Opportunistic infections after transplantation continue to constitute a challenge for management (table 7.8). Cytomegalovirus (CMV) remains the most important infection affecting heart transplant recipients. In the prevention of CMV disease, those at risk of primary disease (donor seropositive, recipient seronegative) should receive prophylaxis."54 In many units, oral ganciclovir is now the preferred route of prophylactic treatment. To monitor activity of CMV infection, assessment of viral load has become a valuable tool. Legionella pneumophila may cause pneumonia of variable severity after cardiac transplantation. Chlorination and heating of water is an important preventive measure. Specific cultures in outbreak situations should be considered to identify less frequent L pneumophila serotypes and the non-pneumophila Legionella species."55 Pneumocystis carinii pneumonia,"56 tuberculosis,"57 toxoplasmosis,"58 pulmonary aspergillosis,"59 and other fungal infections "60 "61 continue to constitute challenges for the immunocompromised heart transplant recipient. Sulfamethoxazole/ trimethoprine is used in most units for P carinii pneumonia prophylaxis.
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