPP/16-083. [24] ZUCKERMAN RA, LIMAYE AP.Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients[J].Am J Transplant, 2013, 13 (Suppl 3):55-66.DOI: 10.1111/ajt.12003. [25] LEGOFF J, PÉRÉ H, BÉLEC L.Diagnosis of genital herpes simplex virus infection in the clinical laboratory[J].Virol J, 2014, 11:83.DOI: 10.1186/1743-422X-11-83. [26] CORREA SIERRA CB, KOURÍ CARDELLÁ V, PÉREZ SANTOS L, et al.Herpesviruses excretion in saliva of pediatric transplant recipients[J].Transpl Infect Dis, 2017, 19(6).DOI: 10.1111/tid.12771. [27] MARTIN-GANDUL C, STAMPF S, HÉQUET D, et al.Preventive strategies against cytomegalovirus and incidence of α-herpesvirus infections in solid organ transplant recipients:a nationwide cohort study[J].Am J Transplant, 2017, 17(7):1813-1822.DOI: 10.1111/ajt.14192. -
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