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KEY CONCEPTS

  • Viral infections caused by herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus, and human herpesvirus 6, can reactivate in immunosuppressed patients and lead to increased morbidity and mortality.

  • Cutaneous HSV and VZV infections have characteristic appearances on physical examination, and confirmation can be obtained with polymerase chain reaction–based molecular assays. Treatment of patients with severe HSV and VZV infections requires the use of intravenous treatment dose of acyclovir, and if started early, it may reduce serious complications.

  • CMV reactivation has varied clinical presentations in patients with hematologic malignancies and hematopoietic cell transplantation (HCT) recipients. Specific viral loads thresholds trigger initiation of antiviral therapy to prevent end-organ disease and serious complications.

  • Adenovirus infections can range from upper respiratory tract infection, pneumonia, gastrointestinal infections, or asymptomatic viremia. Treatment is indicated in immunocompromised patients, such as HCT recipients, with disseminated disease. Cidofovir is the only commercially available agent with in vitro activity against adenoviruses.

  • Community respiratory viral infections are commonly diagnosed in patients with cancer and are associated with increased morbidity and mortality in immunosuppressed patients in particular.

  • Hepatitis B and C viral infections are common in certain parts of the world. Patients with cancer should undergo testing for both viruses before chemotherapy. Prevention of hepatitis B with entecavir or tenofovir is recommended in high-risk patients to prevent fulminant liver failure. Hepatitis C is treated with intent to cure and can be postponed until after chemotherapy.

INTRODUCTION

Viral infections are an important cause of morbidity and mortality in patients with cancer, specifically among patients with hematologic malignancies or recipients of hematopoietic cell transplantation (HCT). Patients with cancer with viral infections may have longer hospitalizations and delays in cancer-related treatment such as chemotherapy, surgery, or radiation. DNA viruses, such as herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV), are well known to cause serious infections in patients with hematologic malignancies or after HCT, resulting in intense monitoring and prophylaxis directed against such viruses.1 Respiratory viral infections are also common among patients with cancer; these include infections related to adenovirus, influenza, parainfluenza, respiratory syncytial virus (RSV), rhinovirus, human coronavirus (HCoV), and human metapneumovirus (hMPV).2 Modern tools of diagnosis can quickly identify viral pathogens, but treatment options are limited for many of these infections. This chapter provides an overview of viral infections in patients with cancer. Special focus is placed on those with hematologic malignancies and HCT recipients because this population is uniquely susceptible to viral infections.

HUMAN HERPESVIRUSES

Infections related to human herpesviruses (HHVs) are common among patients with cancer.3 Morbidity and mortality from these viruses are high among immunosuppressed patients. Herpesviruses are double-stranded DNA viruses. The herpesvirus group has eight members, six of which are important pathogens in immunosuppressed patients (ie, patients with hematologic malignancies, solid-organ or stem cell transplant recipients).4,5 This group of pathogens includes HSV ...

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