1
|
Gu J, Su QQ, Zuo TT, Chen YB. Adenovirus diseases: a systematic review and meta-analysis of 228 case reports. Infection 2020; 49:1-13. [PMID: 32720128 DOI: 10.1007/s15010-020-01484-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The clinical characteristics of various adenovirus (ADV) infection are underexplored up till now. To investigate the risk factors, manifestation, current status of ADV species, treatment and prognosis of this disease. METHODS We performed a Pubmed and Embase systematic review for case report reporting the ADV infection to analyze the clinical characteristics of disease. RESULTS Initial database searched identified articles of which 168 (228 cases) were included in the final analysis. Previous solid organ transplantation [odds ratio (OR) = 3.45, 95% CI 1.31-9.08, P = 0.01], hematopoietic stem cell transplant (OR = 4.24, 95% CI 1.33-13.51, P = 0.01) and hematological malignancy (OR = 4.78, 95% CI 1.70-13.46, P = 0.01) were associated with increased risk of disseminated ADV infection. Use of corticosteroids (OR = 3.86, 95% CI 1.21-12.24, P = 0.02) was a significant risk factor for acquiring urinary tract infections. A total of six species (21 types) of ADV infection have been identified in 100/228 (43.9%) cases. ADV B was the most common species. ADV B species (26/60, 52.0% or 5/41, 12.2% P = 0.001) were more isolated in patients with ADV pneumonia. ADV C (13/15, 86.7% versus 35/86, 40.7% P = 0.001) species were more identified in patients with disseminated disease. The species associated with keratoconjunctivitis is only ADV D in our analysis. Urinary tract ADV infections were observed in ADV A/B/D species. Cidofovir (CDV) (82/228, 36.0%) remained the most commonly antiviral therapy in our cases, followed by ribavirin (15/228, 6.6%), ganciclovir (18/228, 7.9%), and brincidofovir (12/228, 5.3%). Brincidofovir was administered as salvage therapy in 10 cases. Death was reported in 81/228 (35.5%) patients. Mortality rate was higher among patients with gastrointestinal (GI) ADV infection (5/10, 50.0%), ADV pneumonia (20/45, 44.4%) and disseminated ADV infection (53/122, 43.4%). CONCLUSION Previous solid organ transplantation, hematopoietic stem cell transplant and hematological malignancy were risk factors for disseminated ADV infection. Use of corticosteroids was significant for urinary tract ADV infection. Different species correlated with different clinical manifestations of infection. Mortality rate was higher among patients with GI disease, pneumonia and disseminated disease. Our review clarified the current treatment of ADV infections, and more treatment required further investigation.
Collapse
Affiliation(s)
- Jie Gu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Qing-Qing Su
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Ting-Ting Zuo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China.
| |
Collapse
|
2
|
Egan J, Vranic G, Ghasemian SR. Alum irrigation for the treatment of adenovirus induced hemorrhagic cystitis in a kidney transplant recipient. Urol Case Rep 2020; 30:101042. [PMID: 32055446 PMCID: PMC7005441 DOI: 10.1016/j.eucr.2019.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022] Open
Abstract
Adenovirus is a rare cause of hemorrhagic cystitis in the transplant population. We present a case of a forty-one-year-old man with end-stage renal disease who underwent living unrelated donor kidney transplant in 2016. In 2018 he presented with acute onset gross hematuria and dysuria, with serologic testing and immunohistochemical stains of biopsy specimens positive for adenovirus. He was treated with reduction in immunosuppression, cystoscopy with evacuation of clots, and alum bladder irrigation. His hematuria resolved almost immediately with no recurrence to date. This case demonstrates the efficacy and safety of alum irrigation in patients with adenovirus hemorrhagic cystitis.
Collapse
|
3
|
Prospective Assessment of Adenovirus Infection in Pediatric Kidney Transplant Recipients. Transplantation 2019; 102:1165-1171. [PMID: 29762251 DOI: 10.1097/tp.0000000000002100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenovirus infection is associated with graft dysfunction and graft loss in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. METHODS We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. RESULTS Adenovirus viremia was detected in 11 (14.7%) patients at a median onset of 173 days (interquartile range, 109-310 days) posttransplant, 6 (8%) had asymptomatic viremia, and 5 (6.7%) had symptomatic disease (2 with hematuria and 3 with an acute febrile respiratory illness). Viremic patients did not differ from nonviremic patients in age, immunosuppression management, or cytomegalovirus or Epstein-Barr virus serostatus, but were more likely to develop cytomegalovirus viremia during the first 2 years posttransplant. No patient had an increase in creatinine from baseline during the time of adenovirus viremia. In a Cox proportional hazards regression, subclinical adenovirus viremia was not associated with a faster time to a 30% decline in estimated glomerular filtration rate. CONCLUSIONS Adenovirus infection is common among pediatric kidney transplant recipients and frequently causes symptomatic disease; however, symptoms are often mild and are not associated with a decline in graft function. Routine monitoring for adenovirus viremia in pediatric kidney transplant recipients may not be warranted.
Collapse
|
4
|
L Moreira C, Rocha J, Silva M, Silva J, Almeida M, Pedroso S, Vizcaíno R, Martins LS, Dias L, Henriques AC, Cabrita A. Adenovirus infection-A rare cause of interstitial nephritis in kidney transplant. Nefrologia 2018; 39:106-107. [PMID: 30097206 DOI: 10.1016/j.nefro.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/06/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Carla L Moreira
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal.
| | - Joana Rocha
- Nephrology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Margarida Silva
- Pathology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Joana Silva
- Nephrology Department, Hospital Garcia da Orta, EPE, Almada, Portugal
| | - Manuela Almeida
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Sofia Pedroso
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Ramon Vizcaíno
- Pathology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - La Salete Martins
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - Leonídio Dias
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - António Castro Henriques
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| | - António Cabrita
- Nephrology Department, Centro Hospitalar Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
| |
Collapse
|
5
|
Park UJ, Hyun SK, Kim HT, Cho WH, Han SY. Successful treatment of disseminated adenovirus infection with ribavirin and intravenous immunoglobulin in an adult renal transplant recipient: a case report. Transplant Proc 2015; 47:791-3. [PMID: 25891733 DOI: 10.1016/j.transproceed.2014.11.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
Disseminated adenovirus infection in recipients of renal transplants is a rare but often fatal complication. We present a case of a 32-year-old woman who underwent renal transplantation from a deceased donor. Ten months after transplantation, she presented with dysuria, hematuria, and febrile illness. Despite the use of antibiotics, the patient's symptoms continued and worsened and the serum creatinine level was increased. The results of urine and serum polymerase chain reaction were positive for adenovirus. Renal biopsy revealed viral interstitial nephritis. The patient was treated with ribavirin, intravenous immunoglobulin, and reduction in immunosuppression. Her symptoms progressively improved from 7 days after the treatment. Serum and urine polymerase chain reaction for adenovirus became negative 10 and 21 days after the treatment, respectively. She remained in good health with excellent allograft function 6 months later.
Collapse
Affiliation(s)
- U J Park
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea.
| | - S K Hyun
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - H T Kim
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - W H Cho
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - S Y Han
- Division of Nephrology, Keimyung University, Dongsan Medical Center, Daegu, Korea
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Fever, haematuria, and acute graft dysfunction in renal transplant recipients secondary to adenovirus infection: two case reports. Case Rep Nephrol 2013; 2013:195753. [PMID: 24558620 PMCID: PMC3914224 DOI: 10.1155/2013/195753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/28/2012] [Indexed: 11/17/2022] Open
Abstract
We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR.
Collapse
|