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Simon M. Fox

, Angela M. Minassian

, Thomas Rawlinson

, and Brian J. Angus

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date: 04 August 2020

Viral infections are particularly important in the immunocompromised and are a leading cause of death in solid organ transplantation and haematopoietic stem cell transplantation. They represent a particular challenge to the clinician as they can present non-specifically, disease can progress rapidly, and treatment options have variable efficacy. Two further important features of viral infection contribute to their significance. The first is the ability of some viruses (particularly the human herpesviruses) to establish latency and reactivate in circumstances of reduced immune suppression. This makes viruses such as Cytomegalovirus, Epstein–Barr virus, herpes simplex virus, and varicella zoster virus key pathogens in the immunocompromised. The second feature is the association between certain viruses and the development of malignancy (e.g. Epstein–Barr virus and human papilloma viruses). The oncogenic potential of these infections and the failure of immune surveillance is exacerbated in the immunocompromised.

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