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Emerging Viral Infections in Blood <strong>and</strong> Marrow<br />

Transplant Recipients: Focus on Respiratory Syncytial<br />

Virus<br />

Estella Whimbey<br />

The University of Texas M.D. Anderson Cancer Center, Houston, TX<br />

ABSTRACT<br />

The spectrum of viruses causing disease in <strong>blood</strong> <strong>and</strong> <strong>marrow</strong> transplant<br />

recipients has exp<strong>and</strong>ed rapidly in the last decade. Caring for patients with polyviral<br />

infections has become the norm. Among the emerging viruses are herpesviruses<br />

other than cytomegalovirus (CMV), HSV, <strong>and</strong> VZV, such as Epstein-Barr virus<br />

(EBV) <strong>and</strong> human herpes virus (HHV)-6; parvovirus B 19; polyomaviruses (BKV,<br />

JCV); <strong>and</strong> multiple hepatitis viruses <strong>and</strong> gastroenteritis viruses. Opportunistic<br />

infections with these viruses are associated with a broad scope of clinical illnesses,<br />

including acute <strong>and</strong> chronic central nervous system disorders with HHV-6 <strong>and</strong> JCV;<br />

cytopenias with parvovirus B 19 <strong>and</strong> HHV-6; <strong>and</strong> lymphoproliferative disorders<br />

with EBV. Also emerging are the Community Respiratory Viruses: respiratory<br />

syncytial virus (RSV), parainfluenza viruses, influenza viruses, rhinoviruses,<br />

adenoviruses, echoviruses, <strong>and</strong> coxsackieviruses. The respiratory illnesses caused<br />

by these viruses range from self-limited upper respiratory illnesses to fatal<br />

pneumonias depending largely on the type of virus <strong>and</strong> type, degree, <strong>and</strong> duration of<br />

the underlying immunodeficiency. RSV has been associated with an exceptionally<br />

high frequency of fatal viral pneumonia. Some of the community respiratory<br />

viruses, such as influenza, adenoviruses, echoviruses, <strong>and</strong> coxsackiesvirus, cause a<br />

wide range of nonrespiratory clinical syndromes as well. Sophisticated diagnostic<br />

research tools are gradually being integrated into the clinical diagnostic laboratories,<br />

<strong>and</strong> clinical investigations are being undertaken to define the sensitivity <strong>and</strong><br />

specificity of these assays <strong>and</strong> to distinguish shedding of virus from disease. The<br />

need for more effective, less toxic, less costly, <strong>and</strong> easier-to-administer antiviral<br />

drugs has become apparent, as has the need for the routine availability of antiviral<br />

susceptibility testing. Since many of these emerging infections are highly<br />

communicable, infection control strategies are being redefined.<br />

708

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