Abstract
Immunosuppressed patients are at risk of severe herpesvirus infections. Herpes simplex (HSV), varicellazoster (VZV) and Epstein-Barr virus (EBV) infections are associated with characteristic syndromes in this population. Typically I-ISV and VZ:V infections cause mucocutaneous lesions; diagnosis is usually con finned by tissue culture or nuorescent microscopy. The availability of effective antiviral agents, and accurate techniques for laboratory diagnosis have improved the management of I-ISV and VZ:V infections. Antibody assays to demonstrate I-ISVorVZ:V infections are of limited value in immunocompromised patients, because the presence of antibodies does not indicate a decreased risk for HSV, varicella or zoster, but indicates susceptibility for reactivated infection. EBV is associated with lymphoproliferative disorders in transplant recipients. Infection of lymphocytes by EBV is a necessary step in achieving B cell transformation and immortalization. The lack of immunosurveillance against EBV-transformed B cells predisposes patients to developing invasive infiltration of transformed B cells . Diagnostic methods for EBV infections include lymphocyte transfom1ation, serology, and detection of DNA by direct hybridization or by DNA amplification. Quantitative oropharyngeal EBV shedding is a good marker for the development of lymphoproliferative disease in transplant recipients. Patients experiencing primary EBV infection are at the highest risk for lymphoproliferative disorders. Prophylactic antiviral therapy may be of benefit in preventing EBV replication and therefore in decreasing the risk for lymphoproliferation.