101
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Solovyeva SE, Paltseva EM, Morozova MM, Kaabak MM, Krainik NA, Matveev AV. [Clinical and morphological signs of viral damage to a kidney transplant]. Arkh Patol 2017; 79:22-28. [PMID: 28418354 DOI: 10.17116/patol201779222-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Тo compare morphological changes and results of immunohistochemical (IHC) identification of viruses (polyomaviruses, adenoviruses, and herpesviruses) in the biopsy specimens with their clinical manifestations in recipients of renal transplants. MATERIAL AND METHODS Morphological and IHC studies were conducted using 71 needle renal transplant biopsy specimens from patients in the study group and 10 renal biopsy specimens from those in the control group. A number of clinical indicators were estimated. RESULTS IHC examination revealed the expression of adenoviral antigens more commonly in patients with posttransplant nephritis than in recipients without nephritis or in control individuals (p<0.05). The association of patient age and time after kidney transplantation with the severity of viral damage was confirmed: graft loss in children occurred within the first months of surgery (p<0.05). Polyomavirus was detected by PCR in patients with the morphological patterns of polyomavirus nephropathy. Determination of HSV-1 and HSV-2 in the biopsy specimens showed no significant associations with morphological changes. CONCLUSION By taking into account a variety of factors that influence the development of viral nephritis, morphological and IHC examinations should be combined with evaluation of clinical findings.
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Affiliation(s)
- S E Solovyeva
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia; Research Institute of Human Morphology, Russian Academy of Sciences, Moscow, Russia
| | - E M Paltseva
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - M M Morozova
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - M M Kaabak
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - N A Krainik
- Acad. B.V. Petrovsky Russian Surgery Research Center, Moscow, Russia
| | - A V Matveev
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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102
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Niang MN, Diop NS, Fall A, Kiori DE, Sarr FD, Sy S, Goudiaby D, Barry MA, Fall M, Dia N. Respiratory viruses in patients with influenza-like illness in Senegal: Focus on human respiratory adenoviruses. PLoS One 2017; 12:e0174287. [PMID: 28328944 PMCID: PMC5362214 DOI: 10.1371/journal.pone.0174287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/06/2017] [Indexed: 12/20/2022] Open
Abstract
Background Human adenoviruses (HAdVs) are highly contagious pathogens that are associated with a wide spectrum of human illnesses involving the respiratory tract. In the present study, we investigate the epidemiologic and viral molecular features of HAdVs circulating in Senegal after 4 consecutive years of sentinel surveillance of influenza-like Illness cases. Methodology and results From January 2012 to December 2015 swabs were collected from consenting ILI outpatients. Adenoviral detection is performed by rRT-PCR with the Anyplex™ II RV16 Detection kit (Seegene) and molecular characterization was performed using a partial hexon gene sequence. 6381 samples were collected. More than half of patients (51.7%; 3297/6381) were children of ≤ 5 years. 1967 (30.8%) were positive for HAdV with 1561 (79.4%) found in co-infection with at least one another respiratory virus. The most common co-detections were with influenza viruses (53.1%; 1045/1967), rhinoviruses (30%; 591/1967), enteroviruses (18.5%; 364/1967) and RSV (13.5%; 266/1967). Children under 5 were the most infected group (62.2%; 1224/1967; p <0.05). We noted that HAdV was detected throughout the year at a high level with detection peaks of different amplitudes without any clear seasonality. Phylogenetic analysis revealed species HAdV-C in majority, species HAdV-B and one HAdV- 4 genome type. The 9 HAdV-B species like strains from Senegal grouped with genome types HAdV-7, HAdV-55 and HAdV-11 as shown by a phylogenetic branch with a high bootstrap value of (88%). Conclusion In conclusion, the results of the present study suggest strong year-round HAdV activity in Senegal, especially in children up to 5 years of age. Molecular studies revealed that the dominant species in circulation in patients with ILI appears to be HAdV-C and HAdV-B species. The circulation of though HAdV-7 and HAdV-55 genome types is of note as these serotypes are recognized causes of more severe and even fatal acute respiratory infections.
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Affiliation(s)
| | - Ndeye Sokhna Diop
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
| | - Amary Fall
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
| | - Davy E. Kiori
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
| | - Fatoumata Diene Sarr
- Institut Pasteur de Dakar, Unité d’Epidémiologie des maladies infectieuses, Dakar, Sénégal
| | - Sara Sy
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
| | - Déborah Goudiaby
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
| | - Mamadou Aliou Barry
- Institut Pasteur de Dakar, Unité d’Epidémiologie des maladies infectieuses, Dakar, Sénégal
| | - Malick Fall
- Département de Biologie Animale Faculté des Sciences et Techniques Université Cheikh Anta DIOP de Dakar, Dakar, Senegal
| | - Ndongo Dia
- Institut Pasteur de Dakar, Unité de Virologie Médicale, Dakar, Sénégal
- * E-mail:
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103
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Campbell SJ, Kynyk JA, Davis JA. Disseminated adenovirus infection causing severe ARDS. BMJ Case Rep 2017; 2017:bcr-2016-217524. [PMID: 28096226 DOI: 10.1136/bcr-2016-217524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure. His serum adenovirus load was markedly elevated. Treatment was started once the diagnosis of disseminated adenovirus infection was made; however, at that time patient was suffering from refractory hypoxaemia, respiratory acidosis, right heart failure and septic shock. Despite maximal supportive measures our patient ultimately expired over the course of 6 days.
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Affiliation(s)
- Steven J Campbell
- Department of Pulmonary, Critical Care, and Sleep, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica A Kynyk
- Department of Pulmonary, Critical Care, and Sleep, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - John A Davis
- Department of Infectious Diseases, Ohio State University College of Medicine, Columbus, Ohio, USA
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104
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Brincidofovir for Asymptomatic Adenovirus Viremia in Pediatric and Adult Allogeneic Hematopoietic Cell Transplant Recipients: A Randomized Placebo-Controlled Phase II Trial. Biol Blood Marrow Transplant 2017; 23:512-521. [PMID: 28063938 DOI: 10.1016/j.bbmt.2016.12.621] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022]
Abstract
Adenovirus infection in immunocompromised patients contributes to significant morbidity and mortality, especially after allogeneic hematopoietic cell transplantation (HCT). Brincidofovir (BCV, CMX001) is an orally bioavailable lipid conjugate of cidofovir that has in vitro activity against adenoviruses and other double-stranded DNA viruses. This randomized placebo-controlled phase II trial evaluated pre-emptive treatment with BCV for the prevention of adenovirus disease in pediatric and adult allogeneic HCT recipients with asymptomatic adenovirus viremia. Allogeneic HCT recipients with adenovirus viremia were randomized 1:1:1 to receive oral BCV 100 mg (2 mg/kg if <50 kg) twice weekly (BIW), BCV 200 mg (4 mg/kg if <50 kg) once weekly (QW), or placebo for 6 to 12 weeks, followed by 4 weeks of post-treatment follow-up. For randomization, subjects were stratified by screening absolute lymphocyte count (<300 cells/mm3 versus ≥300 cells/mm3). Assignment to BCV or placebo was double blinded; dose frequency was unblinded. The primary endpoint was the proportion of subjects experiencing treatment failure, defined as either progression to probable or definitive adenovirus disease or confirmed increasing adenovirus viremia (≥1 log10 copies/mL) during randomized therapy. Between June 2011 and December 2012, 48 subjects were randomized to the BCV BIW (n = 14), BCV QW (n = 16), or placebo (n = 18) groups. The proportion of subjects with treatment failure in the BCV BIW group was 21% (odds ratio, .53; 95% confidence interval [CI], .11 to 2.71; P = .45), 38% (odds ratio, 1.23; 95% CI, .30 to 5.05, P = .779) in the BCV QW group, and 33% in the placebo group. All-cause mortality was lower in the BCV BIW (14%) and BCV QW groups (31%) relative to the placebo group (39%), but these differences were not statistically significant. After 1 week of therapy, 8 of 12 subjects (67%) randomized to BCV BIW had undetectable adenovirus viremia (<100 copies/mL), compared with 4 of 14 subjects (29%) randomized to BCV QW and 5 of 15 subjects (33%) randomized to placebo. In a post hoc analysis of subjects with viremia ≥1000 copies/mL at baseline, 6 of 7 BCV BIW subjects (86%) achieved undetectable viremia compared with 2 of 8 placebo subjects (25%; P = .04). Early treatment discontinuation because of adverse events was more common in subjects treated with BCV than with placebo. Diarrhea was the most common event in all groups (57% BCV BIW, 38% BCV QW, 28% placebo), but it led to treatment discontinuation in only 1 subject receiving BCV QW. Events diagnosed as acute graft-versus-host disease, primarily of the gastrointestinal tract, were more frequent in the BCV BIW group (50%) than in the BCV QW (25%) and placebo (17%) groups. There was no evidence of myelotoxicity or nephrotoxicity in BCV-treated subjects. The results of this trial confirm the antiviral activity of BCV against adenoviruses. Further investigation is ongoing to define the optimal treatment strategy for HCT recipients with serious adenovirus infection and disease.
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105
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Affiliation(s)
- Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue Suite 900, Chicago, IL 60611, USA.
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106
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Broniek G, Langwińska-Wośko E, Sybilska M, Szaflik JP, Przybylski M, Wróblewska M. Occurrence of viral DNA in paired samples of corneal rim and cornea preservation fluid. J Med Virol 2016; 89:732-736. [PMID: 27588373 DOI: 10.1002/jmv.24675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/13/2022]
Abstract
Corneal transplants have one of the highest success rates among all transplantological procedures. Corneas intended for transplantation are stored in a preservation fluid, which is then tested for bacterial and fungal infections. Among all analyses of infectious complications following corneal transplants, infections caused by bacteria or fungi are the most prominent. Surprisingly, however, apart from a few publications, there is a lack of data regarding the occurrence of viruses in donor corneas and the risk of transmitting these to their recipients. The intention of this research was therefore to determine the frequency with which human herpesvirus 1 (HHV-1), human herpesvirus 2 (HHV-2), and human adenovirus (HAdV) occur in transplanted corneal tissue, as well as in samples of preservation fluid. The study comprised 57 paired samples, with each pair consisting of a fragment of the corneal tissue remaining after its trepanation for transplantation surgery and a sample of corneal preservation fluid. Sample pairs were all tested for the presence of the DNA of three viruses (HHV-1, HHV-2, and HAdV) using real time PCR technique. Viral DNA was found in three of the tested corneas-HHV-1 DNA in one paired sample (1.8%) and adenovirus DNA in two single samples (3.5%). We postulate that virological testing of corneas for transplantation should be considered, particularly in the case of donors with increased risk factors for herpesvirus and adenovirus reactivation. J. Med. Virol. 89:732-736, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- G Broniek
- SPKSO Ophthalmic University Hospital, Medical University of Warsaw, Warsaw, Poland
| | - E Langwińska-Wośko
- SPKSO Ophthalmic University Hospital, Medical University of Warsaw, Warsaw, Poland.,Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - M Sybilska
- SPKSO Ophthalmic University Hospital, Medical University of Warsaw, Warsaw, Poland
| | - J P Szaflik
- SPKSO Ophthalmic University Hospital, Medical University of Warsaw, Warsaw, Poland.,Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - M Przybylski
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - M Wróblewska
- SPKSO Ophthalmic University Hospital, Medical University of Warsaw, Warsaw, Poland.,Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland
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107
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Camargo JF, Morris MI, Abbo LM, Simkins J, Saneeymehri S, Alencar MC, Lekakis LJ, Komanduri KV. The use of brincidofovir for the treatment of mixed dsDNA viral infection. J Clin Virol 2016; 83:1-4. [PMID: 27513204 DOI: 10.1016/j.jcv.2016.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/28/2022]
Abstract
Double-stranded DNA (dsDNA) viral infections constitute a major complication following solid organ and stem cell transplantation. Few therapeutic options are currently available for the treatment of such infections in highly immunocompromised hosts. Brincidofovir is an oral investigational drug with broad antiviral activity against dsDNA viruses in vitro, but clinical experience is limited. Here we report a young female who developed a mixed infection with adenovirus, cytomegalovirus, Epstein-Barr virus and BK polyomavirus after an allogeneic stem cell transplant, and was successfully treated with brincidofovir.
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Affiliation(s)
- Jose F Camargo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States.
| | - Michele I Morris
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Lilian M Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Seyyedeh Saneeymehri
- Department of Pharmacy, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Maritza C Alencar
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Lazaros J Lekakis
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Krishna V Komanduri
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
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108
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Lynch JP, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention. Semin Respir Crit Care Med 2016; 37:586-602. [PMID: 27486739 PMCID: PMC7171713 DOI: 10.1055/s-0036-1584923] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The disease is more severe and dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 50 serotypes of AdV have been identified. Different serotypes display different tissue tropisms that correlate with clinical manifestations of infection. The predominant serotypes circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been conducted. Cidofovir is the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States, but currently are not available to civilians.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Adriana E Kajon
- Department of Infectious Disease, Lovelace Respiratory Research Institute, Albuquerque, New Mexico
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109
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Sun Q, Wang Q, Scott MJ, Billiar TR. Immune Activation in the Liver by Nucleic Acids. J Clin Transl Hepatol 2016; 4:151-7. [PMID: 27350945 PMCID: PMC4913071 DOI: 10.14218/jcth.2016.00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 12/17/2022] Open
Abstract
Viral infection in the liver, including hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, is a major health problem worldwide, especially in developing countries. The infection triggers a pro-inflammatory response in patients that is crucial for host defense. Recent studies have identified multiple transmembrane and cytosolic receptors that recognize pathogen-derived nucleic acids, and these receptors are essential for driving immune activation in the liver. In addition to sensing DNA/RNA from pathogens, these intracellular receptors can be activated by nucleic acids of host origin in response to sterile injuries. In this review, we discuss the expanding roles of these receptors in both immune and nonimmune cells in the liver.
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Affiliation(s)
- Qian Sun
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qingde Wang
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melanie J. Scott
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy R. Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- *Correspondence to: Timothy R. Billiar, Department of Surgery, University of Pittsburgh, Suite F1281, 200 Lothrop Street, Pittsburgh, PA 15213, USA. Tel: +1-412-647-1749, Fax: +1-412-647-3247,
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110
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Lu X, Erdman DD. Quantitative real-time PCR assays for detection and type-specific identification of the endemic species C human adenoviruses. J Virol Methods 2016; 237:174-178. [PMID: 27363737 PMCID: PMC7173114 DOI: 10.1016/j.jviromet.2016.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
Abstract
Human adenoviruses (HAdVs) are medically important respiratory pathogens. Among the 7 recognized species (A-G), species C HAdVs (serotypes 1, 2, 5 and 6) are globally endemic and infect most people early in life. Species C HAdV infections are most often subclinical or mild and can lead to persistent shedding from the gastrointestinal and upper respiratory tracts. They can also cause severe disseminated disease in newborn and immunocompromised persons, where rapid and quantitative detection and identification of the virus would help guide therapeutic intervention. To this end, we developed quantitative type-specific real-time PCR (qPCR) assays for HAdV-1, -2, -5 and -6 targeting the HAdV hexon gene. All type-specific qPCR assays reproducibly detected as few as 5 copies/reaction of quantified hexon recombinant plasmids with a linear dynamic range of 8 log units (5-5×107 copies). No non-specific amplifications were observed with concentrated nucleic acid from other HAdV types or other common respiratory pathogens. Of 199 previously typed HAdV field isolates and positive clinical specimens, all were detected and correctly identified to type by the qPCR assays; 10 samples had 2 HAdV types and 1 sample had 3 types identified which were confirmed by amplicon sequencing. The species C HAdV qPCR assays permit rapid, sensitive, specific and quantitative detection and identification of four recognized endemic HAdVs. Together with our previously developed qPCR assays for the epidemic respiratory HAdVs, these assays provide a convenient alternative to classical typing methods.
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Affiliation(s)
- Xiaoyan Lu
- Gastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dean D Erdman
- Gastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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111
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Mitchell SL, Kajon AE, Kaplan SL, Kim J, Cárdenas AM. An unusual case of disseminated adenovirus infection in a cystic fibrosis, liver transplant patient. J Clin Virol 2016; 81:64-7. [PMID: 27331823 DOI: 10.1016/j.jcv.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Stephanie L Mitchell
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, Philadelphia, PA, United States
| | - Adriana E Kajon
- Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Summer L Kaplan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jason Kim
- Department of Pediatrics, The Perelman School of Medicine, Philadelphia, PA, United States; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ana María Cárdenas
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, Philadelphia, PA, United States; Infectious Diseases Diagnostics Laboratory, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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112
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Abstract
ABSTRACT
Gastrointestinal infections in the immunocompromised host are caused by the common bacterial, viral, fungal, and parasitic agents that also cause infections in the immunocompetent host. Of special consideration is that immunocompromised patients may be at increased risk for infection or disease severity and by pathogens not seen in the competent host. This chapter reviews the various agents, risk factors, and diagnostic approaches to detect gastrointestinal infections in this patient population.
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113
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Ganapathi L, Arnold A, Jones S, Patterson A, Graham D, Harper M, Levy O. Use of cidofovir in pediatric patients with adenovirus infection. F1000Res 2016; 5:758. [PMID: 27239277 PMCID: PMC4863673 DOI: 10.12688/f1000research.8374.2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children's Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alana Arnold
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Jones
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Al Patterson
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Marvin Harper
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ofer Levy
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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114
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Ganapathi L, Arnold A, Jones S, Patterson A, Graham D, Harper M, Levy O. Use of cidofovir in pediatric patients with adenovirus infection. F1000Res 2016; 5:758. [PMID: 27239277 DOI: 10.12688/f1000research.8374.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children's Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alana Arnold
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Jones
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Al Patterson
- Division of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Marvin Harper
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ofer Levy
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Molecular Diagnostics for Viral Infections in Transplant Recipients. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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116
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Ribeiro J, Ferreira D, Arrabalde C, Almeida S, Baldaque I, Sousa H. Prevalence of adenovirus and rotavirus infection in immunocompromised patients with acute gastroenteritis in Portugal. World J Virol 2015; 4:372-376. [PMID: 26568919 PMCID: PMC4641229 DOI: 10.5501/wjv.v4.i4.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To characterize the prevalence of rotavirus (RV) and adenovirus (AdV) infections in immunocompromised patients with acute gastroenteritis.
METHODS: The presence of RV and AdV (serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients (83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and AdV (serotypes 40 and 41) was determined by immunochromatography using the RIDA® Quick Rota-Adeno-Kombi kit (r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM® SPSS® (Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ2 test.
RESULTS: The study revealed 12.4% AdV positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. AdV was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63 (12.4%) were positive for AdV and 4 (0.8%) positive for RV, which by resuming the information of each patient, lead to an overall prevalence of AdV and RV of 6.5% (13/200 patients) and 1.5% (3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that AdV infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks (April 2010 and July 2010).
CONCLUSION: The overall prevalence of AdV and RV infection in immunocompromised patients with acute gastroenteritis was 8% and AdV was the most prevalent agent.
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117
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Klein J, Kuperman M, Haley C, Barri Y, Chandrakantan A, Fischbach B, Melton L, Rice K, Saim M, Yango A, Klintmalm G, Rajagopal A. Late presentation of adenovirus-induced hemorrhagic cystitis and ureteral obstruction in a kidney-pancreas transplant recipient. Proc AMIA Symp 2015; 28:488-91. [PMID: 26424950 DOI: 10.1080/08998280.2015.11929318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report a late presentation of adenovirus-induced renal allograft and bladder infection causing azotemia and hemorrhagic cystitis in a patient 5 years after simultaneous kidney-pancreas transplantation. Adenovirus has been increasingly recognized as a cause of morbidity and mortality in both solid organ and stem cell transplant recipients. We wish to emphasize the importance of early detection, as treatment options involve reduction of immunosuppression, followed by the addition of antiviral agents and supportive care.
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Affiliation(s)
- Jeffrey Klein
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Michael Kuperman
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Clinton Haley
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Yousri Barri
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Arun Chandrakantan
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Bernard Fischbach
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Larry Melton
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Kim Rice
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Muhammad Saim
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Angelito Yango
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Goran Klintmalm
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
| | - Arthi Rajagopal
- Department of Nephrology (Klein, Barri, Chandrakantan, Fischbach, Melton, Rice, Saim, Yango, Rajagopal), Department of Pathology (Kuperman), Division of Infectious Diseases (Haley), and Annette C. and Harold C. Simmons Transplant Institute (Klintmalm), Baylor University Medical Center at Dallas
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118
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Mehta V, Chou PC, Picken MM. Adenovirus disease in six small bowel, kidney and heart transplant recipients; pathology and clinical outcome. Virchows Arch 2015; 467:603-8. [PMID: 26377431 DOI: 10.1007/s00428-015-1846-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/15/2015] [Accepted: 09/04/2015] [Indexed: 12/15/2022]
Abstract
Adenoviruses are emerging as important viral pathogens in hematopoietic stem cell and solid organ transplant recipients, impacting morbidity, graft survival, and even mortality. The risk seems to be highest in allogeneic hematopoietic stem cell transplant recipients as well as heart, lung, and small bowel transplant recipients. Most of the adenovirus diseases develop in the first 6 months after transplantation, particularly in pediatric patients. Among abdominal organ recipients, small bowel grafts are most frequently affected, presumably due to the presence of a virus reservoir in the mucosa-associated lymphoid tissue. Management of these infections may be difficult and includes the reduction of immunosuppression, whenever possible, combined with antiviral therapy, if necessary. Therefore, an awareness of the pathology associated with such infections is important in order to allow early detection and specific treatment. We reviewed six transplant recipients (small bowel, kidney, and heart) with adenovirus graft involvement from two institutions. We sought to compare the diagnostic morphology and the clinical and laboratory findings. The histopathologic features of an adenovirus infection of the renal graft and one native kidney in a heart transplant recipient included a vaguely granulomatous mixed inflammatory infiltrate associated with rare cells showing a cytopathic effect (smudgy nuclei). A lymphocytic infiltrate, simulating T cell rejection, with admixture of eosinophils was also seen. In the small bowel grafts, there was a focal mixed inflammatory infiltrate with associated necrosis in addition to cytopathic effects. In the heart, allograft adenovirus infection was silent with no evidence of inflammatory changes. Immunohistochemical stain for adenovirus was positive in all grafts and in one native kidney. All patients were subsequently cleared of adenovirus infection, as evidenced by follow-up biopsies, with no loss of the grafts. Adenovirus infection can involve allografts as well as native organs in solid organ transplant recipients. Infection is associated with variable necrosis and acute inflammation, in addition to a rejection-like infiltrate. Hematuria in non-renal solid organ transplant recipients may be associated with adenovirus nephritis and clinically silent graft involvement. Prompt diagnosis (aided by immunohistochemistry (IHC) and serology), with specific treatment, can prevent graft loss.
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Affiliation(s)
- Vikas Mehta
- Pathology, Loyola University Medical Center, Chicago, IL, USA
| | - Pauline C Chou
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maria M Picken
- Pathology, Loyola University Medical Center, Chicago, IL, USA.
- Department of Pathology, Renal and Transplant Pathology, Loyola University Medical Center, Bldg#l10, Room#2242, 2160 S. First Avenue, Maywood, IL, 60153, USA.
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119
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Ying B, Toth K, Spencer JF, Aurora R, Wold WSM. Transcriptome sequencing and development of an expression microarray platform for liver infection in adenovirus type 5-infected Syrian golden hamsters. Virology 2015; 485:305-12. [PMID: 26319212 PMCID: PMC4619110 DOI: 10.1016/j.virol.2015.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/03/2015] [Accepted: 07/30/2015] [Indexed: 12/24/2022]
Abstract
The Syrian golden hamster is an attractive animal for research on infectious diseases and other diseases. We report here the sequencing, assembly, and annotation of the Syrian hamster transcriptome. We include transcripts from ten pooled tissues from a naïve hamster and one stimulated with lipopolysaccharide. Our data set identified 42,707 non-redundant transcripts, representing 34,191 unique genes. Based on the transcriptome data, we generated a custom microarray and used this new platform to investigate the transcriptional response in the Syrian hamster liver following intravenous adenovirus type 5 (Ad5) infection. We found that Ad5 infection caused a massive change in regulation of liver transcripts, with robust up-regulation of genes involved in the antiviral response, indicating that the innate immune response functions in the host defense against Ad5 infection of the liver. The data and novel platforms developed in this study will facilitate further development of this important animal model. Syrian hamster transcriptome; 42,707 transcripts representing 34,191 unique genes Syrian hamster custom expression microarray platform Ad5 intravenous infection of the Syrian hamster liver Ad5 upregulation of hamster liver genes involved in innate antiviral response.
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Affiliation(s)
- Baoling Ying
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States
| | - Karoly Toth
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States
| | - Jacqueline F Spencer
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States
| | - Rajeev Aurora
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States
| | - William S M Wold
- Saint Louis University School of Medicine, Department of Molecular Microbiology and Immunology, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States
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120
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Hutspardol S, Essa M, Richardson S, Schechter T, Ali M, Krueger J, Fujii H, Egeler RM, Gassas A. Significant Transplantation-Related Mortality from Respiratory Virus Infections within the First One Hundred Days in Children after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1802-7. [PMID: 26117558 PMCID: PMC7110880 DOI: 10.1016/j.bbmt.2015.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/19/2015] [Indexed: 11/03/2022]
Abstract
Respiratory viral infections (RVI) are important in hematopoietic stem cell transplantations (HSCT) and knowledge regarding incidence, morbidity, mortality, and long-term pulmonary complications is limited. We report a study to evaluate incidence and outcomes, both short and long-term, of RVI in children receiving HSCT. Between January 2000 and December 2012, 844 patients underwent hematopoietic stem cell transplantation (HSCT) at the Hospital for Sick Children: 491 were allogeneic and 353 were autologous. When screening for causes of death in the first year after HSCT in the 844 patients, we found that RVI as a cause of death was only evident in the first 100 days after HSCT. Fifty-four (6.5%) patients were found to have an RVI within the first 100 days after HSCT (allogeneic = 32, autologous = 22). Upper and lower respiratory tract infections were documented in 31 (57%) and 23 (43%) patients, respectively. Viruses were parainfluenza (35%), respiratory syncytial virus (28%), influenza (22%), adenovirus (7%), human metapneumovirus (4%), coronavirus (2%), and rhinovirus (2%). Three patients relapsed with their primary disease before day 100 and were excluded. The overall mortality for the remaining 51 patients was 10% (allogeneic = 4, autologous = 1). All 5 deaths were directly attributable to RVI and all 5 deaths occurred in patients with a lower respiratory tract infection. The remaining patients were followed for a median of 4.3 years (range, 1.4 to 11.8) and no chronic pulmonary complications were observed. A clear seasonal pattern for contracting RVI was evident with 65% of total RVI occurring between October and March (35 of 427 versus 19 of 417, P = .03). Given the significant mortality from RVI and the challenges in preventing them, choosing the time to start HSCT, whenever possible, may help prevent RVI and improve outcomes.
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Affiliation(s)
- Sakara Hutspardol
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada.
| | - Mohammed Essa
- Division of Haematology/Oncology/SCT, King Saud bin Abdulaziz University for Health Sciences, King Abdullah Specialized Children's Hospital Riyadh, Saudi Arabia
| | - Susan Richardson
- Division of Microbiology, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Muhammad Ali
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Joerg Krueger
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Hisaki Fujii
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - R Maarten Egeler
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Adam Gassas
- Division of Haematology/Oncology/BMT, the Hospital for Sick Children, University of Toronto, Ontario, Canada
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121
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A regenerating ultrasensitive electrochemical impedance immunosensor for the detection of adenovirus. Biosens Bioelectron 2015; 68:129-134. [DOI: 10.1016/j.bios.2014.12.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/28/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022]
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122
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Foong Ng K, Kee Tan K, Hong Ng B, Nair P, Ying Gan W. Epidemiology of adenovirus respiratory infections among hospitalized children in Seremban, Malaysia. Trans R Soc Trop Med Hyg 2015; 109:433-9. [PMID: 26038572 DOI: 10.1093/trstmh/trv042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is scarcity of data regarding epidemiology and clinical aspects of human adenovirus acute respiratory infection (ARI) among children in developing countries. METHODS Retrospective data on demographics, clinical presentation, outcomes and laboratory findings of 116 children admitted into Tuanku Jaafar Hospital in Seremban, Malaysia from 2012 to 2013 with documented diagnosis of community-acquired adenovirus ARI were collected and analyzed. RESULTS Male to female ratio was 1.70. Median age was 14 (1-107) months. The commonest symptoms were fever (94.8%; 110/116), cough (82.8%, 96), rhinorrhea (63.8%; 74), interrupted feeding (66.4%; 77), diarrhea (33.6%; 39) and conjunctivitis (21.6%; 25). Mean temperature on admission was 38.4°C±0.9°C. Among all 116 subjects, 20.7% (24) needed oxygen supplementation, 57.8% (67) required intravenous hydration, 11.2% (13) were admitted into the pediatric intensive care unit and 6.9% (8) required mechanical ventilation. Only 1% (1/87) had positive blood culture (Streptococcus pneumoniae) among 87 who received antibiotic treatment. Case fatality rate was 2.6% (3/116) and 1.7% (2/116) developed bronchiolitis obliterans. Median length of hospital stay was 4 (1-50) days. CONCLUSION Adenovirus ARI caused significant morbidity and substantial resource utilization among hospitalized Malaysian children. It should be considered in the differential diagnosis of infants below two years presenting with ARI associated with high fever. Antibiotics should not be prescribed as secondary bacterial infections are uncommon.
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Affiliation(s)
- Khuen Foong Ng
- Pediatric Department, Tuanku Jaafar Hospital, 70300 Seremban, Malaysia
| | - Kah Kee Tan
- Pediatric Department, Tuanku Jaafar Hospital, 70300 Seremban, Malaysia
| | - Boon Hong Ng
- Pediatric Department, Tuanku Jaafar Hospital, 70300 Seremban, Malaysia
| | - Pritiss Nair
- Pediatric Department, Tuanku Jaafar Hospital, 70300 Seremban, Malaysia
| | - Wan Ying Gan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43300 Serdang, Malaysia
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123
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Lo AA, Lo EC, Rao MS, Yang GY. Concurrent Acute Necrotizing Adenovirus Hepatitis and Enterocolitis in an Adult Patient After Double Cord Blood Stem Cell Transplant for Refractory Crohn's Disease. Int J Surg Pathol 2015; 23:404-8. [PMID: 25998316 DOI: 10.1177/1066896915587758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been recently recognized that adenovirus is a pathogen with high morbidity and mortality among immunocompromised patients, particularly after solid organ or stem cell transplant. Confluent necrotizing hepatitis secondary to adenovirus infection alone or together with other organ involvement is extremely rare. There are only 32 cases of confluent necrotizing hepatitis reported in adults since 1960 and most occur after iatrogenic immunosuppression for bone marrow or solid organ transplantation or in other states of immunosuppression, including acquired immunodeficiency syndrome or chemotherapy treatment. We present the first case of concurrent adenovirus-induced necrotizing hepatitis and enterocolitis in an adult patient after double cord stem cell transplant for refractory Crohn's disease. Additionally, we report the imaging and morphologic findings and discuss the potential significance of morphology and immunohistochemistry as a practical approach for identifying adenovirus.
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Affiliation(s)
- Amy A Lo
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - Edward C Lo
- University of Illinois at Chicago, Chicago, IL, USA
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124
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Nguyen C, Kaku S, Tutera D, Kuschner WG, Barr J. Viral Respiratory Infections of Adults in the Intensive Care Unit. J Intensive Care Med 2015; 31:427-41. [PMID: 25990273 DOI: 10.1177/0885066615585944] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
Viral lower respiratory tract infections (LRTIs) are an underappreciated cause of critical illness in adults. Recent advances in viral detection techniques over the past decade have demonstrated viral LRTIs are associated with rates of morbidity, mortality, and health care utilization comparable to those of seen with bacterial community acquired and nosocomial pneumonias. In this review, we describe the relationship between viral LRTIs and critical illness, as well as discuss relevant clinical features and management strategies for the more prevalent respiratory viral pathogens.
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Affiliation(s)
- Christopher Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shawn Kaku
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominic Tutera
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ware G Kuschner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Pulmonary Section, Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Juliana Barr
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
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125
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Toth K, Ying B, Tollefson AE, Spencer JF, Balakrishnan L, Sagartz JE, Buller RML, Wold WSM. Valganciclovir inhibits human adenovirus replication and pathology in permissive immunosuppressed female and male Syrian hamsters. Viruses 2015; 7:1409-28. [PMID: 25807051 PMCID: PMC4379578 DOI: 10.3390/v7031409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 12/14/2022] Open
Abstract
Adenovirus infections of immunocompromised pediatric hematopoietic stem cell transplant patients can develop into serious and often deadly multi-organ disease. There are no drugs approved for adenovirus infections. Cidofovir (an analog of 2-deoxycytidine monophosphate) is used at times but it can be nephrotoxic and its efficacy has not been proven in clinical trials. Brincidofovir, a promising lipid-linked derivative of cidofovir, is in clinical trials. Ganciclovir, an analog of 2-deoxyguanosine, has been employed occasionally but with unknown efficacy in the clinic. In this study, we evaluated valganciclovir against disseminated adenovirus type 5 (Ad5) infection in our permissive immunosuppressed Syrian hamster model. We administered valganciclovir prophylactically, beginning 12 h pre-infection or therapeutically starting at Day 1, 2, 3, or 4 post-infection. Valganciclovir significantly increased survival, reduced viral replication in the liver, and mitigated the pathology associated with Ad5 infection. In cultured cells, valganciclovir inhibited Ad5 DNA replication and blocked the transition from early to late stage of infection. Valganciclovir directly inhibited Ad5 DNA polymerase in vitro, which may explain, at least in part, its mechanism of action. Ganciclovir and valganciclovir are approved to treat infections by certain herpesviruses. Our results support the use of valganciclovir to treat disseminated adenovirus infections in immunosuppressed patients.
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Affiliation(s)
- Karoly Toth
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - Baoling Ying
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - Ann E Tollefson
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - Jacqueline F Spencer
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - Lata Balakrishnan
- Department of Biology, Indiana University - Purdue University Indianapolis, Indianapolis, IN 46202, USA.
| | - John E Sagartz
- Department of Comparative Medicine, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - Robert Mark L Buller
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
| | - William S M Wold
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, 1100 S. Grand Blvd., St. Louis, MO 63104, USA.
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126
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Abstract
Human adenoviruses (HAdVs) are an important cause of infections in both immunocompetent and immunocompromised individuals, and they continue to provide clinical challenges pertaining to diagnostics and treatment. The growing number of HAdV types identified by genomic analysis, as well as the improved understanding of the sites of viral persistence and reactivation, requires continuous adaptions of diagnostic approaches to facilitate timely detection and monitoring of HAdV infections. In view of the clinical relevance of life-threatening HAdV diseases in the immunocompromised setting, there is an urgent need for highly effective treatment modalities lacking major side effects. The present review summarizes the recent progress in the understanding and management of HAdV infections.
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127
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Ackoundou-N'Guessan C, Coulibaly N, Guei CM, Aye D, N'guessan FY, N'Dah JK, Lagou DA, Tia MW, Coulibaly PA, Nzoue S, Konan S, Gnionsahe DA. [Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature]. Nephrol Ther 2015; 11:104-10. [PMID: 25684056 DOI: 10.1016/j.nephro.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.
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Affiliation(s)
| | - Noël Coulibaly
- Unité pilote de transplantation rénale, service d'urologie, institut de cardiologie, CHU de Treichville, Km 1 boulevard de Marseille, BP V 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Cyr Monley Guei
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Denis Aye
- Service d'anesthésie et de réanimation, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Francis Yapi N'guessan
- Service d'anesthésie et de réanimation, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | - Justin Kouame N'Dah
- Service d'anatomie pathologique, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | | | - Mélanie Weu Tia
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Sita Nzoue
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Serges Konan
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
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128
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Rajkumar V, Chiang CSM, Low JM, Cui L, Lin RTP, Tee NWS, Maiwald M, Chong CY, Thoon KC, Tan NWH. Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2015; 44:50-59. [PMID: 25797817 DOI: 10.47102/annals-acadmedsg.v44n2p50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Human adenoviruses (HAdVs) can cause a variety of human illnesses, with associated temporal and geographic changes in disease incidence. We report the emergence of an outbreak of HAdV infections in Singapore, presumably caused by a change of the predominating type to HAdV-7. We examined the clinical features of children admitted with HAdV infection to 1 institution and the risk factors for severe infection. MATERIALS AND METHODS This is a retrospective case-control study of all HAdV-infected children admitted during weeks 1 to 19 in 2013, as identified from laboratory records. A descriptive retrospective analysis of epidemiology, clinical data and the outcome of these children was also performed. Patients with severe infections were defined as cases, those with non-severe infections as controls, and the 2 groups were compared to find possible independent risk factors. RESULTS Eighty-five patients with HAdV infection were studied, including 11 (12.9%) cases and 74 (87.1%) controls. Binary logistic regression showed that cases were more likely to be <2 years old (adjusted OR 10.6, 95% CI, 1.8 to 63.2) and to have significant comorbidities (adjusted OR 19.9, 95% CI, 3.4 to 116.1) compared to controls. The predominant type in 2013 was HAdV-7, which differed from 2011 and 2012, when HAdV-3 was more common. There was a trend towards pneumonia being more common in patients infected with HAdV-7 than in patients infected with other types, although this did not reach statistical significance (OR 2.8, 95% CI, 0.9 to 8.7). CONCLUSION The emergence of HAdV-7 in a population where other HAdV types had circulated previously may have caused the outbreak in Singapore, and this was associated with more serious infections in children. Young age (<2 years) and significant comorbidities were associated with more severe HAdV infection.
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Affiliation(s)
- Veena Rajkumar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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129
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Tong LX, Worswick SD. Viral infections in acute graft-versus-host disease: a review of diagnostic and therapeutic approaches. J Am Acad Dermatol 2015; 72:696-702. [PMID: 25582535 DOI: 10.1016/j.jaad.2014.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND While immunosuppressive therapy for acute graft-versus-host disease (aGVHD) advances, viral reactivation has been found to be an increasingly common complication in these patients. Dermatologists may often be consulted on inpatient services for evaluation. OBJECTIVE We investigated the literature for the role of viral infections in aGVHD and review the current evidence regarding management. METHODS Articles in the public domain regarding aGVHD, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, hepatitis viruses, parvovirus B19, and respiratory viruses were included. RESULTS Dermatologic findings vary between different viral antigens, and some infections may be a marker for the development of aGVHD or worsen prognosis. LIMITATIONS The heterogeneous cohorts of the studies reviewed often preclude direct comparison between results. CONCLUSION The relationship between viral reactivation and aGVHD may be bidirectional and is worthy of further exploration. Additional studies are needed to determine appropriate prophylaxis and treatment.
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Affiliation(s)
- Lana X Tong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Scott D Worswick
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California.
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130
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Bruminhent J, Athas DM, Hess BD, Flomenberg P. Disseminated adenovirus disease in heart transplant recipient presenting with conjunctivitis. Transpl Infect Dis 2015; 17:125-8. [PMID: 25571908 DOI: 10.1111/tid.12342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/10/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
We report a 65-year-old heart transplant recipient who presented with conjunctivitis, likely acquired from a family member who worked at a daycare center during an outbreak of conjunctivitis. He developed a severe adenoviral pneumonitis, which was successfully treated with intravenous cidofovir combined with a reduction of immunosuppression.
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Affiliation(s)
- J Bruminhent
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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131
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132
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Infectious Complications. BLOOD AND MARROW TRANSPLANT HANDBOOK 2015. [PMCID: PMC7123792 DOI: 10.1007/978-3-319-13832-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infections remain a cause of significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT). The conditioning regimen (chemotherapy, radiation therapy), mucosal damage, type of transplant, immune suppressive therapy, and graft-versus-host disease (GVHD) all predispose the HSCT recipient to infection. Abnormal B- and T-lymphocyte function results in impaired humoral and cellular immunity, respectively. Neutrophil function is impaired by the use of corticosteroids and other medications. Hypogammaglobulinemia and functional asplenia are common. The occurrence of infections in an individual patient varies according to the phase of the transplant process and reflects the type(s) of immune defect(s), underlying disease, endogenous host flora, exposure history, and pre-treatment infections.
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133
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Cidofovir and brincidofovir reduce the pathology caused by systemic infection with human type 5 adenovirus in immunosuppressed Syrian hamsters, while ribavirin is largely ineffective in this model. Antiviral Res 2014; 112:38-46. [PMID: 25453340 DOI: 10.1016/j.antiviral.2014.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/23/2022]
Abstract
There are no drugs approved specifically to treat disseminated adenovirus (Ad) infections in humans. Cidofovir is active against Ad in cell culture, and it is used frequently in the clinic with disseminated infection in pediatric transplant patients; however, controlled clinical studies have not been conducted to prove the anti-Ad efficacy of cidofovir. Brincidofovir, a lipid-linked derivative of cidofovir, which has strong activity against Ad in cell culture and in animal models, is a promising new drug currently in clinical trials. Ribavirin, which has modest activity against some Ad types in cell culture, has been used in the clinic against disseminated Ad, but the efficacy of ribavirin is unknown. In the current study, we have examined the activity of cidofovir, brincidofovir, and ribavirin against disseminated Ad5 infection in the immunosuppressed Syrian hamster model. Hamsters are immunosuppressed by treatment with cyclophosphamide, then infected intravenously with Ad5, leading to disseminated Ad5 infection, especially in the liver. We found that cidofovir and brincidofovir have excellent activity against Ad5 pathology and replication in the liver, even when administered therapeutically starting at 3 days post-challenge with Ad5. Ribavirin did not have anti-Ad5 activity in our model. Our data support the use of cidofovir and brincidofovir in humans for the treatment of disseminated Ad infections in humans.
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134
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Kajon AE, Lamson D, Shudt M, Oikonomopoulou Z, Fisher B, Klieger S, St George K, Hodinka RL. Identification of a novel intertypic recombinant species D human adenovirus in a pediatric stem cell transplant recipient. J Clin Virol 2014; 61:496-502. [PMID: 25449172 DOI: 10.1016/j.jcv.2014.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/08/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Human adenoviruses (HAdV) are known opportunistic pathogens in hematopoietic stem cell transplant (SCT) recipients. The detection of HAdV infection in children after SCT has been implicated as a determinant of poor outcome but specific associations between HAdV species or individual HAdV types and disease are poorly understood. OBJECTIVES Characterization of a HAdV-D strain isolated from multiple clinical specimens of an 11-year-old female recipient of a matched unrelated donor peripheral SCT for T-cell lymphoma and case report. STUDY DESIGN Archived HAdV PCR-positive plasma, urine, and stool specimens were processed for virus isolation and detailed molecular typing. Complete genomic sequencing was carried out on 2 isolates. RESULTS The patient tested positive for HAdV DNA by real-time PCR of a stool specimen at 44 days after initiation of a SCT conditioning regimen. In the subsequent 3 months, HAdV was detected in plasma, urine and stool specimens in association with symptoms of gastroenteritis and hemorrhagic cystitis. A novel HAdV-D with a HAdV20-like hexon gene was isolated from both urine and stool specimens. All isolates yielded identical restriction profiles with endonucleases BamHI, BglII, BstEII, HindIII, PstI and SmaI. Analysis of 2 complete genomic sequences further identified the virus as a novel intertypic recombinant HAdV-D (P20/H20/F42) closely related to HAdV42. CONCLUSIONS This case highlights the identification of a previously unknown HAdV-D from an immunocompromised host. In this patient, the course of adenovirus infection is compatible with reactivation of a latent virus or a primary opportunistic infection. Adenoviremia in this patient resolved without definitive adenovirus-directed antiviral therapy.
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Affiliation(s)
- Adriana E Kajon
- Infectious Disease Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
| | - Daryl Lamson
- Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Matthew Shudt
- Applied Genomics Technologies Core, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Zacharoula Oikonomopoulou
- Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian Fisher
- Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Klieger
- Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kirsten St George
- Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Richard L Hodinka
- Department of Pathology and Laboratory Medicine and Clinical Virology Laboratory, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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135
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Ganciclovir inhibits human adenovirus replication and pathogenicity in permissive immunosuppressed Syrian hamsters. Antimicrob Agents Chemother 2014; 58:7171-81. [PMID: 25224011 DOI: 10.1128/aac.03860-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adenovirus infections of immunocompromised patients can develop into deadly multiorgan or systemic disease. The virus is especially threatening for pediatric allogeneic hematopoietic stem cell transplant recipients; according to some studies, 10% or more of these patients succumb to disease resulting from adenovirus infection. At present, there is no drug approved for the treatment or prevention of adenovirus infections. Compounds that are approved to treat other virus infections are used off-label to combat adenovirus, but only anecdotal evidence of the efficacy of these drugs exists. Ganciclovir, a drug approved for the treatment of herpesvirus infection, was previously reported to be effective against human adenoviruses in vitro. To model adenovirus infections in immunocompromised humans, we examined ganciclovir's efficacy in immunosuppressed Syrian hamsters intravenously infected with type 5 human adenovirus (Ad5). This animal model is permissive for Ad5 replication, and the animals develop symptoms similar to those seen in humans. We demonstrate that ganciclovir suppresses Ad5 replication in the liver of infected hamsters and that it mitigates the consequences of Ad5 infections in these animals when administered prophylactically or therapeutically. We show that ganciclovir inhibits Ad5 DNA synthesis and late gene expression. The mechanism of action for the drug is not clear; preliminary data suggest that it exerts its antiadenoviral effect by directly inhibiting the adenoviral DNA polymerase. While more extensive studies are required, we believe that ganciclovir is a promising drug candidate to treat adenovirus infections. Brincidofovir, a drug with proven activity against Ad5, was used as a positive control in the prophylactic experiment.
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136
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Norvell JP. Liver disease after hematopoietic cell transplantation in adults. Transplant Rev (Orlando) 2014; 29:8-15. [PMID: 25315987 DOI: 10.1016/j.trre.2014.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
Abstract
Liver-related complications constitute a large component of the overall morbidity and mortality associated with hematopoietic cell transplantation. Affecting up to 80% of allogeneic HCT recipients, prompt recognition and treatment are essential. The differential diagnosis is broad and is best categorized by time of onset after transplantation. Early complications include drug-induced liver injury, sinusoidal obstruction syndrome, and graft-versus-host disease. Late complications include infectious sequelae, cirrhosis, and hepatic malignancies. Patients being considered for hematopoietic cell transplantation should be screened and evaluated for liver-related complications to help improve outcomes.
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Affiliation(s)
- J P Norvell
- Department of Medicine, Division of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
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137
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Babady NE. The FilmArray® respiratory panel: an automated, broadly multiplexed molecular test for the rapid and accurate detection of respiratory pathogens. Expert Rev Mol Diagn 2014; 13:779-88. [PMID: 24151847 PMCID: PMC7103684 DOI: 10.1586/14737159.2013.848794] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The FilmArray Respiratory Panel (RP) (BioFire(™) Diagnostics, Inc., Salt Lake City, UT, USA) is the first multiplex molecular panel cleared by the US FDA for the detection of both bacterial and viral respiratory pathogens in nasopharygeal swabs. The FilmArray RP targets 20 pathogens including 17 viruses and subtypes and three bacteria, and is performed with minimal sample manipulation. The FilmArray RP has a fully automated sample-to-answer workflow with a turn-around-time of approximately 1 h. The reported sensitivity and specificity of the assay ranges from 80 to 100 and 100%, respectively, with the sensitivity for the adenovirus as low as 46%. A new version of the FilmArray RP assay (version 1.7) with improved sensitivity for the adenovirus was released in 2013. The performance characteristics and simplified workflow have allowed its implementation in a wide range of laboratories. The FilmArray RP has changed the diagnostic landscape and will have a significant impact on the care of patients with respiratory tract infection.
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Affiliation(s)
- N Esther Babady
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, S428D, New York, NY, 10044, USA
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138
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Abstract
Hematopoietic stem cell transplantation (HSCT) is an accepted treatment for a variety of hematologic malignancies. The profound immunosuppression these patients experience adversely affects their risk of infection. This risk is much higher than in the general population and requires aggressive diagnostic and therapeutic interventions. The chapter will outline the major infections after HSCT.
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139
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Sandkovsky U, Vargas L, Florescu DF. Adenovirus: current epidemiology and emerging approaches to prevention and treatment. Curr Infect Dis Rep 2014; 16:416. [PMID: 24908344 DOI: 10.1007/s11908-014-0416-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Infections caused by adenoviruses are associated with significant morbidity and mortality in both hematopoietic stem cell and solid organ transplant recipients. The risk seems to be highest in allogeneic hematopoietic stem cell transplant recipients as well as heart, lung and small-bowel transplant recipients. Management of these infections may be difficult and includes reduction of immunosuppression whenever possible combined sometimes with antiviral therapy (mainly cidofovir). The currently available antiviral therapy is limited by the need for intravenous administration, potentially significant renal and hematologic toxicities. New emerging therapies such as brincidofovir and transfusion of adenovirus-specific T-lymphocytes may increase the available armamentarium for these potentially life-threatening infections.
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Affiliation(s)
- Uriel Sandkovsky
- Division of Infectious Diseases, Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA
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140
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Abstract
Viruses are a common and important cause of severe community-acquired pneumonia, and may lead to severe respiratory disease and admission to the intensive care unit. Influenza is the most common virus associated with severe viral pneumonia, although other important causes include respiratory syncytial virus, adenovirus, metapneumonia virus, and coronaviruses. Viral pneumonias tend to have a seasonal predilection and are often preceded by a typical viral prodrome. This article focuses on severe influenza pneumonia, including the 2009 H1N1 pandemic, and briefly discusses other causes of severe respiratory disease of viral etiology.
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Affiliation(s)
- Clare D Ramsey
- Section of Respiratory Medicine, Department of Medicine, University of Manitoba, RS 314, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada; Section of Critical Care, Department of Medicine, University of Manitoba, GC 425, 820 Sherbrook Street, Winnipeg, Manitoba R3T 2N2, Canada; Department of Community Health Sciences, University of Manitoba, S113, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
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141
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Relationship of BK polyoma virus (BKV) in the urine with hemorrhagic cystitis and renal function in recipients of T Cell-depleted peripheral blood and cord blood stem cell transplantations. Biol Blood Marrow Transplant 2014; 20:1204-10. [PMID: 24769326 DOI: 10.1016/j.bbmt.2014.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023]
Abstract
Hematopoietic stem cell transplant (HSCT) recipients are at significant risk for BK virus (BKV) reactivation, hemorrhagic cystitis (HC), and renal dysfunction. We prospectively monitored 98 patients who had received HSCT by serial BKV PCR in the urine through day (D) +100 to analyze the relationship between BK viruria and HC, serum creatinine (Cr), and creatinine clearance (CrCl) through D +180 or death. Patients, median age 52 years (range, 20 to 73), received T cell-depleted (50%) or cord blood allografts (21%). Median pre-HSCT BKV IgG titers were 1:10,240. Incremental increase in BKV IgG titers correlated with developing BK viruria ≥ 10(7) copies/mL. By D +100, 53 (54%) patients had BK viruria. BKV load in the urine increased at engraftment and persisted throughout D +100. HC developed in 10 patients (10%); 7 of 10 with BK viruria. In competing risk analyses, BK viruria ≥ 10(7) copies/mL, older age, cytomegalovirus reactivation, and foscarnet use were risk factors for HC. Cr and CrCl at 2, 3, and 6 months after HSCT were similar between patients with and without BK viruria.
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142
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Lee L, Ison M. Diarrhea caused by viruses in transplant recipients. Transpl Infect Dis 2014; 16:347-58. [DOI: 10.1111/tid.12212] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/11/2013] [Accepted: 12/21/2013] [Indexed: 01/25/2023]
Affiliation(s)
- L.Y. Lee
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Northwestern University Transplant Outcomes Research Collaborative; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
| | - M.G. Ison
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Northwestern University Transplant Outcomes Research Collaborative; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Division of Infectious Diseases Northwestern University Feinberg School of Medicine; Chicago Illinois USA
- Division of Organ Transplantation; Northwestern University Feinberg School of Medicine; Chicago Illinois USA
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143
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Rady K, Walters G, Brown M, Talaulikar G. Allograft adenovirus nephritis. Clin Kidney J 2014; 7:289-92. [PMID: 25852891 PMCID: PMC4377743 DOI: 10.1093/ckj/sfu020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/19/2014] [Indexed: 11/13/2022] Open
Abstract
We present an uncommon case of allograft adenovirus tubulointerstitial nephritis in a 63-year-old male 6 weeks following cadaveric renal transplantation for end-stage renal failure secondary to hypertensive nephrosclerosis. The patient presented with acute onset of fevers, dysuria, haematuria and diarrhoea with acute graft dysfunction. A renal biopsy demonstrated necrotizing tubulointerstitial nephritis with viral cytopathic changes and no evidence of rejection. Adenovirus was identified as the pathogen. Treatment involved the reduction in the patient's usual immunosuppression, intravenous immunoglobulin, piperacillin-tazobactam and ganciclovir. We present the clinical and pathological findings of necrotizing adenoviral nephropathy, highlighting the importance of considering this diagnosis in renal transplant recipients presenting with interstitial nephritis in the setting of a systemic illness.
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Affiliation(s)
- Kirsty Rady
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
| | - Giles Walters
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
| | - Michael Brown
- Department of Pathology , The Canberra Hospital , Canberra, ACT , Australia
| | - Girish Talaulikar
- Department of Nephrology , The Canberra Hospital , Canberra, ACT , Australia
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144
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Dawood US, Nelson A, Wu D, Otto S, Russ GR. Disseminated adenovirus infection in kidney transplant recipient. Nephrology (Carlton) 2014; 19 Suppl 1:10-3. [DOI: 10.1111/nep.12192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ubaidullah S Dawood
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
| | - Adam Nelson
- Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Danielle Wu
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
| | - Sophia Otto
- Royal Adelaide Hospital; Adelaide South Australia Australia
- SA Pathology; Adelaide South Australia Australia
| | - Graeme R Russ
- Royal Adelaide Hospital; Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Services; Adelaide South Australia Australia
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145
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Abstract
Adenovirus infections have been associated with significant morbidity and mortality in immunocompromised hosts. The clinical significance of adenovirus disease in heart transplantation is not well-defined; in particular, the significance of adenovirus identification in myocardium remains unclear. Although severe adenovirus disease has been described in heart transplant recipients, adenovirus infections seem to be more frequently associated with increased risk of adverse cardiac events, such as rejection, ventricular dysfunction, coronary vasculopathy, need for retransplantation, and graft loss because of death. Cidofovir is currently considered the standard of treatment for adenovirus disease not responding to reduction of immunosuppression.
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146
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Schreiber J, Langhorst H, Jüttner R, Rathjen FG. The IgCAMs CAR, BT-IgSF, and CLMP: Structure, Function, and Diseases. ADVANCES IN NEUROBIOLOGY 2014; 8:21-45. [DOI: 10.1007/978-1-4614-8090-7_2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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147
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Mochizuki K, Kondo Y, Hosokawa K, Ohata K, Yamazaki H, Takami A, Sasaki M, Sato Y, Nakanuma Y, Nakao S. Adenovirus pneumonia presenting with nodular shadows on chest X-ray in two unrelated allogeneic bone marrow transplant recipients. Intern Med 2014; 53:499-503. [PMID: 24583443 DOI: 10.2169/internalmedicine.53.1192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adenoviruses are increasingly recognized as important pathogens following allogeneic stem cell transplantation. We herein report two cases of disseminated adenovirus infection that presented with nodular shadows on chest X-ray after allogeneic bone marrow transplantation from unrelated donors. Both patients died of respiratory failure. Autopsies revealed adenovirus infection of multiple organs. Adenovirus infection should be suspected when nodular lung lesions of unknown origin appear in allogeneic stem cell transplant recipients.
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Affiliation(s)
- Kanako Mochizuki
- Department of Cellular Transplantation Biology, Division of Cancer Medicine, Kanazawa University Graduate School of Medical Science, Japan
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Matthes-Martin S, Boztug H, Lion T. Diagnosis and treatment of adenovirus infection in immunocompromised patients. Expert Rev Anti Infect Ther 2013; 11:1017-28. [PMID: 24073835 DOI: 10.1586/14787210.2013.836964] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In immunocompromised patients, human adenovirus (HAdV) infections can cause life-threatening multiorgan disease. This review summarizes the incidence and risk factors of invasive human adenovirus infections in immunocompromised patients as well as the recently developed standards for diagnostic methods and strategies according to the predominant risk factors in adults and children. Recommendations for preemptive and therapeutic treatment strategies and the outcome in different risk groups are presented. Novel therapeutic approaches including CMX001, a new orally bioavailable lipid conjugate of cidofovir and the transfer of adenovirus-specific donor T cells in the context of allogeneic stem cell transplantation are discussed.
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Affiliation(s)
- Susanne Matthes-Martin
- St Anna Children's Hospital, Stem cell transplantation, Medical University of Vienna, Vienna, Austria
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Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant 2013; 2013:969186. [PMID: 24066254 PMCID: PMC3771480 DOI: 10.1155/2013/969186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022] Open
Abstract
Adenoviruses (AdV) are emerging pathogens with a prevalence of 11% viruria and 6.5% viremia in kidney transplant recipients. Although AdV infection is common, interstitial nephritis (ADVIN) is rare with only 13 biopsy proven cases reported in the literature. We report a case of severe ADVIN with characteristic histological features that includes severe necrotizing granulomatous lesion with widespread tubular basement membrane rupture and hyperchromatic smudgy intranuclear inclusions in the tubular epithelial cells. The patient was asymptomatic at presentation, and the high AdV viral load (quantitative PCR>2,000,000 copies/mL in the urine and 646,642 copies/mL in the serum) confirmed the diagnosis. The patient showed excellent response to a combination of immunosuppression reduction, intravenous cidofovir, and immunoglobulin therapy resulting in complete resolution of infection and recovery of allograft function. Awareness of characteristic biopsy findings may help to clinch the diagnosis early which is essential since the disseminated infection is associated with high mortality of 18% in kidney transplant recipients. Cidofovir is considered the agent of choice for AdV infection in immunocompromised despite lack of randomized trials, and the addition of intravenous immunoglobulin may aid in resolution of infection while help prevention of rejection.
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Abstract
PURPOSE To describe the demographics, clinical manifestations, treatment and outcomes of patients with human adenovirus (HAdV) hepatitis. METHODS A case of fulminant HAdV hepatitis in a patient with chronic lymphocytic leukemia receiving rituximab and fludarabine is described. We conducted a comprehensive review of the English-language literature through May, 2012 in search of definite cases of HAdV hepatitis. RESULTS Eighty-nine cases were reviewed. Forty-three (48 %) were liver transplant recipients, 19 (21 %) were bone marrow transplant recipients, 11 (12 %) had received chemotherapy, five (6 %) had severe combined immunodeficiency, four (4 %) were HIV infected, two had heart transplantation, and two were kidney transplant recipients. Ninety percent (46/51) of patients presented within 6 months following transplantation. Fever was the most common initial symptom. Abdominal CT scan revealed hypodense lesions in eight of nine patients. Diagnosis was made by liver biopsy in 43 (48 %), and on autopsy in 46 (52 %). The HAdV was isolated at other sites in 54 cases. Only 24 of 89 patients (27 %) survived: 16 whose immunosuppression was reduced, six with liver re-transplantation, and two who received cidofovir and intravenous immunoglobulin. CONCLUSION HAdV hepatitis can manifest as a fulminant illness in immunocompromised hosts. Definitive diagnosis requires liver biopsy. Early consideration of a viral etiology, reduction in immunosuppression, and liver transplantation can be potentially life-saving.
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