[Infections in heart transplantations]

Infections are one of the most important problems in heart transplants recipients: they are responsible for half total mortality within one year after surgery and one third of mortality during the following period. Underlying medical illness of the host, lack of specific immunity, prior colonization are conditions that may contribute to infections after surgery: immunosuppression to contrast rejection or due to Cytomegalovirus (CMV) infection are other factors favoring infections. Lung infections are most frequent. During the first month after surgery microorganisms responsible are the same found in cardiosurgery patients, staphylococci and gram negative, and occasionally herpes simplex virus (ESV) reactivated infections occur. From the second to the sixth month most of the CMV and Toxoplasma infections occur, with some Pneumocystis and mycotic events. Both are so frequent that in a seronegative host a specific prophylaxis against CMV and Toxoplasma is regularly recommended. The very late period more than six month after surgery is characterized by common infections seen in any population, that may present in altered or more severe fashion due to immune suppression. Another late event is cryptococcal meningitis.