Dr. Aruna Subramanian answers some frequently asked questions about infectious diseases. As Co-Director of the Johns Hopkins Transplant Infectious Disease team, Dr. Subramanian heads up a fulltime clinical service of four dedicated professionals. The purpose of the Transplant Infectious Disease clinical service is to educate patients and staff on the prevention, treatment and impact of infectious diseases within the Johns Hopkins transplant community. |
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What is Cytomegolovirus or CMV?
"Cytomegolovirus" is a virus that causes various infections in the post transplant period. CMV usually causes fever, fatigue, and can suppress your white blood cell count. It can also affect various organs in your body, especially your transplanted organ. Some people can get pneuomonitis (lung), hepatitis (liver), gastroenteritis (diarrhea) from it.
When does Johns Hopkins first begin to educate patients about CMV?
Most people do not know about CMV because it usually does not cause major infections among individuals who are not immunosuppressed. At the time of transplant evaluation, the transplant team orders labwork that screens for any medical issues (including CMV) that may require treatment before, during or after the transplant process. Before your transplant team orders these tests, your coordinator will review with you what labwork is required and will answer all of your questions.
How does a transplant patient get CMV infection?
A transplant recipient who has never been exposed to the virus, for example, children or CMV seronegative adults (adults whose blood tests negative for CMV) can get primary CMV from: 1) exposure to others with active CMV infection 2) blood products that have not been treated to remove CMV (Johns Hopkins and many other hospitals use safe blood which should not contain CMV) or 3) the transplanted organ they receive if the donor carried CMV (Johns Hopkins tests all donor organs for the presence of CMV.) Transplant recipients who have previously been exposed to the virus develop active CMV infection when the virus they carry becomes activated. This can happen after transplant because the patient’s immune system is suppressed from the medications given to prevent or treat rejection.
How does Johns Hopkins protect transplant patients’ health from active CMV infection?
CMV can be prevented in patients who are at high risk for primary infection or reactivation with either an IV medication called ganciclovir or an oral medicine called valganciclovir (Valcyte). Without these medicines CMV disease is most common in the first 6 months after transplant, or following treatment for an episode of rejection. The oral medication is often given for 3 to 6 months after transplant or for a few months after treatment for severe rejection. Active CMV disease is treated with higher doses of the same medicines. It is important to continue high doses of the medicines until there is no CMV found in the blood.
Immunizations against the flu and other infections are important, but remember - transplant recipients can not accept any live vaccines. Live vaccines may trigger infections in people who are taking immunosuppression medications. For this reason, you can not accept the nasal flu mist; it is a live vaccine. If you are not sure if the vaccine is a live one, just ask. One of the best preventions for infections this - or any - season is to WASH YOUR HANDS REGULARLY. This simple act can help you and your loved ones avoid any number of infections. |
