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A case of severe pneumonia with viremia caused by adenovirus B7 identified by off-label use of a multiplex PCR system. IDCases 2020; 23:e01011. [PMID: 33304812 PMCID: PMC7718441 DOI: 10.1016/j.idcr.2020.e01011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Severe infection with human adenovirus (HAdV) is uncommon in adults, and the lack of reliable point-of-care testing makes the diagnosis challenging. A 39-year-old immunocompetent Indian man developed severe pneumonia, and his condition became life-threatening despite antimicrobial therapy. While sputum and blood cultures remained negative, a multiplex PCR respiratory panel (Filmarray Respiratory Panel), which is only approved for use with nasopharyngeal samples, detected HAdV in the serum and tracheal aspirates on day 5. We therefore initiated ganciclovir, steroids, and intravenous immunoglobulin. The patient's respiratory condition improved significantly, and he eventually recovered without complications. We later confirmed that conventional PCR of serum detected HAdV-B7. Our case illustrated that a respiratory panel using multiplex PCR successfully detected HAdV in unapproved samples. Such off-label analyses may support the early diagnosis of infections caused by pathogens that are difficult to identify by routine microbiological examination.
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Di Ciaccio PR, Avdic S, Sutrave G, Clancy L, Withers B, Blyth E, McLeod D, Gottlieb DJ. Successful treatment of CMV, EBV, and adenovirus tissue infection following HLA-mismatched allogeneic stem cell transplant using infusion of third-party T cells from multiple donors in addition to antivirals, rituximab, and surgery. Transpl Infect Dis 2020; 23:e13528. [PMID: 33236399 DOI: 10.1111/tid.13528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/18/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
Viral infections, principally cytomegalovirus, Epstein Barr virus (EBV) and adenovirus, are a leading cause of morbidity and mortality after allogeneic stem cell transplantation. The use of systemic antivirals is limited by limited efficacy and organ toxicities. Inability to clear infection is exacerbated by transplant-related immunosuppression and prophylaxis or treatment of acute graft versus host disease. We report the first patient to clear three serious viral infections after stem cell transplant using third-party donor partially human leukocyte antigen (HLA) matched virus-specific cytotoxic T cells. The patient, a 53 year old female with transplanted for relapsed leukemia, with severe graft versus host disease received five T cell infusions from three separate donors that ultimately cleared serious systemic infections with cytomegalovirus and adenovirus, and an EBV-driven lymphoma. Systemic antivirals had resulted in failed clinical responses. Use of repeated infusions of partially HLA matched virus-specific T cells from banks containing cryopreserved cells should be strongly considered in transplant recipients with single or multiple refractory viral infections.
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Affiliation(s)
| | - Selmir Avdic
- Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - Gaurav Sutrave
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - Leighton Clancy
- Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - Barbara Withers
- Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - Emily Blyth
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia
| | - Duncan McLeod
- Department of Pathology, Westmead Hospital, Sydney, NSW, Australia
| | - David J Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Stem Cell Transplant and Cell Therapies Program, Westmead Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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53
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Thomas SJ, Young RT, Steinbach WJ, Lugo DJ. Risks and outcomes of adenovirus disease in pediatric hematopoietic stem cell transplant recipients-Comparison of current antiviral treatment options. Transpl Infect Dis 2020; 23:e13505. [PMID: 33174293 DOI: 10.1111/tid.13505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenovirus disease (ADVd) is a significant burden in pediatric hematopoietic stem cell transplant (HSCT) recipients. However, current knowledge of risk factors associated with poor clinical outcome and the effectiveness of antiviral therapy are not well understood. This study determined the relationship between transplant characteristics and risk of ADVd and also compared time to resolution of disease between pediatric patients who did and did not receive antiviral therapy. METHODS We conducted a retrospective, single-center cohort study of pediatric patients undergoing HSCT at Duke University (2005-2016). Cases of ADVd were defined a priori using a classification tool. Cox proportional hazards (CPH) regression models were used to compare the hazard of ADVd between HSCT recipients differing by type of transplant and type of conditioning regimen. The hazard of time to resolution of ADVd by antiviral therapy (cidofovir, brincidofovir, both, or neither) was compared. RESULTS Ninety-three of 830 subjects had ADVd post-HSCT (11.2%). Umbilical cord transplant (UCT) recipients had 2.30 (95% CI 1.57, 6.90, P = .002) higher hazard of developing ADVd compared to non-cord allogeneic transplants, and 6.30 higher (95% CI 2.70, 19.61, P < .001) hazard compared to autologous transplants. Subjects who did not receive antiviral therapy experienced earlier resolution of ADVd compared to subjects who received therapy, even after adjusting for subjects with disseminated disease (HR [95% CI]: 3.75 [1.57, 8.93], P = .003). CONCLUSIONS Pediatric UCT recipients are at a higher risk for ADVd. Antiviral therapy was not associated with an earlier resolution of ADVd, even in patients with higher disease burden.
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Affiliation(s)
- Sanya J Thomas
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca T Young
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - William J Steinbach
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Pediatric Immunocompromised Host Program, Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Debra J Lugo
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Pediatric Immunocompromised Host Program, Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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54
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Laracy JC, Verna EC, Pereira MR. Antivirals for COVID-19 in Solid Organ Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2020; 7:355-365. [PMID: 33101837 PMCID: PMC7575337 DOI: 10.1007/s40472-020-00304-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To evaluate the critical studies published so far on the most promising antiviral therapies for COVID-19, with particular emphasis on any solid organ transplant-specific information. RECENT FINDINGS Although the literature is increasing exponentially, most clinical trials have been preliminary, thus lacking robust evidence to support many of the drugs discussed here. The main exception is remdesivir, for which several trials have been published supporting its use for patients with severe COVID-19. No solid organ transplant-specific data on remdesivir or other antiviral therapies have been published so far. SUMMARY While further studies are urgently needed, in particular those specific to solid organ transplant recipients, the evidence so far only supports the use of remdesivir for patients with severe COVID-19.
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Affiliation(s)
- Justin C. Laracy
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, 622 W 168th St PH 876 W, New York, NY 10032 USA
| | - Elizabeth C. Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY USA
| | - Marcus R. Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, 622 W 168th St PH 876 W, New York, NY 10032 USA
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55
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Saha B, Parks RJ. Recent Advances in Novel Antiviral Therapies against Human Adenovirus. Microorganisms 2020; 8:E1284. [PMID: 32842697 PMCID: PMC7563841 DOI: 10.3390/microorganisms8091284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 12/27/2022] Open
Abstract
Human adenovirus (HAdV) is a very common pathogen that typically causes minor disease in most patients. However, the virus can cause significant morbidity and mortality in certain populations, including young children, the elderly, and those with compromised immune systems. Currently, there are no approved therapeutics to treat HAdV infections, and the standard treatment relies on drugs approved to combat other viral infections. Such treatments often show inconsistent efficacy, and therefore, more effective antiviral therapies are necessary. In this review, we discuss recent developments in the search for new chemical and biological anti-HAdV therapeutics, including drugs that are currently undergoing preclinical/clinical testing, and small molecule screens for the identification of novel compounds that abrogate HAdV replication and disease.
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Affiliation(s)
- Bratati Saha
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Robin J. Parks
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Matar AJ, Yoon JC, Mehta AK, Phadke VK, Guarner J, Greer AM, Lo DJ, Magliocca JF, Kitchens WH. Adenovirus causing hepatic abscess formation and unexplained fever in adult liver transplant recipients. Transpl Infect Dis 2020; 23:e13435. [PMID: 32748558 DOI: 10.1111/tid.13435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
Adenovirus infection is commonly associated with self-limited respiratory and gastrointestinal illnesses. However, infection in immunocompromised individuals, such as transplant recipients, can cause severe life-threatening illness including pneumonitis, hemorrhagic cystitis, nephritis, hepatitis, and enterocolitis. In orthotopic liver transplant recipients, adenovirus viremia can cause hepatitis leading to marked transaminitis, allograft loss, and death. Although hepatic abscesses mediated by adenovirus have been described in other immunosuppressed patient populations, it has very rarely been described in liver transplant recipients. Here, we report two adult cases of hepatic abscesses following liver transplantation secondary to adenovirus infection and describe the successful treatment of these patients. Adenovirus should be considered as an uncommon etiology of hepatic abscess and unexplained fevers in adults following liver transplantation.
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Affiliation(s)
- Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jane C Yoon
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Aneesh K Mehta
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Varun K Phadke
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeannette Guarner
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashley M Greer
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
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57
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Disseminated infection with novel human adenovirus (genotype 79) following allogeneic hematopoietic stem cell transplantation. Ann Hematol 2020; 100:2421-2422. [PMID: 32556545 DOI: 10.1007/s00277-020-04151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
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58
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Abstract
BACKGROUND Several evidence-based guidelines for the management of children with febrile neutropenia (FN) have been published, with special focus in bacterial and fungal infections. However, the role of acute respiratory infections caused by respiratory viruses (RV) has not been clearly established. The aim of this study was to evaluate the epidemiology, clinical presentation and outcome of acute respiratory infections in children with FN. METHODS Patients, <18 years of age admitted to the Pediatric Oncology-Hematology Unit after developing FN between November 2010 and December 2013, were prospectively included in the study. Children were evaluated by clinical examination and laboratory tests. Nasopharyngeal sample was obtained for detection of RV. RESULTS There was a total of 112 episodes of FN in 73 children admitted to the hospital during a 32-month period. According to disease severity, 33% of the episodes were considered moderate or severe. Rhinovirus was the most frequently detected RV (66.6%; 24/36), followed by parainfluenza. On regard to clinical outcome, RV-infected children developed fewer episodes of moderate or severe FN compared with non-RV infected children (16.7% vs. 33.3%; P = 0.08). CONCLUSIONS A great proportion of children with FN admitted to a tertiary hospital had a RV isolation. The rate of this RV isolation was significantly higher when a rapid molecular test was used compared with conventional microbiologic methods. Rhinovirus was the most frequently isolated, although its role as an active agent of acute infection was not clear. Children with FN and a RV isolate had a lower rate of severe disease.
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59
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Papanicolaou GA, Dvorak CC, Dadwal S, Maron G, Prasad VK, Giller R, Abdel-Azim H, Sadanand A, Casciano R, Chandak A, Huang S, Nichols G, Brundage T, Vainorius E, Mozaffari E, Hutcheson R. Practice patterns and incidence of adenovirus infection in allogeneic hematopoietic cell transplant recipients: Multicenter survey of transplant centers in the United States. Transpl Infect Dis 2020; 22:e13283. [PMID: 32267590 DOI: 10.1111/tid.13283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Adenovirus (AdV) is increasingly recognized as a threat to successful outcomes after allogeneic hematopoietic cell transplantation (allo-HCT). Guidelines have been developed to inform AdV screening and treatment practices, but the extent to which they are followed in clinical practice in the United States is still unknown. The incidence of AdV in the United States is also not well documented. The main objectives of the AdVance US study were thus to characterize current AdV screening and treatment practices in the United States and to estimate the incidence of AdV infection in allo-HCT recipients across multiple pediatric and adult transplant centers. METHODS Fifteen pediatric centers and 6 adult centers completed a practice patterns survey, and 15 pediatric centers and four adult centers completed an incidence survey. RESULTS The practice patterns survey results confirm that pediatric transplant centers are more likely than adult centers to routinely screen for AdV, and are also more likely to have a preemptive AdV treatment approach compared to adult centers. Perceived risk of AdV infection is a determining factor for whether routine screening and preemptive treatment are implemented. Most pediatric centers screen higher-risk patients for AdV weekly, in blood, and have a preemptive AdV treatment approach. The incidence survey results show that from 2015 to 2017, a total of 1230 patients underwent an allo-HCT at the 15 pediatric transplant centers, and 1815 patients underwent an allo-HCT at the 4 adult transplant centers. The incidences of AdV infection, AdV viremia, and AdV viremia ≥ 1000 copies/mL within 6 months after the first allo-HCT were 23%, 16%, and 9%, respectively, for patients at pediatric centers, and 5%, 3%, and 2%, respectively, for patients at adult centers. CONCLUSIONS These findings provide a more recent estimate of the incidence of AdV infection in the United States, as well as a multicenter view of practice patterns around AdV infection screening and intervention criteria, in pediatric and adult allo-HCT recipients.
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Affiliation(s)
| | | | | | - Gabriela Maron
- St Jude Children's Research Hospital Infectious Diseases Department, Memphis, TN, USA
| | - Vinod K Prasad
- Duke University Medical Center Department of Pediatrics, Durham, NC, USA
| | - Roger Giller
- Bone Marrow Transplant and Cellular Therapeutic Program, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Arhanti Sadanand
- Emory University Children's Healthcare of Atlanta, Atlanta, GA, USA
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60
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Ye F, Han Y, Zhu J, Li P, Zhang Q, Lin Y, Wang T, Lv H, Wang C, Wang C, Zhang J. First Identification of Human Adenovirus Subtype 21a in China With MinION and Illumina Sequencers. Front Genet 2020; 11:285. [PMID: 32318094 PMCID: PMC7155751 DOI: 10.3389/fgene.2020.00285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/03/2022] Open
Abstract
Human adenoviruses (HAdVs) have been demonstrated to cause a diversity of diseases among children and adults. The circulation of human adenovirus type 21 (HAdV21) has been mainly documented within closed environments in several countries. Nonetheless, respiratory infections or outbreaks due to HAdV21 have never been reported in China. MinION and Illumina platforms were employed to identify the potential pathogen from a throat swab. Discrepancies between MinION and Illumina sequencing were validated and corrected via polymerase chain reaction (PCR). Genomic characterization and recombinant event detection were then performed. Among the 35,466 high-quality MinION reads, a total of 5,999 reads (16.91%) could be aligned to HAdV21 reference genomes (genome sizes ≈35.3 kb), among which 20 had a length of >30 kb. A genome sequence assembled from MinION reads was further classified as HAdV subtype 21a. Random downsampling revealed as few as 500 nanopore reads could cover ≥96.49% of current genome. Illumina sequencing displayed good consistency (pairwise nucleotide identity = 99.91%) with MinION sequencing but with 31 discrepancies that were further validated and confirmed by PCR coupled with Sanger sequencing. Restriction enzymes such as BamHI and KpnI were able to distinguish the present genome from HAdV21 prototype and HAdV21b. Phylogenetic analysis employing whole-genome sequences placed our genome with members only from subtype 21a. Common features among HAdV21a strains were identified, including polymorphisms discovered in penton and 100 kDa hexon assembly–associated proteins and a recombinant event in the E4 gene. Using MinION and Illumina sequencers, we identified the first HAdV21a strain from China, which could provide key genomic data for disease control and epidemiological investigations.
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Affiliation(s)
- Fuqiang Ye
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Yifang Han
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Juanjuan Zhu
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Peng Li
- Center for Infectious Disease Control, Center for Disease Control and Prevention of People's Liberation Army of China, Beijing, China
| | - Qi Zhang
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Yanfeng Lin
- Center for Infectious Disease Control, Center for Disease Control and Prevention of People's Liberation Army of China, Beijing, China
| | - Taiwu Wang
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Heng Lv
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Changjun Wang
- Center for Infectious Disease Control, Center for Disease Control and Prevention of People's Liberation Army of China, Beijing, China
| | - Chunhui Wang
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
| | - Jinhai Zhang
- Department of Disease Control and Prevention, Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
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Xu J, Berastegui-Cabrera J, Chen H, Pachón J, Zhou J, Sánchez-Céspedes J. Structure-Activity Relationship Studies on Diversified Salicylamide Derivatives as Potent Inhibitors of Human Adenovirus Infection. J Med Chem 2020; 63:3142-3160. [PMID: 32045239 DOI: 10.1021/acs.jmedchem.9b01950] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effective treatment of adenovirus (HAdV) infections in immunocompromised patients still poses great challenges. Herein, we reported our continued efforts to optimize a series of salicylamide derivatives as potent inhibitors of HAdV infection. Of these, nine compounds (11, 13, 14, 17, 20, 58, 60, 62, and 70) showed significantly improved anti-HAdV activities with nanomolar to submicromolar IC50 values and high selectivity indexes (SI > 100), indicating better safety windows, compared to those of the lead compound niclosamide. Our mechanistic assays suggest that compounds 13, 62, and 70 exert their activities in the HAdV entry pathway, while compounds 14 and 60 likely target the HAdV DNA replication, and 11, 17, 20, and 58 inhibit later steps after DNA replication. Given the broad anti-viral activity profile of niclosamide, these derivatives may also offer therapeutic potential for other viral infections.
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Affiliation(s)
- Jimin Xu
- Chemical Biology Program, Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas 77555, United States
| | - Judith Berastegui-Cabrera
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, E41013 Seville, Spain
| | - Haiying Chen
- Chemical Biology Program, Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas 77555, United States
| | - Jerónimo Pachón
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, E41013 Seville, Spain.,Department of Medicine, University of Seville, E-41009 Seville, Spain
| | - Jia Zhou
- Chemical Biology Program, Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas 77555, United States
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, E41013 Seville, Spain
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62
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Bruminhent J, Worawichawong S, Tongsook C, Pasomsub E, Boongird S, Watcharananan SP. Epidemiology and Outcomes of Early-Onset and Late-Onset Adenovirus Infections in Kidney Transplant Recipients. Open Forum Infect Dis 2019; 6:ofz489. [PMID: 32128332 PMCID: PMC7047955 DOI: 10.1093/ofid/ofz489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022] Open
Abstract
Objective Adenovirus (ADV) infection after kidney transplantation (KT) causes significant morbidity. Patient characteristics and outcomes of ADV infection in KT recipients were investigated. Method All adult KT recipients with ADV infection between January 2015 and June 2019 were included. ADV infection/disease was defined as detection of ADV DNA in clinical specimens/plus symptoms. Clinical and laboratory findings, treatments, and outcomes were assessed. Results Adenovirus infection was diagnosed in 24 of 751 (3.2%) KT recipients. Twenty (83%) were male with a median age of 47 years (interquartile range [IQR], 36–58). Fifteen (63%) underwent deceased donor KT, and 13 (54%) received induction therapy. Twenty-one (88%) and 4 (17%) patients developed hemorrhagic cystitis and disseminated disease, respectively. There were equal distributions of early-onset (EOI) (≤3 months) and late-onset (LOI) (>3 months) infections. Patients who were diagnosed with EOI had lower median absolute lymphocyte counts compared with those with LOI (735/mm3 [IQR, 543–1123] vs 1122/mm3 [IQR, 784–1344], P = .04). All achieved resolution after reduction of their immunosuppression regimen and 13 (54%) received cidofovir therapy. Eighteen (75%) developed allograft dysfunction, of which 67% were transient. One (4%) underwent nephrectomy for allograft failure and 1 (4%) died (non-ADV–related). Patients with EOI were more likely to receive cidofovir therapy (75% vs 33%, P = .04) and develop other opportunistic infections (75% vs 8%, P < .001). Conclusions Adenovirus infection after KT typically involves a genitourinary system and transiently impairs an allograft function. Those who developed early infection tend to have more lymphopenia, coinfection, and receive antiviral therapy.
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Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutatip Tongsook
- Division of Virology, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ekawat Pasomsub
- Division of Virology, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarinya Boongird
- Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriorn P Watcharananan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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63
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Brincidofovir as a Salvage Therapy in Controlling Adenoviremia in Pediatric Recipients of Hematopoietic Stem Cell Transplant. J Pediatr Hematol Oncol 2019; 41:e467-e472. [PMID: 30969265 DOI: 10.1097/mph.0000000000001480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Adenovirus infection is a well-known complication in patients receiving hematopoietic stem cell transplantation (HSCT). Brincidofovir (BCV) is an orally bioavailable lipid conjugate of cidofovir, which has activity against adenoviruses. We present a review of adenovirus infections treated with BCV which were unresponsive to cidofovir initially in 4 patients and it was used upfront in one patient. Children with adenovirus infection following HSCT treated with BCV, between July 2014 and February 2018 were recognized. Five patients including 3 male and 2 female with a median age of 10 years (range, 2.2 to 10 y) were identified. The median days of adenoviremia detection was 18 days (range, 7 to 303 d) posttransplant. The median peak viral load by quantitative polymerase chain reaction was 21,38,000 copies/mL (range, 1,77,200 to 31,97,000 copies/mL). The median time from first detection of adenoviremia to become negative was 30 days (range, 15 to 113 d). The sites involved were gastrointestinal tract in all patients and 2 patients had additional respiratory tract involvement. Two patients survived and 3 patients died of sepsis. All patients responded well to BCV and no adverse effect was noticed. We saw the good safety profile and excellent antiadenoviral activity of BCV in pediatric patients receiving HSCT without the nephrotoxicity and it may have a role in preemptive therapy.
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Readler JM, AlKahlout AS, Sharma P, Excoffon KJDA. Isoform specific editing of the coxsackievirus and adenovirus receptor. Virology 2019; 536:20-26. [PMID: 31394408 PMCID: PMC6733617 DOI: 10.1016/j.virol.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
The Coxsackievirus and adenovirus receptor (CAR) is both a viral receptor and cell adhesion protein. CAR has two transmembrane isoforms that localize distinctly in polarized epithelial cells. Whereas the seven exon-encoded isoform (CAREx7) exhibits basolateral localization, the eight exon-encoded isoform (CAREx8) can localize to the apical epithelial surface where it can mediate luminal adenovirus infection. To further understand the distinct biological functions of these two isoforms, CRISPR/Cas9 genomic editing was used to specifically delete the eighth exon of the CXADR gene in a Madine Darby Canine Kidney (MDCK) cell line with a stably integrated lentiviral doxycycline-inducible CAREx8 cDNA. The gene-edited clone demonstrated a significant reduction in adenovirus susceptibility when both partially and fully polarized, and doxycycline-induction of CAREx8 restored sensitivity to adenovirus. These data reinforce the importance of CAREx8 in apical adenovirus infection and provide a new model cell line to probe isoform specific biological functions of CAR.
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MESH Headings
- Adenoviruses, Human/genetics
- Adenoviruses, Human/metabolism
- Animals
- Base Sequence
- CRISPR-Associated Protein 9/genetics
- CRISPR-Associated Protein 9/metabolism
- CRISPR-Cas Systems
- Clustered Regularly Interspaced Short Palindromic Repeats
- Coxsackie and Adenovirus Receptor-Like Membrane Protein/genetics
- Coxsackie and Adenovirus Receptor-Like Membrane Protein/metabolism
- DNA, Complementary/genetics
- DNA, Complementary/metabolism
- Dogs
- Doxycycline/pharmacology
- Exons
- Gene Editing/methods
- Gene Expression Regulation, Viral
- Humans
- Madin Darby Canine Kidney Cells
- Promoter Regions, Genetic/drug effects
- Protein Isoforms/genetics
- Protein Isoforms/metabolism
- RNA, Guide, CRISPR-Cas Systems/genetics
- RNA, Guide, CRISPR-Cas Systems/metabolism
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Affiliation(s)
- James M Readler
- Biomedical Sciences PhD Program, Wright State University, Dayton, OH, 45435, USA; Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Amal S AlKahlout
- Department of Biological Sciences, Wright State University, Dayton, OH, 45435, USA
| | - Priyanka Sharma
- Department of Biological Sciences, Wright State University, Dayton, OH, 45435, USA
| | - Katherine J D A Excoffon
- Biomedical Sciences PhD Program, Wright State University, Dayton, OH, 45435, USA; Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA; Department of Biological Sciences, Wright State University, Dayton, OH, 45435, USA.
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65
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Pochineni V, Randhawa P, Puttarajappa C. Fever and Gross Hematuria in Kidney Transplant Recipient. Am J Kidney Dis 2019; 72:A15-A18. [PMID: 30244696 DOI: 10.1053/j.ajkd.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/19/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Vaishnavi Pochineni
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Parmjeet Randhawa
- Division of Transplantation Pathology, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Chethan Puttarajappa
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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66
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Wold WSM, Tollefson AE, Ying B, Spencer JF, Toth K. Drug development against human adenoviruses and its advancement by Syrian hamster models. FEMS Microbiol Rev 2019; 43:380-388. [PMID: 30916746 DOI: 10.1093/femsre/fuz008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023] Open
Abstract
The symptoms of human adenovirus infections are generally mild and self-limiting. However, these infections have been gaining importance in recent years because of a growing number of immunocompromised patients. Solid organ and hematopoietic stem cell transplant patients are subjected to severe immunosuppressive regimes and cannot efficaciously eliminate virus infections. In these patients, adenovirus infections can develop into deadly multi-organ disseminated disease. Presently, in the absence of approved therapies, physicians rely on drugs developed for other purposes to treat adenovirus infections. As there is a need for anti-adenoviral therapies, researchers have been developing new agents and repurposing existing ones to treat adenovirus infections. There are several small molecule drugs that are being tested for their efficacy against human adenoviruses; some of these have reached clinical trials, while others are still in the preclinical phase. Besides these compounds, research on immunotherapy against adenoviral infection has made significant progress, promising another modality for treatment. The availability of an animal model confirmed the activity of some drugs already in clinical use while proving that others are inactive. This led to the identification of several lead compounds that await further development. In the present article, we review the current status of anti-adenoviral therapies and their advancement by in vivo studies in the Syrian hamster model.
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Affiliation(s)
- William S M Wold
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO, USA
| | - Ann E Tollefson
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO, USA
| | - Baoling Ying
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO, USA
| | - Jacqueline F Spencer
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO, USA
| | - Karoly Toth
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO, USA
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67
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Human adenovirus species C recombinant virus continuously circulated in China. Sci Rep 2019; 9:9781. [PMID: 31278296 PMCID: PMC6611784 DOI: 10.1038/s41598-019-46228-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/24/2019] [Indexed: 11/09/2022] Open
Abstract
To date, at least three lineages (Lineage 1-3) that are related to recombinant human adenovirus species C (HAdV-C) have been identified in China. Among them, Lineage 1 includes two Chinese strains, strain KR699642-CHN-20093 (CBJ11) and strain MF315029-CHN-2013 (BJ09), which were collected in Beijing in 2009 and 2013, respectively. Herein, we performed genomic and bioinformatics analysis of two HAdV-C strains (strain SX-2000-140 and strain SX-2004-327) that were isolated from the feces of two healthy children in Shanxi province of China in 2000 and 2004, respectively. Results revealed that the genomes of both Shanxi strains had the highest homology to two Chinese HAdV-C strains belonging to Lineage 1 and harbored the genetic elements of these two strains, thereby presuming that Lineage1 has been circulated in mainland of China for decades. In addition, though the viruses in Lineage 1 showed slightly different recombinant patterns resulting from the recombinant events among the five types of HAdV-C, all the Lineage 1 viruses shared the highest sequence similarities with the HAdV-2 prototype strain (NC_001405-USA-1953) across the genome, especially in the major capsid genes including hexon, and fiber. These results indicated that Lineage 1 viruses that were associated with recombinants shared a common ancestor that is closely related to the HAdV-2 virus. Our current findings confirmed that frequent recombination among the different HAdV-C types might be an important driving force for the molecular evolution of HAdV-C. Therefore, there is a strong need for further comprehensive and systematic monitoring, detection, and research on HAdV-C.
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68
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Fontana L, Strasfeld L. Respiratory Virus Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:523-544. [PMID: 30940462 PMCID: PMC7126949 DOI: 10.1016/j.idc.2019.02.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Respiratory virus infections in hematologic stem cell transplant recipients and patients with hematologic malignancies are increasingly recognized as a cause of significant morbidity and mortality. The often overlapping clinical presentation makes molecular diagnostic strategies imperative for rapid diagnosis and to inform understanding of the changing epidemiology of each of the respiratory viruses. Most respiratory virus infections are managed with supportive therapy, although there is effective antiviral therapy for influenza. The primary focus should remain on primary prevention infection control procedures and isolation precautions, avoidance of ill contacts, and vaccination for influenza.
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Affiliation(s)
- Lauren Fontana
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA.
| | - Lynne Strasfeld
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA
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69
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Girardi V, Gregianini TS, Gularte JS, Demoliner M, Seadi CF, Straliotto SM, Martins LG, Spilki FR. Temporal dynamics of Human mastadenovirus species in cases of respiratory illness in southern Brazil. Braz J Microbiol 2019; 50:677-684. [PMID: 31030411 DOI: 10.1007/s42770-019-00084-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/12/2019] [Indexed: 01/26/2023] Open
Abstract
Human mastadenovirus (HAdV) genus is related to several diseases, among them upper and lower respiratory tract illness. HAdV species B, C, D, and E are mainly associated with respiratory infections. The goal of this work was to identify the HAdV species associated with respiratory infections in hospitalized patients from southern Brazil. Samples were collected from 1996 to 2004 and 2011 to 2017. During this period, 28,524 samples were collected, and 9983 were positive for respiratory viruses, being 435 for HAdV. From these 435 samples, 57 were selected for characterization of HAdV species. For screening the presence of HAdV, a partial sequence of the DNA polymerase gene (DNApol gene) was amplified by nested PCR. Partial nucleotide sequencing was performed in positive samples, and HAdV (DNApol gene) was detected in 53 samples: species B (28; 49.1%), C (16; 28.0%), D (2; 3.5%), E (5; 8.7%), and untyped (2; 3.5%). Specie D was found only in 2017 and specie E in 2011 and 2012. The age of the patients ranged from < 1 to 81 years old, and 62.3% were male. No relationship between gender or age and identified HAdV species were observed. In addition, in the period of 2013-2017, 18 samples from patients who died were analyzed: 11 were related to species B, 4 to C, and 2 to D and 1 remained untyped. Circulation of HAdV species D and E varied over the years, but species B and C were present throughout the evaluated period. In addition, respiratory infections by HAdV affect elderly and children mainly.
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Affiliation(s)
- Viviane Girardi
- Laboratório de Microbiologia Molecular, Universidade Feevale, ERS 239 no. 2755, Novo Hamburgo, RS, 93352-000, Brazil.
| | - Tatiana Schäffer Gregianini
- Laboratório Central da Secretaria de Saúde do Estado do Rio Grande do Sul, LACEN/SES-RS, Av. Ipiranga, 5400, Porto Alegre, RS, 90610-000, Brazil
| | - Juliana Schons Gularte
- Laboratório de Microbiologia Molecular, Universidade Feevale, ERS 239 no. 2755, Novo Hamburgo, RS, 93352-000, Brazil
| | - Meriane Demoliner
- Laboratório de Microbiologia Molecular, Universidade Feevale, ERS 239 no. 2755, Novo Hamburgo, RS, 93352-000, Brazil
| | - Claudete Farina Seadi
- Laboratório Central da Secretaria de Saúde do Estado do Rio Grande do Sul, LACEN/SES-RS, Av. Ipiranga, 5400, Porto Alegre, RS, 90610-000, Brazil
| | - Selir Maria Straliotto
- Laboratório Central da Secretaria de Saúde do Estado do Rio Grande do Sul, LACEN/SES-RS, Av. Ipiranga, 5400, Porto Alegre, RS, 90610-000, Brazil
| | - Letícia Garay Martins
- Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul-CEVS/SES-RS, Av. Ipiranga, 5400, Porto Alegre, RS, 90610-000, Brazil
| | - Fernando Rosado Spilki
- Laboratório de Microbiologia Molecular, Universidade Feevale, ERS 239 no. 2755, Novo Hamburgo, RS, 93352-000, Brazil
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70
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Florescu DF, Schaenman JM. Adenovirus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13527. [PMID: 30859626 DOI: 10.1111/ctr.13527] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 01/06/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including pneumonitis, colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus surveillance testing should not be performed in asymptomatic recipients. Serial quantitative PCR might play a role in the decision to initiate or assess response to therapy in a symptomatic patient. The initial and most important components of therapy remain supportive care and decrease in immunosuppression. The use of antiviral therapy is not supported by prospective randomized clinical trials. However, intravenous cidofovir is considered the standard practice for treatment of severe, progressive, or disseminated adenovirus disease in most transplant centers. Intravenous immunoglobulin may be beneficial, primarily in a select group of patients with hypogammaglobulinemia. Future approaches to treatment of adenovirus disease may include administration of adenovirus-specific T-cell therapy.
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Affiliation(s)
- Diana F Florescu
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joanna M Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine, Los Angeles, California
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71
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Goldman JD, Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13507. [PMID: 30793386 DOI: 10.1111/ctr.13507] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/05/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of urinary tract infections (UTI) in solid organ transplantation, focusing on kidney transplant (KT) recipients. KT recipients have unique risk factors for UTI, including indwelling stents and surgical manipulation of the genitourinary tract. KT recipients experience multi-drug antibiotic-resistant infections-UTI prevention and management strategies must consider risks of antimicrobial resistance. Non-antimicrobial prevention strategies for UTI in KT recipients are reviewed. It is important to recognize that some renal transplant recipients with UTI may primarily present with fever, malaise, leukocytosis, or a non-specific sepsis syndrome without symptoms localized to the urinary tract. However, asymptomatic bacteriuria (AB) must be distinguished from UTI because AB is not necessarily a disease state. Accumulating data indicate that there are no benefits of antibiotics for treatment of AB in KT recipients more than 2 months after post-transplant. Further research is needed on management of AB in the early (<2 months) post-transplant period, prophylaxis for UTI in this era of antibiotic resistance, recurrent UTI, non-antimicrobial prevention of UTI, and uropathogens identified in donor urine and/or preservative fluid cultures.
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Affiliation(s)
- Jason D Goldman
- Division of Infectious Diseases, Swedish Medical Center, Seattle, Washington.,Division of Infectious Diseases, University of Washington, Seattle, Washington
| | - Kathleen Julian
- Division of Infectious Diseases, Penn State Hershey Medical Center, Hershey, Pennsylvania
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72
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Zhang X, Zhang X, Luo C, Liu Z, Chen Y, Dong S, Jiang C, Yang S, Wang F, Xiao X. Volume-Enhanced Raman Scattering Detection of Viruses. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1805516. [PMID: 30706645 DOI: 10.1002/smll.201805516] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/16/2019] [Indexed: 05/18/2023]
Abstract
Virus detection and analysis are of critical importance in biological fields and medicine. Surface-enhanced Raman scattering (SERS) has shown great promise in small molecule and even single molecule detection, and can provide fingerprint signals of molecules. Despite the powerful detection capabilities of SERS, the size discrepancy between the SERS "hot spots" (generally, <10 nm) and viruses (usually, sub-100 nm) yields poor detection reliability of viruses. Inspired by the concept of molecular imprinting, a volume-enhanced Raman scattering (VERS) substrate composed of hollow nanocones at the bottom of microbowls (HNCMB) is developed. The hollow nanocones of the resulting VERS substrates serve a twofold purpose: 1) extending the region of Raman signal enhancement from the nanocone surface (e.g., surface "hot spots") to the hollow area within the cone (e.g., volume "hot spots")-a novel method of Raman signal enhancement, and 2) directing analyte such as viruses of a wide range of sizes to those VERS "hot spots" while simultaneously increasing the surface area contributing to SERS. Using HNCMB VERS substrates, greatly improved Raman signals of single viruses are demonstrated, an achievement with important implications in disease diagnostics and monitoring, biomedical fields, as well as in clinical treatment.
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Affiliation(s)
- Xingang Zhang
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
| | - Xiaolei Zhang
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
| | - Changliang Luo
- Department of Clinical Laboratory Medicine and Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhengqi Liu
- Institute of Optoelectronic Materials and Technology, College of Physics and Communication Electronics, Jiangxi Normal University, Nanchang, 330022, China
| | - Yiyun Chen
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
| | - Shilian Dong
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
| | - Changzhong Jiang
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
| | - Shikuan Yang
- Institute for Composites Science Innovation, School of Materials Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Fubing Wang
- Department of Clinical Laboratory Medicine and Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiangheng Xiao
- Department of Physics and Key Laboratory of Artificial Micro- and Nano-structures of Ministry of Education, Hubei Nuclear Solid Physics Key Laboratory and Center for Ion Beam Application, School of Resource and Environmental Science, Wuhan University, Wuhan, 430072, China
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73
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Abstract
Currently, 88 different Human Adenovirus (HAdV) types are grouped into seven HAdV species A to G. Most types (57) belong to species HAdV-D. Recombination between capsid genes (hexon, penton and fiber) is the main factor contributing to the diversity in species HAdV-D. Noteworthy, species HAdV-C contains so far only five types, although species HAdV-C is highly prevalent and clinically significant in immunosuppressed patients. Therefore, the evolution of species HAdV-C was studied by generating 51 complete genome sequences from circulating strains. Clustering of the whole genome HAdV-C sequences confirmed classical typing results (fifteen HAdV-C1, thirty HAdV-C2, four HAdV-C5, two HAdV-C6). However, two HAdV-C2 strains had a novel penton base sequence and thus were re-labeled as the novel type HAdV-C89. Fiber and early gene region 3 (E3) sequences clustered always with the corresponding prototype sequence but clustering of the E4 region indicated recombination events in 26 out of the 51 sequenced specimens. Recombination of the E1 gene region was detected in 16 circulating strains. As early gene region sequences are not considered in the type definition of HAdVs, evolution of HAdV-C remains on the subtype level. Nonetheless, recombination of the E1 and E4 gene regions may influence the virulence of HAdV-C strains.
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74
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Killerby ME, Rozwadowski F, Lu X, Caulcrick-Grimes M, McHugh L, Haldeman AM, Fulton T, Schneider E, Sakthivel SK, Bhatnagar J, Rabeneck DB, Zaki S, Gerber SI, Watson JT. Respiratory Illness Associated With Emergent Human Adenovirus Genome Type 7d, New Jersey, 2016-2017. Open Forum Infect Dis 2019; 6:ofz017. [PMID: 30800698 DOI: 10.1093/ofid/ofz017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/06/2018] [Accepted: 01/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background Human adenoviruses (HAdVs) are known causes of respiratory illness outbreaks in congregate settings, but cases and clusters are less well described from community settings in the United States. During December 2016-February 2017, the New Jersey Department of Health received reports of HAdV infections from 3 sources in 3 adjacent counties. We investigated to characterize the epidemiologic, laboratory, and clinical features of this HAdV outbreak. Methods A case was defined as a New Jersey resident with acute respiratory illness during December 1, 2016-March 31, 2017 with laboratory identification of HAdV genome type 7d (HAdV-7d). Human adenovirus was detected by real-time and conventional polymerase chain reaction and molecular typed by partial hexon capsid protein gene sequencing. The HAdV genome type was identified by whole genome sequencing analysis. Available medical, public health, and surveillance records were reviewed. Results We identified 12 cases, including 3 treatment facility patients, 7 college students, and 2 cases at a tertiary-care hospital. Four cases died; all had underlying comorbidities. Nine HAdV-7d whole genome sequences obtained from all 3 sites were nearly identical. Conclusions Transmission of HAdV-7d occurred in community and congregate settings across 3 counties and resulted in severe morbidity and mortality in some cases with underlying comorbidities. Clinicians and local and state health departments should consider HAdV in patients with severe respiratory infection.
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Affiliation(s)
- Marie E Killerby
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development
| | - Faye Rozwadowski
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development.,New Jersey Department of Health, Trenton
| | - Xiaoyan Lu
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | | | | | | | | | - Eileen Schneider
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Senthilkumar K Sakthivel
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.,Battelle, Columbus, Ohio
| | - Julu Bhatnagar
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Demi B Rabeneck
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherif Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I Gerber
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - John T Watson
- Respiratory Viruses Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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75
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González-Vicent M, Verna M, Pochon C, Chandak A, Vainorius E, Brundage T, Mozaffari E, Nichols G, Rao K. Current practices in the management of adenovirus infection in allogeneic hematopoietic stem cell transplant recipients in Europe: The AdVance study. Eur J Haematol 2019; 102:210-217. [PMID: 30418684 PMCID: PMC6850370 DOI: 10.1111/ejh.13194] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 02/03/2023]
Abstract
Objective Adenovirus (AdV) infections are potentially life‐threatening for allogeneic hematopoietic stem cell transplant (allo‐HCT) recipients. The AdVance study aimed to evaluate the incidence, management, and outcomes of AdV infections in European allo‐HCT recipients. Methods As part of the study, physician surveys were conducted to determine current AdV screening and treatment practices at their center. Results All of the 28 respondents who treat pediatric patients reported routine AdV screening practices, with 93% screening all allo‐HCT recipients and others screening those with transplant‐related risk factors. Nearly all centers take a pre‐emptive approach to AdV treatment in both high‐ (89%) and low‐risk patients (75%). Among the 14 respondents who treat adult patients, 5 (36%) reported routine screening practices and few (21%) screen all allo‐HCT recipients unless risk factors are present. In adults, pre‐emptive AdV treatment is uncommon and quantitative AdV thresholds are rare. Typical treatment for all patients with symptomatic AdV infection is off‐label intravenous cidofovir. Conclusions Our findings confirm that screening for AdV is more common in pediatric patients. Antiviral treatment is employed in both pediatric and adult patients, although adults are generally treated when AdV disease is diagnosed. The approach to AdV screening and treatment is risk‐based and consistent with clinical guidelines.
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Affiliation(s)
| | - Marta Verna
- Pediatric Hematology, MBBM Foundation, Monza, Italy
| | - Cécile Pochon
- Allogeneic Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Oncohematology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | | | | | | | | | | | - Kanchan Rao
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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76
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Pettengill MA, Babu TM, Prasad P, Chuang S, Drage MG, Menegus M, Lamson DM, Lu X, Erdman D, Pecora N. Probable Donor-Derived Human Adenovirus Type 34 Infection in 2 Kidney Transplant Recipients From the Same Donor. Open Forum Infect Dis 2018; 6:ofy354. [PMID: 30882008 PMCID: PMC6411205 DOI: 10.1093/ofid/ofy354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Human adenovirus type 34 (HAdV-34) infection is a recognized cause of transplant-associated hemorrhagic cystitis and, in rare cases, tubulointerstitial nephritis. The source of such infections is often difficult to assess, that is, whether acquired as a primary infection, exposure to a pathogen in the transplanted organ, or reactivation of an endogenous latent infection. We present here 2 cases of likely transplant-acquired HAdV-34 infection from the same organ donor, manifesting as tubulointerstitial nephritis in 1.
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Affiliation(s)
- Matthew A Pettengill
- University of Rochester Medical Center, Rochester, New York.,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tara M Babu
- University of Rochester Medical Center, Rochester, New York
| | | | - Sally Chuang
- University of Rochester Medical Center, Rochester, New York
| | | | | | - Daryl M Lamson
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Xiaoyan Lu
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dean Erdman
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Pecora
- University of Rochester Medical Center, Rochester, New York
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77
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Cidofovir Diphosphate Inhibits Adenovirus 5 DNA Polymerase via both Nonobligate Chain Termination and Direct Inhibition, and Polymerase Mutations Confer Cidofovir Resistance on Intact Virus. Antimicrob Agents Chemother 2018; 63:AAC.01925-18. [PMID: 30397065 DOI: 10.1128/aac.01925-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022] Open
Abstract
Human adenovirus (AdV) can cause fatal disease in immune-suppressed individuals, but treatment options are limited, in part because the antiviral cytidine analog cidofovir (CDV) is nephrotoxic. The investigational agent brincidofovir (BCV) is orally bioavailable, nonnephrotoxic, and generates the same active metabolite, cidofovir diphosphate (CDVpp). However, its mechanism of action against AdV is poorly understood. Therefore, we have examined the effect of CDVpp on DNA synthesis by a purified adenovirus 5 (AdV5) DNA polymerase (Pol). CDVpp was incorporated into nascent DNA strands and promoted a nonobligate form of chain termination (i.e., AdV5 Pol can extend, albeit inefficiently, a DNA chain even after the incorporation of a first CDVpp molecule). Moreover, unlike a conventional mismatched base pair, misincorporated CDVpp was not readily excised by the AdV5 Pol. At elevated concentrations, CDVpp inhibited AdV5 Pol in a manner consistent with both chain termination and direct inhibition of Pol activity. Finally, a recombinant AdV5 was constructed, containing Pol mutations (V303I and T87I) that were selected following an extended passage of wild-type AdV5 in the presence of BCV. This virus had a 2.1-fold elevated 50% effective concentration (EC50) for BCV and a 1.9-fold increased EC50 for CDV; thus, these results confirmed that viral resistance to BCV and CDV can be attributed to mutations in the viral Pol. These findings show that the anti-AdV5 activity of CDV and BCV is mediated through the viral DNA Pol and that their antiviral activity may occur via both (nonobligate) chain termination and (at high concentration) direct inhibition of AdV5 Pol activity.
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78
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Hemmersbach-Miller M, Bailey ES, Kappus M, Prasad VK, Gray GC, Alspaugh JA. Disseminated Adenovirus Infection After Combined Liver-Kidney Transplantation. Front Cell Infect Microbiol 2018; 8:408. [PMID: 30524972 PMCID: PMC6256197 DOI: 10.3389/fcimb.2018.00408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022] Open
Abstract
Human adenovirus (HAdV) infections are well-described after hematopoietic stem cell transplantation but less well understood in solid organ transplantation (SOT). We describe a case of disseminated HAdV type 21 infection 5 months after combined liver-kidney transplantation, expanding the limited literature describing this infection in the SOT population.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Emily S Bailey
- Division of Infectious Diseases, School of Medicine and Global Health Institute, Duke University School of Medicine, Durham, NC, United States
| | - Matthew Kappus
- Division of Hepatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Vinod K Prasad
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Gregory C Gray
- Division of Infectious Diseases, School of Medicine and Global Health Institute, Duke University School of Medicine, Durham, NC, United States
| | - J Andrew Alspaugh
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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79
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Successful treatment of disseminated adenovirus infection with cidofovir and intravenous immunoglobulin in an infant following heart transplant. Cardiol Young 2018; 28:888-889. [PMID: 29690948 DOI: 10.1017/s1047951118000379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
For most patients, adenoviruses cause few acute health concerns and are often self-limiting. Patients who are immunocompromised or immunosuppressed, however, are at risk for disseminated adenovirus and suffer high morbidity and mortality, without well-defined treatment options. We report the case of a 9-month-old boy who was successfully treated for disseminated adenovirus infection with intravenous immunoglobulin and cidofovir 3 months post heart transplant, tailored to serum adenoviral load and clinical response. We emphasise the importance of early identification, monitoring, and a potentially novel treatment in the paediatric cardiac transplant population with disseminated adenovirus infection.
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80
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Toth K, Spencer JF, Ying B, Tollefson AE, Hartline CB, Richard ET, Fan J, Lyu J, Kashemirov BA, Harteg C, Reyna D, Lipka E, Prichard MN, McKenna CE, Wold WSM. USC-087 protects Syrian hamsters against lethal challenge with human species C adenoviruses. Antiviral Res 2018; 153:1-9. [PMID: 29510156 PMCID: PMC5891362 DOI: 10.1016/j.antiviral.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 02/08/2023]
Abstract
Human adenoviruses (AdV) cause generally mild infections of the respiratory and GI tracts as well as some other tissues. However, AdV can cause serious infection in severely immunosuppressed individuals, especially pediatric patients undergoing allogeneic hematopoietic stem cell transplantation, where mortality rates are up to 80% with disseminated disease. Despite the seriousness of AdV disease, there are no drugs approved specifically to treat AdV infections. We report here that USC-087, an N-alkyl tyrosinamide phosphonate ester prodrug of HPMPA, the adenine analog of cidofovir, is highly effective against multiple AdV types in cell culture. USC-087 is also effective against AdV-C6 in our immunosuppressed permissive Syrian hamster model. In this model, hamsters are immunosuppressed by treatment with high dose cyclophosphamide. Injection of AdV-C6 (or AdV-C5) intravenously leads to a disseminated infection that resembles the disease seen in humans, including death. We have tested the efficacy of orally-administered USC-087 against the median lethal dose of intravenously administered AdV-C6. USC-087 completely prevented or significantly decreased mortality when administered up to 4 days post challenge. USC-087 also prevented or significantly decreased liver damage caused by AdV-C6 infection, and suppressed virus replication even when administered 4 days post challenge. These results imply that USC-087 is a promising candidate for drug development against HAdV infections.
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Affiliation(s)
- Karoly Toth
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | | | - Baoling Ying
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Ann E Tollefson
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | | | - Eric T Richard
- University of Southern California, Los Angeles, CA 90089, USA
| | - Jiajun Fan
- University of Southern California, Los Angeles, CA 90089, USA
| | - Jinglei Lyu
- University of Southern California, Los Angeles, CA 90089, USA
| | | | - Cheryl Harteg
- Therapeutic Systems Research Laboratories, Inc, Ann Arbor, MI 48108, USA
| | - Dawn Reyna
- Therapeutic Systems Research Laboratories, Inc, Ann Arbor, MI 48108, USA
| | - Elke Lipka
- Therapeutic Systems Research Laboratories, Inc, Ann Arbor, MI 48108, USA
| | - Mark N Prichard
- University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | | | - William S M Wold
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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81
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Respiratory Viruses and Other Relevant Viral Infections in the Lung Transplant Recipient. LUNG TRANSPLANTATION 2018. [PMCID: PMC7123387 DOI: 10.1007/978-3-319-91184-7_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As advances occur in surgical technique, postoperative care, and immunosuppressive therapy, the rate of mortality in the early postoperative period following lung transplantation continues to decline. With the improvements in immediate and early posttransplant mortality, infections and their sequel as well as rejection and chronic allograft dysfunction are increasingly a major cause of posttransplant mortality. This chapter will focus on infections by respiratory viruses and other viral infections relevant to lung transplantation, including data regarding the link between viral infections and allograft dysfunction.
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82
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Przybylski M, Rynans S, Waszczuk-Gajda A, Bilinski J, Basak GW, Jędrzejczak WW, Wróblewska M, Młynarczyk G, Dzieciątkowski T. Sequence typing of human adenoviruses isolated from Polish patients subjected to allogeneic hematopoietic stem cell transplantation – a single center experience. Hematology 2018; 23:633-638. [DOI: 10.1080/10245332.2018.1457308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Maciej Przybylski
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
| | - Sylwia Rynans
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Bilinski
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz W. Basak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław W. Jędrzejczak
- Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wróblewska
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
- Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Młynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Dzieciątkowski
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
- Department of Microbiology, Central Clinical Hospital in Warsaw, Warsaw, Poland
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83
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Sulejmani N, Nagai S, Safwan M, Rizzari MD, Raoufi M, Abouljoud MS, Ramesh M. Brincidofovir as Salvage Therapy for Adenovirus Disease in Intestinal Transplant Recipients. Pharmacotherapy 2018; 38:470-475. [PMID: 29457839 DOI: 10.1002/phar.2094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adenoviruses are double-stranded DNA viruses that typically cause mild self-limiting respiratory, ocular, and gastrointestinal infections. In immunocompromised patients, especially transplant recipients, the infection can be severe, with dissemination and multiorgan failure. In intestinal transplant recipients, the incidence is as high as 57%. To our knowledge, no standardized guidelines or U.S. Food and Drug Administration-approved medications exist for the treatment of adenovirus disease. AIMS We describe two isolated intestinal transplant recipients who developed adenovirus disease (viremia with viral enteritis) that was managed with a new experimental drug, brincidofovir (an oral lipid conjugate prodrug of cidofovir), as salvage therapy. RESULTS The first patient was a 44-year-old woman who developed adenoviral enteritis 1 month after transplantation, which resolved with ribavirin therapy. Two weeks later, the infection recurred, and brincidofovir was initiated. While receiving this therapy for 3 months, she developed severe acute rejection, which was managed with rabbit antithymocyte globulin followed by infliximab. Eventually, complete resolution of the rejection and adenoviral enteritis was achieved. At 12 months posttransplantation, the patient was healthy and tolerating enteral feeding. The second patient was a 28-year-old man who had undergone isolated intestinal transplantation 6 years before he presented with generalized weakness and an increased ostomy output; he was diagnosed with adenoviral enteritis. Maintenance immunosuppression was reduced, and brincidofovir was started. The infection resolved with a month of therapy. Six months after the infection, he was healthy and tolerating enteral feeding. CONCLUSION This is the first publication, to our knowledge, to describe two cases in which brincidofovir was used to successfully treat adenovirus infection in intestinal transplant recipients. Thus, these cases demonstrate that brincidofovir appears to be a safe and effective option in the management of adenoviral enteritis in these patients.
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Affiliation(s)
| | - Shunji Nagai
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Mohamed Safwan
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Michael D Rizzari
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Mohammad Raoufi
- Department of Pathology, Henry Ford Hospital, Detroit, Michigan
| | - Marwan S Abouljoud
- Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Mayur Ramesh
- Department of Infectious Disease, Henry Ford Hospital, Detroit, Michigan
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84
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Law N, Kumar D. Post-transplant Viral Respiratory Infections in the Older Patient: Epidemiology, Diagnosis, and Management. Drugs Aging 2018; 34:743-754. [PMID: 28965331 PMCID: PMC7100819 DOI: 10.1007/s40266-017-0491-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Organ and stem cell transplantation has been one of the greatest advances in modern medicine, and is the primary treatment modality for many end-stage diseases. As our population ages, so do the transplant recipients, and with that comes many new challenges. Respiratory viruses have been a large contributor to the mortality and morbidity of solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Respiratory viruses are generally a long-term complication of transplantation and primarily acquired in the community. With the emergence of molecular methods, newer respiratory viruses are being detected. Respiratory viruses appear to cause severe disease in the older transplant population. Influenza vaccine remains the mainstay of prevention in transplant recipients, although immunogenicity of current vaccines is suboptimal. Limited therapies are available for other respiratory viruses. The next decade will likely bring newer antivirals and vaccines to the forefront. Our goal is to provide the most up to date knowledge of respiratory viral infections in our aging transplant population.
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Affiliation(s)
- Nancy Law
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, PMB 11-174, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, PMB 11-174, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
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85
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Abstract
Adenoviridae is a family of double-stranded DNA viruses that are a significant cause of upper respiratory tract infections in children and adults. Less commonly, the adenovirus family can cause a variety of gastrointestinal, ophthalmologic, genitourinary, and neurologic diseases. Most adenovirus infections are self-limited in the immunocompetent host and are treated with supportive measures. Fatal infections can occur in immunocompromised patients and less frequently in the healthy. Adenoviral vectors are being studied for novel biomedical applications including gene therapy and immunization. In this review we will focus on the spectrum of adenoviral infections in humans.
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Affiliation(s)
- Subrat Khanal
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
| | - Pranita Ghimire
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
| | - Amit S Dhamoon
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
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86
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Cho SY, Lee HJ, Lee DG. Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea. Korean J Intern Med 2018; 33:256-276. [PMID: 29506345 PMCID: PMC5840605 DOI: 10.3904/kjim.2018.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/28/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a treatment for hematologic malignancies, immune deficiencies, or genetic diseases, ect. Recently, the number of HSCTs performed in Korea has increased and the outcomes have improved. However, infectious complications account for most of the morbidity and mortality after HSCT. Post-HSCT infectious complications are usually classified according to the time after HSCT: pre-engraftment, immediate post-engraftment, and late post-engraftment period. In addition, the types and risk factors of infectious complications differ according to the stem cell source, donor type, conditioning intensity, region, prophylaxis strategy, and comorbidities, such as graft-versushost disease and invasive fungal infection. In this review, we summarize infectious complications after HSCT, focusing on the Korean perspectives.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Jeong Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Dong-Gun Lee, M.D. Division of Infectious Diseases, Department of Internal Medicine, The Catholic Blood and Marrow Transplantation Centre, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6003 Fax: +82-2-535-2494 E-mail:
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87
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Chehadeh W, Al-Adwani A, John SE, Al-Dhufairi S, Al-Dousari H, Alkhaledi M, Al-Nakib W. Adenovirus types associated with severe respiratory diseases: A retrospective 4-year study in Kuwait. J Med Virol 2018; 90:1033-1039. [PMID: 29446483 PMCID: PMC7167181 DOI: 10.1002/jmv.25059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022]
Abstract
Human adenovirus (HAdV) infection can result in a severe respiratory disease. The aim of this study was to identify HAdV types detected in patients hospitalized for severe respiratory illness. The study population consisted of 743 patients with severe respiratory disease admitted to four major hospitals in Kuwait between January 2013 and December 2016. Respiratory specimens were retrospectively screened for 20 respiratory viruses by real-time PCR. The HAdV hexon gene was amplified and directly sequenced, and HAdV types were identified by performing Bayesian phylogenetic analysis. HAdV DNA was detected in 27 (3.6%) patients, with peaks in November and March. Most patients were infants and young children suffering from pneumonia or acute bronchiolitis. The detected HAdV types were C1, C2, C5, B3, and B7. Clusters of HAdV C1, C2, and C5 were observed with high posterior probability. All patients infected with HAdV C5 and 50% of patients infected with HAdV C2 or B7 were admitted to the intensive care unit (ICU). Co-infection with other viruses was detected in 44.4% of patients. The most common co-infecting virus was rhinovirus (HRV). HAdV/HRV co-infection was detected in two children who presumably developed disseminated HAdV infection and died. This is the first report describing the circulation of HAdV types associated with severe outcomes in Kuwait. These findings highlight the need for a national surveillance system to monitor changes in predominant HAdV types and increased numbers of severe respiratory infections.
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Affiliation(s)
- Wassim Chehadeh
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Anfal Al-Adwani
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Sonia Elezebeth John
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Shaikhah Al-Dhufairi
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Hessa Al-Dousari
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Maha Alkhaledi
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
| | - Widad Al-Nakib
- Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait
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88
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Nagarakanti S, Bishburg E, Bapat A. Adenovirus, herpes simplex virus and cytomegalovirus infection in a lung transplant recipient. IDCases 2018; 11:91-93. [PMID: 29552490 PMCID: PMC5849788 DOI: 10.1016/j.idcr.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/04/2022] Open
Abstract
Allograft infections post lung transplantation have a significant impact on morbidity and mortality. We report a rare case of triple viral infection with adenovirus, Herpes Simplex virus (HSV) and Cytomegalovirus (CMV) in a lung transplant recipient.
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Affiliation(s)
- Sandhya Nagarakanti
- Newark Beth Israel medical Center, Division of Infectious Disesases, 201 Lyons Ave, G-3, Newark, NJ 07112, United States
| | - Eliahu Bishburg
- Newark Beth Israel medical Center, Division of Infectious Disesases, 201 Lyons Ave, G-3, Newark, NJ 07112, United States
| | - Anita Bapat
- Newark Beth Israel medical Center, Division of Infectious Disesases, 201 Lyons Ave, G-3, Newark, NJ 07112, United States
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Abstract
INTRODUCTION Traditional inactivated and protein vaccines generate strong antibodies, but struggle to generate T cell responses. Attenuated pathogen vaccines generate both, but risk causing the disease they aim to prevent. Newer gene-based vaccines drive both responses and avoid the risk of infection. While these replication-defective (RD) vaccines work well in small animals, they can be weak in humans because they do not replicate antigen genes like more potent replication-competent (RC) vaccines. RC vaccines generate substantially stronger immune responses, but also risk causing their own infections. To circumvent these problems, we developed single-cycle adenovirus (SC-Ad) vectors that amplify vaccine genes, but that avoid the risk of infection. This review will discuss these vectors and their prospects for use as vaccines. AREAS COVERED This review provides a background of different types of vaccines. The benefits of gene-based vaccines and their ability to replicate antigen genes are described. Adenovirus vectors are discussed and compared to other vaccine types. Replication-defective, single-cycle, and replication-competent Ad vaccines are compared. EXPERT COMMENTARY The potential utility of these vaccines are discussed when used against infectious diseases and as cancer vaccines. We propose a move away from replication-defective vaccines towards more robust replication-competent or single-cycle vaccines.
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Affiliation(s)
- Michael Barry
- a Division of Infectious Diseases, Department of Medicine, Department of Immunology, Department of Molecular Medicine , Mayo Clinic , Rochester , MN , USA
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90
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Scott MK, Chommanard C, Lu X, Appelgate D, Grenz L, Schneider E, Gerber SI, Erdman DD, Thomas A. Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013-2014. Emerg Infect Dis 2018; 22:1044-51. [PMID: 27191834 PMCID: PMC4880082 DOI: 10.3201/eid2206.151898] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013-July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection.
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MESH Headings
- Adenovirus Infections, Human/diagnosis
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/history
- Adenovirus Infections, Human/virology
- Adenoviruses, Human/classification
- Adenoviruses, Human/genetics
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- Genotype
- History, 21st Century
- Hospitalization
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Oregon/epidemiology
- Phylogeny
- Population Surveillance
- Respiratory Tract Infections/diagnosis
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/history
- Respiratory Tract Infections/virology
- Severity of Illness Index
- Symptom Assessment
- Young Adult
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91
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Hibbert KA, Shepard JAO, Lane RJ, Azar MM. Case 1-2018. A 39-Year-Old Woman with Rapidly Progressive Respiratory Failure. N Engl J Med 2018; 378:182-190. [PMID: 29320657 DOI: 10.1056/nejmcpc1712222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathryn A Hibbert
- From the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Harvard Medical School - both in Boston
| | - Jo-Anne O Shepard
- From the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Harvard Medical School - both in Boston
| | - Rebekah J Lane
- From the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Harvard Medical School - both in Boston
| | - Marwan M Azar
- From the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (K.A.H., R.J.L.), Radiology (J.-A.O.S.), and Pathology (M.M.A.), Harvard Medical School - both in Boston
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Ramirez CGB, McCauley J. Infection in Kidney Transplantation. CONTEMPORARY KIDNEY TRANSPLANTATION 2018. [PMCID: PMC7123753 DOI: 10.1007/978-3-319-19617-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infection is an important cause of morbidity and mortality after kidney transplantation. It has been estimated that 70% of kidney transplant recipients will experience an infection episode within the first 3 years after transplantation (Dharnidharka et al. 2007). After cardiovascular disease, infection is the second leading cause of death in recipients with allograft function (Snyder et al. 2009). The immunosuppressive therapy required to prevent organ rejection places the kidney transplant recipient at increased risk for donor-derived, nosocomial, and community-acquired infections as well as reactivation of latent pathogens. Pretransplant screening, immunizations, and optimal antibacterial and antiviral prophylaxis can help to reduce the impact of infection. Awareness of the approach to infection in the transplant recipient including diagnostic and management strategies is essential to optimizing outcomes.
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Affiliation(s)
- Carlo Gerardo B. Ramirez
- Transplant Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA
| | - Jerry McCauley
- Division of Nephrology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
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93
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Rennert H, Ramrattan G, Chen Z, McIntire P, Michaeel A, Khazanova A, Jenkins SG, Sipley J. Evaluation of a human adenovirus viral load assay using the Altona RealStar® PCR test. Diagn Microbiol Infect Dis 2017; 90:257-263. [PMID: 29433999 DOI: 10.1016/j.diagmicrobio.2017.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/29/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
This study evaluated the performance of the Altona Diagnostics RealStar® Adenovirus Research Use Only (RUO) real-time PCR reagents for HAdV quantitation in plasma samples from immunodeficient patients. The assay was linear from 2.30-9.17 log10 copies/mL (coefficient of determination; R2=0.998) with limits of detection and quantification of 2.19 log10 and 2.30 log10 copies/mL (>95% positivity rate), respectively. Assay precision was highly reproducible with coefficients of variance ranging from 0% to 4.7%. A comparison of 66 matched samples showed good agreement (R2=0.845) between the Altona and the reference laboratory assay, with an average negative bias (-0.24 log10 copies/mL). Genotyping analysis demonstrated that HAdV species B and C accounted for 77% of the positive samples. A significant (≥0.9 log10) difference in quantitation between both tests was found for three HAdV types (HAdV types A12, B14 and F41). In conclusion, the Altona RealStar® test is a reliable and sensitive assay for HAdV DNA quantitation.
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Affiliation(s)
- Hanna Rennert
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
| | - Girish Ramrattan
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, New York, NY
| | - Patrick McIntire
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY
| | - Alber Michaeel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Anna Khazanova
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY
| | - Stephen G Jenkins
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - John Sipley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY
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94
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Ying B, Spencer JF, Tollefson AE, Wold WSM, Toth K. Male Syrian hamsters are more susceptible to intravenous infection with species C human adenoviruses than are females. Virology 2017; 514:66-78. [PMID: 29132049 DOI: 10.1016/j.virol.2017.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 12/25/2022]
Abstract
Recently, increasing attention has been focused on the influence of sex on the course of infectious diseases. Thus far, the best-documented examples point toward an immune-mediated mechanism: the generally stronger immune response in females can result in a faster clearance of the pathogen or, conversely, a more severe immune-mediated pathology. Here, we report that human species C adenoviruses replicate more and cause more pathology in male Syrian hamsters than in females. We also show that this sex disparity is not caused by a stronger immune response to the infection by the female hamsters. Rather, the liver of male hamsters is more susceptible to adenovirus infection: after intravenous injection, more hepatocytes become infected in male animals than in females. We hypothesize that Kupffer cells (hepatic tissue macrophages) of female animals are more active in sequestering circulating virions, and thus protect hepatocytes more efficiently than those of males.
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Affiliation(s)
- Baoling Ying
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, St. Louis, MO, USA
| | - Jacqueline F Spencer
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, St. Louis, MO, USA
| | - Ann E Tollefson
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, St. Louis, MO, USA
| | - William S M Wold
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, St. Louis, MO, USA.
| | - Karoly Toth
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, St. Louis, MO, USA.
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95
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96
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Toth K, Tollefson AE, Spencer JF, Ying B, Wold WS. Combination therapy with brincidofovir and valganciclovir against species C adenovirus infection in the immunosuppressed Syrian hamster model allows for substantial reduction of dose for both compounds. Antiviral Res 2017; 146:121-129. [DOI: 10.1016/j.antiviral.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
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97
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Walter JM, Wunderink RG. Severe Respiratory Viral Infections: New Evidence and Changing Paradigms. Infect Dis Clin North Am 2017; 31:455-474. [PMID: 28687214 PMCID: PMC7347414 DOI: 10.1016/j.idc.2017.05.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lower respiratory tract infection is a leading cause of death in the United States. Advances in diagnostic testing have improved our ability to detect pathogens. Viral pathogens are important causal pathogens in immunocompetent patients. As the number of elderly adults and those with chronic medical conditions increases, the burden of viral respiratory infections will increase. Clinicians must be familiar with the characteristics of rhinovirus, human adenoviruses, respiratory syncytial virus, and human metapneumovirus. Major challenges include distinguishing true infection from asymptomatic carriage and characterizing patients admitted with severe lower respiratory tract infection who do not have a causative pathogen identified.
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Affiliation(s)
- James M Walter
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Arkes 14-000, Chicago, IL 60611, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Arkes 14-000, Chicago, IL 60611, USA.
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99
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Abstract
Similarly to the general population, genitourinary tract infections are common conditions in theimmunocompromised host. They can be furthermore divided into infections of the urinary tract and genital tract infections. Transplant recipients are more likely to have infections of the urinary tract infections while persons with human immunodeficiency virus (HIV) are at higher risk for the second group of infections, especially sexually transmitted infections (STIs). Manifestations of these diseases can be associated with more complications and can be more severe. We provide an overview of manifestations, diagnosis, and management of these disorders.
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100
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Abstract
Adenoviruses are a highly prevalent infection that can cause a range of clinical syndromes in immunocompromised patients, ranging from localized disease of the respiratory tract, gastrointestinal tract, or urinary tract to disseminated disease. Adenovirus infections may develop in this unique population as the result of primary infection or reactivation of latent virus. Disease can be potentially progressive with high rates of mortality in patients with pneumonia and disseminated disease. Fortunately, cidofovir and its lipid ester, brincidofovir, appear to be effective for the treatment of adenovirus, although neither is specifically approved for this indication. Adenovirus should always be considered when immunocompromised patients present with any clinical syndrome that could be compatible with adenoviral infection. Once disease is suspected, cultures or molecular testing of appropriate specimens should be obtained and blood should be sent for adenovirus polymerase chain reaction (PCR) whenever adenovirus is suspected. Monitoring of quantitative viral loads in blood is helpful in predicting response to therapy with a significant drop (>1 log) associated with a higher probability of clinical response.
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