Hautinfektionen nach Transplantation

Abstract

Skin infections after transplantation are frequent and of special importance because they may be quite severe. The spectrum of dermatologic infections in transplant recipients includes bacterial, mycotic and viral diseases. Pyoderma, herpes virus 6/7, herpes simplex virus, varicella-zoster virus, cytomegalovirus and candida infections predominate. Rare pathogens must be also considered. Cutaneous infections can be divided into three phases following transplantation. Diagnosis and adequate early therapy together with specific prophylaxis and follow-up of transplant patients should be strived for to avoid life-threatening complications.

Skin Changes Following Organ Transplantation

“…In addition to the common fungal infections of the nails and the soles of the feet that are also seen in immunocompetent persons, transplant patients often suffer from pityriasis versicolor-a harmless condition in itself-and mucocutaneous candidiasis (29). The latter most often arises in the first year after transplantation or after treatment for tissue rejection (28). Systemic mycoses are an important clinical complication of immunosuppression, and primary pulmonary infections with Aspergillus spp.…”

“…Attenuation of the T-cellmediated immune response by immunosuppression favors not only the development of tumors (as discussed above), but also the invasion and dissemination of atypical, unusually severe clinical variants of skin infection. In immunosuppressed patients, infections with rare pathogens play a larger role in the differential diagnosis of skin infections (28).…”

“…Temporary increases in the steroid dose to treat rejection reac- Dermato-oncologic criteria for patient evaluation before transplantation cytology and histology, enables the timely and specific diagnosis of many types of fungal pneumonia (29). Immunosuppressed patients are also characterized by the more common occurrence of otherwise rare mycoses, including infections wtih Mucor spp., Alternaria spp., and pheohyphomycetes, and even disseminated cryptococcosis (28). It should be borne in mind that drugs given systemically to combat dermatomycoses may interact with immunosuppressant drugs (28).…”

“…Immunosuppressed patients are also characterized by the more common occurrence of otherwise rare mycoses, including infections wtih Mucor spp., Alternaria spp., and pheohyphomycetes, and even disseminated cryptococcosis (28). It should be borne in mind that drugs given systemically to combat dermatomycoses may interact with immunosuppressant drugs (28).…”

“…Among transplant patients who are not taking vala-/ganciclovir for cytomegalovirus (CMV) prophylaxis, reactivation of herpes simplex viruses (HSV) and varicella-zoster virus (VZV) occurs in 0-30% of patients within 6 months (29). Clinical episodes of HSV and VZV reactivation closely resemble those seen in immunocompetent persons if the transplantation took place long ago, but reactivations in the setting of high-dose immunosuppression-in the first few weeks after transplantation, or during treatment for rejection reactions-tend to produce larger, sometimes necrotizing lesions (28,29). VZV or HSV infection, especially primary infection, may spread systemically to cause potentially fatal pneumonia, vasculitis, hepatitis, or encephalitis; this danger can be lessened by timely and appropriate virostatic treatment (29).…”