Infectious complications of acute and chronic GVHD.
Immune defects prolonged by treatment regimens for graft-versus-host disease (GVHD) include cell-mediated immunity and hypogammaglobulinemia. Infections have become increasingly important during GVHD therapy, paradoxically because the success of immunosuppressive practice has led to improved survival. Infections originate from both endogenous and exogenous sources. Regimens for prevention of infection include: (a) continued surveillance monitoring for infections with reliable diagnostic testing, and (b) antimicrobial prophylaxis for those pathogens without markers that could be followed for surveillance. Repeated episodes of the same infection, diagnosis of a new life-threatening infection, or specific underlying hematologic diagnoses should prompt a look for gross immunoglobulin deficiency that could be corrected in the short term by immunoglobulin therapy. At times, measurement of CD4+ lymphocyte counts will assist in determining whether augmented prophylaxis is warranted. Since their efficacy may be limited, vaccine injections are not given during the immunosuppression associated with GVHD therapy, with the exception of influenza.
Young
Jo-Anne H
JA
Division of Infectious Disease and International Medicine, Department of Medicine of the University of Minnesota, MMC 250, 420 Delaware Street SE Minneapolis, MN 55455, USA. vanbu004@umn.edu
D000890:Anti-Infective Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000276:immunology* / Q000382:microbiology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D009894:Opportunistic Infections / Q000517:prevention & control*; D014611:Vaccination; D014777:Virus Diseases / Q000517:prevention & control; D017735:Virus Latency
D000890:Anti-Infective Agents; D000998:Antiviral Agents