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NUEVAS RECOMENDACIONES EN LA PREVENCION DE INFECCIONES OPORTUNISTAS ENTRE RECEPTORES DE TRASPLANTES DE CELULAS MADRE HEMATOPOYETICAS

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Se destaca la importancia de la prevención con aciclovir en pacientes con Herpes simplex, la utilidad del ganciclovir en la profilaxis del citomegalovirus, el uso de fluconazol para combatir la candidiasis, la profilaxis con TMP-SMZ en la neumonía por Pneumocystis y el esquema de vacunación a seguir en pacientes que reciben trasplantes.
dykewicz.jpg Autor:
Clare a. Dykewicz
Columnista Experto de SIIC
Artículos publicados por Clare a. Dykewicz
Recepción del artículo
6 de Agosto, 2003 		Aprobación
9 de Septiembre, 2003
Primera edición
6 de Noviembre, 2003 		Segunda edición, ampliada y corregida
7 de Junio, 2021

NUEVAS RECOMENDACIONES EN LA PREVENCION DE INFECCIONES OPORTUNISTAS ENTRE RECEPTORES DE TRASPLANTES DE CELULAS MADRE HEMATOPOYETICAS

Resumen
Las "Recomendaciones para la prevención de infecciones oportunistas en receptores de trasplantes de células madre hematopoyéticas", publicadas por los CDC (Centers for Disease Control and Prevention) y la American Society for Blood and Marrow Transplantation de los EE.UU. en 2000, proveen recomendaciones basadas en la evidencia para evitar infecciones entre los pacientes con trasplante de células madre hamatopoyéticas (TCMH). Las recomendaciones clave incluyen la administración de (1) aciclovir a todos los pacientes seropositivos para virus Herpes simplex con trasplante alogénico de TCMH, como prevención de la reactivación del HSV durante el período temprano posterior al trasplante; (2) profilaxis con ganciclovir o terapia preventiva a todos los pacientes con trasplante alogénico de TCMH con riesgo de contraer enfermedad por citomegalovirus desde el día del injerto hasta el día 100 posterior al trasplante; (3) 400 mg por día de fluconazol vía oral o intravenosa para la prevención de infección por especies de Candida susceptibles a dicho antibiótico en receptores alogénicos de TCMH; y (4) profilaxis para la neumonía por Pneumocystis a todos los pacientes con TCMH durante todos los períodos de inmunocompromiso luego del injerto. Las pautas también recomiendan la vacunación contra difteria, tétanos, tos convulsa o tétanos difteria; polio; H. influenzae y hepatitis B en estos pacientes a los 12, 14 y 24 meses postrasplante. La vacunación contra sarampión, paperas y rubéola debe retrasarse hasta cumplidos los 24 meses del trasplante y se debe reservar para pacientes que se supone que son inmunocompetentes. Se recomienda en receptores de TCMH la administración de por vida en forma anual de la vacuna inactiva contra la gripe.

Palabras clave
Trasplante de células madre hematopoyéticas, infecciones oportunistas, infección por citomegalovirus, infección por virus Herpes simplex


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UPDATE ON THE GUIDELINES FOR PREVENTING OPORTUNISTIC INFECTIONS AMONG HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS

Abstract
The "Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients," published in 2000 by the Centers for Disease Control and Prevention (CDC) and the American Society for Blood and Marrow Transplantation, provides evidence-based recommendations for preventing infections among hematopoietic stem cell transplant (HSCT) recipients. Key recommendations include administering 1) acyclovir to all herpes simplex virus (HSV)-seropositive allogeneic HSCT recipients to prevent HSV reactivation during the early post-transplant period, 2) ganciclovir prophylaxis or pre-emptive therapy to all allogeneic HSCT recipients at risk for cytomegalovirus disease from engraftment to day +100 post-HSCT, 3) fluconazole 400 mg/day po. or i.v. to prevent infection from fluconazole-susceptible Candida species in allogeneic HSCT recipients, and 4) prophylaxis for Pneumocystis pneumonia to all allogeneic HSCT patients throughout all periods of immunocompromise after engraftment. The guidelines also recommend giving diphtheria, tetanus, acellular pertussis or tetanus-diphtheria; inactivated polio; H. influenzae; and hepatitis B vaccines to HSCT recipients at 12, 14, and 24 months post-HSCT. Administration of the measles, mumps, rubella vaccine should be delayed until 24 months post-HSCT and should be reserved for HSCT recipients who are presumed immunocompetent. Lifelong seasonal administration of inactivated influenza vaccine is recommended for HSCT recipients.

Key words
Trasplante de células madre hematopoyéticas, infecciones oportunistas, infección por citomegalovirus, infección por virus Herpes simplex


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Especialidades
Principal: Infectología
Relacionadas: Epidemiología, Hematología, Medicina Interna, Salud Pública



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Bibliografía del artículo
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