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Hissong E, Arora K, Andy C, Jessurun J, Yantiss RK. Histologic Manifestations of Gastrointestinal Adenovirus Infection After Stem Cell Transplant. Am J Surg Pathol 2024; 48:521-527. [PMID: 38329327 DOI: 10.1097/pas.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Adenovirus can cause severe disease in hematopoietic stem cell transplant (HSCT) patients. Histopathologic features of this infection in gastrointestinal biopsies and their distinction from graft-versus-host disease (GVHD) have been incompletely studied. We retrospectively identified patients with gastrointestinal adenovirus infection. H&E-stained sections were reviewed and the histologic features were recorded. The extent of immunostaining was determined using a semiquantitative scale and a maximum number of positive cells per high-power field. Information regarding the clinical course and endoscopic findings were obtained from the electronic medical records. The study group included 32 HSCT patients. Most (81%) presented with diarrhea and detectable virus in the serum. Twenty patients had multiorgan involvement in the gastrointestinal tract, mostly in the duodenum (62%) and colon (56%). Characteristic features included apoptotic epithelial cells with nuclear disarray (84%) and tufted aggregates of degenerating epithelial cells (69%), the latter of which was more commonly seen in the study population more than a control group of HSCT patients with GI involvement by GVHD. Viral inclusions were limited to the superficial epithelium in 59% of samples, and the density of viral inclusions within biopsies was variable (grade 1: 40%, grade 2: 38%, and grade 3: 22%). Following therapy, 10 patients (30%) improved and 14 (42%) had progressive disease. Patients with disease progression were often older (64 vs. 36 years, P =0.01) with higher serologic viral loads, prior history of GVHD, multifocal involvement, and increased number and density of immunoreactive nuclei. Adenovirus infection elicits a spectrum of histologic changes that can simulate or occur in combination with gastrointestinal GVHD. Patients with progressive disease are more likely to have high viral loads and more extensive infection of the gastrointestinal tract.
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Affiliation(s)
| | | | - Caroline Andy
- Population Health Sciences, Weill Cornell Medicine, New York, NY
| | | | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL
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2
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Cavallazzi R, Ramirez JA. Influenza and Viral Pneumonia. Infect Dis Clin North Am 2024; 38:183-212. [PMID: 38280763 DOI: 10.1016/j.idc.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are in general nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, Louisville, KY, USA.
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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3
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Brüssow H. Non-A to E hepatitis in children: Detecting a novel viral epidemic during the COVID-19 pandemic. Microb Biotechnol 2023; 16:1879-1887. [PMID: 37602673 PMCID: PMC10527185 DOI: 10.1111/1751-7915.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
During the COVID-19 pandemic, two further novel viral epidemics were described in 2022, monkeypox virus infections in men having sex with men and non-A to E hepatitis in children. The latter occurred in the first half of 2022 with about 1000 cases worldwide, necessitating liver transplantation in 5% and causing death in 2% of patients. It took some effort to clarify the cause of the novel hepatitis epidemic. Researchers were confronted with a polymicrobial viral infection consisting of an adenovirus-associated virus type 2 (AAV2) infection, co-occurring with either human adenovirus type 41 (HAdV41) or herpesvirus infections; most prominently human herpesvirus type 6 (HHV-6). AAV-2, a small Dependovirus of the Parvovirus family, needs these helper viruses for its replication. AAV2 is used as a vector for liver-targeting gene therapy but was not previously known to cause acute hepatitis. HAdV41 and HHV-6 are mostly known to cause diarrhoea and febrile illnesses associated with skin rashes in children, respectively. Except for a few case reports of HHV-6 hepatitis, HAdV and HHV-6 are mostly known as major pathogens in immunosuppressed transplantation patients. A potential role of SARS-CoV-2 has also been discussed but the most popular hypothesis involves an indirect role of the COVID-19 pandemic for this novel disease. Exposure to HHV-6 infections occurs nearly quantitatively during the first year of life. Social distancing measures, followed by the lifting of these measures in 2022 might have caused a delayed exposure to multiple, normally benign childhood viral infections eliciting a dysregulated immune response with pathological effects for liver cells. In the fall of 2022, when these conditions were not longer met, case numbers dwindled. The hypothesis of an unequilibrated immune response instead of intrinsic cytopathic activity of the implicated viruses is further supported by the enrichment of a particular HLA allele in cases over controls.
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Affiliation(s)
- Harald Brüssow
- Laboratory of Gene Technology, Department of BiosystemsKU LeuvenLeuvenBelgium
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4
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Inamoto Y, Takeda W, Hirakawa T, Sakaguchi H, Nakano N, Uchida N, Doki N, Ikegame K, Katayama Y, Sawa M, Kuriyama T, Hiramoto N, Ota S, Ozawa Y, Kataoka K, Kanda Y, Hino M, Kimura T, Atsuta Y, Fukuda T, Nagafuji K. Adenovirus disease after hematopoietic cell transplantation: A Japanese transplant registry analysis. Am J Hematol 2022; 97:1568-1579. [PMID: 36087061 DOI: 10.1002/ajh.26723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
We analyzed a Japanese registry database to elucidate the incidence, risk factors, and outcomes of adenovirus (AdV) disease after autologous and allogeneic hematopoietic cell transplantation (HCT) in contemporary real-world patients. We evaluated the cumulative incidence of AdV disease, as well as risk factors, survival, and treatment details, among 25 233 patients who underwent autologous HCT and 48 380 patients who underwent allogeneic HCT between 2005 and 2019. The 1-year cumulative incidences of AdV disease after autologous and allogeneic HCT were 0.18% and 1.52%, respectively, in children, and 0.49% and 2.99%, respectively, in adults. Among patients with AdV disease, renourinary infection was the most common manifestation, and viremia or disseminated disease occurred in 6% of those after autologous HCT and 19% of those after allogeneic HCT. In multivariate analysis, age ≥50 years and lymphoma were associated with AdV disease after autologous HCT, while patients age ≥50 years, male patients, lymphoma, HCT-specific comorbidity index ≥3, human leukocyte antigen-mismatched or haploidentical donors, cord blood, in vivo T-cell depletion, HCT from 2005 to 2009, acute graft-versus-host disease (GVHD), and chronic GVHD were associated with AdV disease after allogeneic HCT. The 1-year probabilities of survival after disease diagnosis were 65% in autologous HCT and 44% in allogeneic HCT. Regardless of the AdV disease burden, there was an increased risk of mortality after both autologous and allogeneic HCT. The most commonly used antiviral agents were cidofovir and vidarabine. The probabilities of improvement and survival with currently available agents were suboptimal. AdV disease after HCT remains a challenge. Better antiviral modalities are necessary.
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Affiliation(s)
- Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Takeda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hirotoshi Sakaguchi
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nobuaki Nakano
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Takuro Kuriyama
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Moeko Hino
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takafumi Kimura
- Preparation Department, Japanese Red Cross Kinki Block Blood Center, Osaka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Nagafuji
- Department of Hematology and Oncology, Kurume University School of Medicine, Kurume, Japan
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Abstract
Adenoviruses result in a wide array of clinical presentations, including primarily respiratory, gastrointestinal, genitourinary, or systemic infections. Although adenovirus causes mild disease limited to a single organ system in immunocompetent individuals, severe and life-threatening infections do rarely occur. Disseminated disease and severe localized disease resulting in significant morbidity and mortality have been well described in the immunocompromised populations. Although asymptomatic viremia, respiratory tract, and gastrointestinal infections are the most common disease in most transplant patients, renal transplant patients more commonly experience urinary tract infections, including hemorrhagic cystitis or nephritis. Diagnosis requires astute clinical awareness of the patient's clinical presentation that would be compatible with adenovirus combined with cultures, molecular testing, polymerase chain reaction, and tissue sampling. There is no Food and Drug Administration-approved treatment for adenovirus; however, several studies have evaluated therapeutic options including cidofovir, brincidofovir, and immunotherapy. This article will summarize our current understanding of adenovirus in the transplant population.
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Affiliation(s)
- Omar M. Al-Heeti
- Divisions of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Helen P. Cathro
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Michael G. Ison
- Divisions of Infectious Diseases and Organ Transplantation, Transplant and Immunocompromised Host Infectious Diseases Service, Northwestern University Feinberg School of Medicine, Chicago, IL
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6
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Khalifa A, Andreias L, Velpari S. Adenovirus Hepatitis in Immunocompetent Adults. J Investig Med High Impact Case Rep 2022; 10:23247096221079192. [PMID: 35225036 PMCID: PMC8891914 DOI: 10.1177/23247096221079192] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 35-year-old female with no medical history presented with fever. Laboratory work was normal except for elevated liver function test (LFT): alkaline phosphatase (AP) (296), aspartate transaminase (AST) (343), alanine transaminase (ALT) (378), and international normalized ratio (INR) (1.23). Ultrasound liver was normal. Infectious workup was negative for hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), Herpes simplex virus (HSV), and COVID-19. Similarly, autoimmune hepatitis, Wilson, and alpha-1 antitrypsin workup were negative. She reported taking Yogi-Kanthika (ayurvedic-proprietary medicine) on/off for seasonal sore throat, yet RUCAM-score was 2 (unlikely a drug induced injury). Respiratory-viral-panel came positive for adenovirus. With supportive treatment, symptoms and LFT trended down, thus, liver biopsy decision was deferred. We believe this is the first reported case of adenovirus hepatitis in an immunocompetent adult. Hence, we suggest that clinicians should consider a refined differential diagnosis for elevated LFT (that includes adenovirus).
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Affiliation(s)
- Ali Khalifa
- Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital, NJ, USA
| | - Laura Andreias
- Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital, NJ, USA
| | - Sugirdhana Velpari
- Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital, NJ, USA
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7
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Mouse Adenovirus Type 1 Persistence Exacerbates Inflammation Induced by Allogeneic Bone Marrow Transplantation. J Virol 2022; 96:e0170621. [PMID: 35045262 DOI: 10.1128/jvi.01706-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bone marrow transplantation (BMT) recipients are at risk for substantial morbidity and mortality from human adenovirus infections, often in the setting of reactivation of persistent virus. Human adenovirus persistence in mucosal lymphocytes has been described, but specific cellular reservoirs of persistence and effects of persistence on host responses to unrelated stimuli are not completely understood. We used mouse adenovirus type 1 (MAV-1) to characterize persistence of an adenovirus in its natural host and test the hypothesis that persistence increases complications of bone marrow transplantation (BMT). Following intranasal infection of C57BL/6J mice, MAV-1 DNA was detected in lung, mediastinal lymph nodes, and liver during acute infection at 7 days post infection (dpi), and at lower levels at 28 dpi that remained stable through 150 dpi. Expression of early and late viral transcripts was detected in those organs at 7 dpi but not at later time points. MAV-1 persistence was not affected by deficiency of IFN-γ. We detected no evidence of MAV-1 reactivation in vivo following allogeneic BMT of persistently infected mice. Persistent infection did not substantially affect mortality, weight loss, or pulmonary inflammation following BMT. However, T cell infiltration and increased expression of pro-inflammatory cytokines consistent with graft-versus-host disease (GVHD) were more pronounced in livers of persistently infected BMT mice than in uninfected BMT mice. These results suggest that MAV-1 persists in multiple sites without detectable evidence of ongoing replication. Our results indicate that MAV-1 persistence alters host responses to an unrelated challenge, even in the absence of detectable reactivation. Importance Long-term persistence in an infected host is an essential step in the life cycle of DNA viruses. Adenoviruses persist in their host following acute infection, but the nature of adenovirus persistence remains incompletely understood. Following intranasal infection of mice, we found that MAV-1 persists for a prolonged period in multiple organs, although we did not detect evidence of ongoing replication. Because BMT recipients are at risk for substantial morbidity and mortality from human adenovirus infections, often in the setting of reactivation of persistent virus in the recipient, we extended our findings using MAV-1 infection in a mouse model of BMT. MAV-1 persistence exacerbated GVHD-like inflammation following allogeneic BMT, even in the absence of virus reactivation. This novel finding suggests that adenovirus persistence has consequences, and it highlights the potential for a persistent adenovirus to influence host responses to unrelated challenges.
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8
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Keramari S, Poutoglidou F, Poutoglidis A, Sotiropoulos D, Savopoulos C, Chlichlia K, Chatzis S, Xagorari A, Kaiafa G. Adenoviral Infections in Bone Marrow Transplanted Adult Patients: A Review of the 44 Cases Reported in the Last 25 Years. Cureus 2021; 13:e19865. [PMID: 34963865 PMCID: PMC8708484 DOI: 10.7759/cureus.19865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/24/2022] Open
Abstract
Adenoviral infections in immunocompromised individuals may be life-threatening conditions. The aim of this review is to document all the reported cases of adenoviral infection is patients having undergone bone marrow transplantation (BMT). A comprehensive literature search of the databases Pubmed, Science Direct, and Google Scholar was conducted to identify all the case reports of adenoviral infections in BMT patients. A total of 30 articles with 44 patients were included. The most common underlying condition was acute lymphocytic leukemia (23%) followed by acute myeloid leukemia (18%). The most common site of infection was disseminated (50%), followed by liver infection (8%) and hemorrhagic cystitis (8%). Cidofovir was administered in 40.9% of the cases, and death was reported in 34.4% of them. Ribavirin was administered as monotherapy in 15.9% of patients, with a mortality rate of 57.1%. We found that the antiviral drug option had no statistically significant effect on the mortality rate (p=0.242). Also, the absence of graft-versus-host disease (GVHD) was not associated with an improved outcome (p=0.523). There was, however, a statistically significant difference in the outcome based on the site of infection (p=0.005), with a higher rate of mortality in the disseminated and gastrointestinal cases. To the best of our knowledge, this is the first review documenting all the cases of adenoviral infections in BMT patients. Future randomized studies are needed to validate the results of the present study.
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Affiliation(s)
- Stergiani Keramari
- Department of Paediatrics, University General Hospital of Thessaloniki AHEPA, Thessaloniki, GRC
| | - Frideriki Poutoglidou
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Damianos Sotiropoulos
- Department of Haematology and Public Cord Blood Bank, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Christos Savopoulos
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Thessaloniki, GRC
| | - Katerina Chlichlia
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, GRC
| | | | - Angeliki Xagorari
- Department of Haematology and Public Cord Blood Bank, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, GRC
| | - Georgia Kaiafa
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Thessaloniki, GRC
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9
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Chaekal OK, Soave R, Chen Z, Shore T, Mayer S, Phillips A, Mei Hsu J, Gomez-Arteaga A, Rennert H, Drelick A, Orfali N, Walsh TJ, Small CB, Kodiyanplakkal RPL, Plate M, Satlin MJ, van Besien K. Adenovirus viremia after in vivo T-cell depleted allo-transplant in adults: low lymphocyte counts are associated with uncontrolled viremia and fatal outcomes. Leuk Lymphoma 2021; 63:435-442. [PMID: 34643477 DOI: 10.1080/10428194.2021.1978088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of adenovirus viremia and the role of screening in preventing adenovirus disease in adult transplant recipients are not well defined. Between January 2017 and May 2020, 262 allogeneic transplants were performed using in vivo T-cell depletion. Adenovirus viremia was found in 59 patients for a cumulative incidence of 10% by one hundred days and 23% (95% CI 20-26%) by one year. There was a higher incidence of viremia associated with cord blood transplant (p = .04). No other patient, donor or transplant characteristics were identified that predicted for viremia. In 47 patients (80%), viremia remained well below 200,000 copies/mL and resolved. Twelve patients developed high level viremia. Treatment with antivirals and in some cases adoptive cell therapy, was often ineffective and only two survived. Low lymphocyte count at initial detection of adenovirus viremia was the best predictor of uncontrolled disease.
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Affiliation(s)
- Ok-Kyong Chaekal
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Rosemary Soave
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Zhengming Chen
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adrienne Phillips
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Jing Mei Hsu
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra Gomez-Arteaga
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hanna Rennert
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alex Drelick
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Nina Orfali
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Thomas J Walsh
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Catherine B Small
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Rosy Priya L Kodiyanplakkal
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Markus Plate
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Koen van Besien
- Department of Medicine, Division of Hematology/Oncology, Cell Therapy Program, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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10
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Chandorkar A, Anderson AD, Morris MI, Natori Y, Jimenez A, Komanduri KV, Camargo JF. Viral kinetics and outcomes of adenovirus viremia following allogeneic hematopoietic cell transplantation. Clin Transplant 2021; 35:e14481. [PMID: 34516017 DOI: 10.1111/ctr.14481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenovirus (AdV) is a serious infection following hematopoietic cell transplantation (HCT). Little is known about AdV viral kinetics and optimal threshold for initiation of pre-emptive therapy. METHODS Single-center retrospective study of 16 consecutive adult HCT recipients with detectable AdV identified over a 5-year period. RESULTS Median time to AdV reactivation after HCT was 176 days (IQR 86-408). Nine patients received cidofovir, although 14/16 had no tissue-invasive disease. Among treated patients, median duration of viremia was shorter when initiating treatment at viral loads < 10,000 copies/ml (28 vs. 52 days). All-cause mortality in this cohort was 44%. All six patients (five of which were untreated) with peak viral loads < 10,000 copies/ml survived; whereas only 30% (3/10) of patients with peak viral loads greater than this threshold survived, despite most (n = 8; 80%) of them receiving cidofovir (P = .01). Three-month survival following diagnosis of AdV viremia was significantly lower with peak viremia > 10,000 copies/ml (100 vs. 17%; P = .005). CONCLUSION AdV is associated with high all-cause mortality, especially for viremia > 10,000 copies/ml. Delaying therapy until viremia reaches AdV levels ≥10,000 copies/ml was associated with more protracted infection and poor outcomes. Larger studies are needed.
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Affiliation(s)
- Aditya Chandorkar
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anthony D Anderson
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michele I Morris
- Immunocompromised Host Service, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yoichiro Natori
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA.,Division of Infectious Diseases, Miami Transplant Institute, Jackson Health System, Miami, Florida, USA
| | - Antonio Jimenez
- Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Krishna V Komanduri
- Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Jose F Camargo
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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11
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Myers CE, Houldcroft CJ, Roy S, Margetts BK, Best T, Venturini C, Guerra-Assunção JA, Williams CA, Williams R, Dunn H, Hartley JC, Rao K, Rolfe KJ, Breuer J. Using Whole Genome Sequences to Investigate Adenovirus Outbreaks in a Hematopoietic Stem Cell Transplant Unit. Front Microbiol 2021; 12:667790. [PMID: 34276599 PMCID: PMC8284422 DOI: 10.3389/fmicb.2021.667790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
A recent surge in human mastadenovirus (HAdV) cases, including five deaths, amongst a haematopoietic stem cell transplant population led us to use whole genome sequencing (WGS) to investigate. We compared sequences from 37 patients collected over a 20-month period with sequences from GenBank and our own database of HAdVs. Maximum likelihood trees and pairwise differences were used to evaluate genotypic relationships, paired with the epidemiological data from routine infection prevention and control (IPC) records and hospital activity data. During this time period, two formal outbreaks had been declared by IPC, while WGS detected nine monophyletic clusters, seven were corroborated by epidemiological evidence and by comparison of single-nucleotide polymorphisms. One of the formal outbreaks was confirmed, and the other was not. Of the five HAdV-associated deaths, three were unlinked and the remaining two considered the source of transmission. Mixed infection was frequent (10%), providing a sentinel source of recombination and superinfection. Immunosuppressed patients harboring a high rate of HAdV positivity require comprehensive surveillance. As a consequence of these findings, HAdV WGS is being incorporated routinely into clinical practice to influence IPC policy contemporaneously.
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Affiliation(s)
- Chloe E Myers
- Cambridge Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom
| | | | - Sunando Roy
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Ben K Margetts
- Division of Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Timothy Best
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Cristina Venturini
- Division of Infection and Immunity, University College London, London, United Kingdom
| | | | - Charlotte A Williams
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Rachel Williams
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Helen Dunn
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - John C Hartley
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Kanchan Rao
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Kathryn J Rolfe
- Cambridge Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom.,Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
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12
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Ali S, Prakash S, Murali AR. Hepatic Manifestations of Nonhepatotropic Infectious Agents Including Severe Acute Respiratory Syndrome Coronavirus-2, Adenovirus, Herpes Simplex Virus, and Coxiella burnetii. Gastroenterol Clin North Am 2021; 50:383-402. [PMID: 34024447 DOI: 10.1016/j.gtc.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nonhepatotropic viruses such as adenovirus, herpes simplex virus, flaviviruses, filoviruses, and human herpes virus, and bacteria such as Coxiella burnetii, can cause liver injury mimicking acute hepatitis. Most of these organisms cause a self-limited infection. However, in immunocompromised patients, they can cause severe hepatitis or in some cases fulminant hepatic failure requiring an urgent liver transplant. Hepatic dysfunction is also commonly seen in patients with severe acute respiratory syndrome coronavirus-2 infection. Patients with preexisting liver diseases are likely at risk for severe coronavirus disease 2019 (COVID-19) and may be associated with poor outcomes.
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Affiliation(s)
- Saeed Ali
- Department of Internal Medicine, University of Iowa Healthcare, 200 Hawkins Drive, SE 636 GH, Iowa City, IA 52242, USA
| | - Sameer Prakash
- Department of Internal Medicine, University of Iowa Healthcare, 200 Hawkins Drive, SE 636 GH, Iowa City, IA 52242, USA
| | - Arvind R Murali
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 4553 JCP, Iowa City, IA 52242, USA.
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13
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Wang X, Patel SA, Haddadin M, Cerny J. Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus. Ther Adv Infect Dis 2021; 8:20499361211018027. [PMID: 34104434 PMCID: PMC8155777 DOI: 10.1177/20499361211018027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022] Open
Abstract
Human cytomegalovirus and Epstein-Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients' characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft-versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.
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Affiliation(s)
- Xin Wang
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shyam A Patel
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Michael Haddadin
- Division of Hematology-Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA
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14
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Jansen SA, Nijhuis W, Leavis HL, Riezebos-Brilman A, Lindemans CA, Schuurman R. Broad Virus Detection and Variant Discovery in Fecal Samples of Hematopoietic Transplant Recipients Using Targeted Sequence Capture Metagenomics. Front Microbiol 2020; 11:560179. [PMID: 33281758 PMCID: PMC7705093 DOI: 10.3389/fmicb.2020.560179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Pediatric allogeneic hematopoietic stem cell transplantation (HSCT) patients often suffer from gastro-intestinal (GI) disease caused by viruses, Graft-versus-Host Disease (GVHD) or a combination of the two. Currently, the GI eukaryotic virome of HSCT recipients remains relatively understudied, which complicates the understanding of its role in GVHD pathogenicity. As decisions regarding immunosuppressive therapy in the treatment of virus infection or GVHD, respectively, can be completely contradicting, it is crucial to better understand the prevalence and relevance of viruses in the GI tract in the HSCT setting. A real time PCR panel for a set of specific viruses widely used to diagnose the most common causes of GI viral gastroenteritis is possibly insufficient to grasp the full extent of viruses present. Therefore, we applied the targeted sequence capture method ViroCap to residual fecal samples of 11 pediatric allogeneic HSCT recipients with GI symptoms and a suspicion of GVHD, to enrich for nucleic acids of viruses that are known to infect vertebrate hosts. After enrichment, NGS was applied to broadly detect viral sequences. Using ViroCap, we were able to detect viruses such as norovirus and adenovirus (ADV), that had been previously detected using clinical diagnostic PCR on the same sample. In addition, multiple, some of which clinically relevant viruses were detected, including ADV, human rhinovirus (HRV) and BK polyomavirus (BKV). Interestingly, in samples in which specific PCR testing for regular viral GI pathogens did not result in a diagnosis, the ViroCap pipeline led to the detection of viral sequences of human herpesvirus (HHV)-7, BKV, HRV, KI polyomavirus and astrovirus. The latter was an only recently described variant and showed extensive sequence mismatches with the applied real time PCR primers and would therefore not have been detected if tested. Our results indicate that target enrichment of viral nucleic acids through ViroCap leads to sensitive and broad possibly clinically relevant virus detection, including the detection of newer variants in clinical HSCT recipient samples. As such, ViroCap could be a useful detection tool clinically, but also in studying the associations between viral presence and GVHD.
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Affiliation(s)
- Suze A Jansen
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Wouter Nijhuis
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Helen L Leavis
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Caroline A Lindemans
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Rob Schuurman
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
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15
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Onda Y, Kanda J, Sakamoto S, Okada M, Anzai N, Umadome H, Tashima M, Haga H, Watanabe C, Hanaoka N, Fujimoto T, Takaori-Kondo A. Detection of adenovirus hepatitis and acute liver failure in allogeneic hematopoietic stem cell transplant patients. Transpl Infect Dis 2020; 23:e13496. [PMID: 33075208 DOI: 10.1111/tid.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
Human adenovirus (HAdV) is an important cause of the common cold and epidemic keratoconjunctivitis in immunocompetent individuals. In immunocompromised patients, HAdV can sometimes cause severe infection such as cystitis, gastroenteritis, pneumonia, encephalitis, hepatitis, or disseminated disease, resulting in significant morbidity and also mortality. In particular, severe cases have been reported in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Indeed HAdV has been recognized as a pathogen that requires careful monitoring in allo-HSCT patients. While HAdV hepatitis leading to severe acute liver failure is rare, such liver failure progresses rapidly and is often fatal. Unfortunately, HAdV hepatitis has few characteristic symptoms and physical findings, which makes it difficult to promptly confirm and start treatment. We report here four cases of HAdV hepatitis after allo-HSCT and their autopsy findings.
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Affiliation(s)
- Yoshiyuki Onda
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan.,Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Soichiro Sakamoto
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Mutsumi Okada
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Naoyuki Anzai
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Hiroshi Umadome
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Masaro Tashima
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Chihiro Watanabe
- Department of Diagnostic Pathology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Nozomu Hanaoka
- Center for Infectious Disease Risk Management, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuguto Fujimoto
- Center for Infectious Disease Risk Management, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality. RECENT FINDINGS Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients SUMMARY: This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI.
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17
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Santos CAQ, Rhee Y, Czapka MT, Kazi AS, Proia LA. Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients. J Clin Med 2020; 9:jcm9030865. [PMID: 32245201 PMCID: PMC7141503 DOI: 10.3390/jcm9030865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Hematopoietic stem cell transplant recipients are at increased risk of infection and immune dysregulation due to reception of cytotoxic chemotherapy; development of graft versus host disease, which necessitates treatment with immunosuppressive medications; and placement of invasive catheters. The prevention and management of infections in these vulnerable hosts is of utmost importance and a key “safety net” in stem cell transplantation. In this review, we provide updates on the prevention and management of CMV infection; invasive fungal infections; bacterial infections; Clostridium difficile infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible “safety net” for these immunocompromised hosts.
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18
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Mystery eye: Human adenovirus and the enigma of epidemic keratoconjunctivitis. Prog Retin Eye Res 2019; 76:100826. [PMID: 31891773 DOI: 10.1016/j.preteyeres.2019.100826] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022]
Abstract
Known to occur in widespread outbreaks, epidemic keratoconjunctivitis (EKC) is a severe ocular surface infection with a strong historical association with human adenovirus (HAdV). While the conjunctival manifestations can vary from mild follicular conjunctivitis to hyper-acute, exudative conjunctivitis with formation of conjunctival membranes, EKC is distinct as the only form of adenovirus conjunctivitis in which the cornea is also involved, likely due to the specific corneal epithelial tropism of its causative viral agents. The initial development of a punctate or geographic epithelial keratitis may herald the later formation of stromal keratitis, and manifest as subepithelial infiltrates which often persist or recur for months to years after the acute infection has resolved. The chronic keratitis in EKC is associated with foreign body sensation, photophobia, glare, and reduced vision. However, over a century since the first clinical descriptions of EKC, and over 60 years since the first causative agent, human adenovirus type 8, was identified, our understanding of this disorder remains limited. This is underscored by a current lack of effective diagnostic tools and treatments. In part, stasis in our knowledge base has been encouraged by the continued acceptance, and indeed propagation of, inaccurate paradigms pertaining to disease etiology and pathogenesis, particularly with regard to mechanisms of innate and adaptive immunity within the cornea. Owing to its often persistent and medically refractory visual sequelae, reconsideration of key aspects of EKC disease biology is warranted to identify new treatment targets to curb its worldwide socioeconomic burden.
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19
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Association between adenovirus viral load and mortality in pediatric allo-HCT recipients: the multinational AdVance study. Bone Marrow Transplant 2019; 54:1632-1642. [PMID: 30804489 PMCID: PMC6957460 DOI: 10.1038/s41409-019-0483-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/24/2019] [Accepted: 02/09/2019] [Indexed: 02/06/2023]
Abstract
This multivariable analysis from the AdVance multicenter observational study assessed adenovirus (AdV) viremia peak, duration, and overall AdV viral burden-measured as time-averaged area under the viremia curve over 16 weeks (AAUC0-16)-as predictors of all-cause mortality in pediatric allo-HCT recipients with AdV viremia. In the 6 months following allo-HCT, 241 patients had AdV viremia ≥ 1000 copies/ml. Among these, 18% (43/241) died within 6 months of first AdV ≥ 1000 copies/ml. Measures of AdV viral peak, duration, and overall burden of infection consistently correlate with all-cause mortality. In multivariable analyses, controlling for lymphocyte recovery, patients with AdV AAUC0-16 in the highest quartile had a hazard ratio of 11.1 versus the lowest quartile (confidence interval 5.3-23.6); for peak AdV viremia, the hazard ratio was 2.2 for the highest versus lowest quartile. Both the peak level and duration of AdV viremia were correlated with short-term mortality, independent of other known risk factors for AdV-related mortality, such as lymphocyte recovery. AdV AAUC0-16, which assesses both peak and duration of AdV viremia, is highly correlated with mortality under the current standard of care. New therapeutic agents that decrease AdV AAUC0-16 have the potential of reducing mortality in this at-risk patient population.
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20
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Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited, but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, 550 South Jackson Street, ACB, A3R27, Louisville, KY 40202, USA.
| | - Julio A Ramirez
- Division of Infectious Diseases, University of Louisville, Med Center One, 501 E. Broadway Suite 100, Louisville, KY 40202, USA
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21
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Shamriz O, Chandrakasan S. Update on Advances in Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders. Immunol Allergy Clin North Am 2018; 39:113-128. [PMID: 30466768 DOI: 10.1016/j.iac.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) in patients with primary immunodeficiency disorders (PIDDs) is being increasingly used as a curative option. Understanding the critical components, such as disease's nature and activity and pre-HSCT and post-HSCT patient care is key to a successful outcome. HSCT should be tailored to the underlying PIDD, as different PIDDs, such as severe combined immune deficiency, Treg dysfunction, and phagocytic disorders, have different transplant approaches. Therefore, successful HSCT in patients with PIDDs requires teamwork between immunologists and transplant physicians. In this article, the authors elaborate on various aspects of PIDD-HSCT and highlight recent advances.
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Affiliation(s)
- Oded Shamriz
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, 2015 Uppergate Drive, ECC Room 418, Atlanta, GA 30030, USA; Pediatric Division, Hadassah-Hebrew University Medical Center, Ein-Kerem, POB 12000, Jerusalem, Israel 91120
| | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, 2015 Uppergate Drive, ECC Room 418, Atlanta, GA 30030, USA.
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22
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Abstract
Abstract
Background: BK virus infection is common but is usually asymptomatic. However, it can become life threatening as severe hemorrhagic cystitis (HC) or the polyomavirus-associated nephropathy (PVAN) particularly in immune compromised and transplant recipients. Some investigators have studied the pathophysiology and there are anecdotal and uncontrolled studies of therapy with few conclusions allowing treatment guidelines. Objectives: Summarize literature review of current knowledge concerning the nature, epidemiology, pathophysiology, diagnosis and treatment of this common virus infection. Results: HC is a not uncommon and often misdiagnosed infection from BK virus. It is usually self limited but can become life threatening in immune compromised patients. PVAN threatens survival of transplanted kidneys and is difficult to differentiate from rejection without sophisticated molecular diagnostic technology. We have sufficient information for making a diagnosis of BK virus disease by using clinical, serological and molecular technology. Studies using manipulation of immunosuppression and a variety of antiviral agents, including cidofovir, leflunomide, intravenous immunoglobulin, vidarabine, fluroquinolones, have been published but most were uncontrolled reports of few cases. Cidofovir offers some promise but more must be learned before there is hope for evidence-based treatment guidelines.
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23
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Adenovirus Hepatitis: Clinicopathologic Analysis of 12 Consecutive Cases From a Single Institution. Am J Surg Pathol 2017; 41:810-819. [PMID: 28296681 DOI: 10.1097/pas.0000000000000834] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adenoviruses are common pathogens that usually cause self-limited infections. However, in the immunocompromised host they can cause severe infections involving multiple organs including the liver. A search of the pathology database at Stanford University Medical Center (1995 to 2016) identified 12 cases of adenovirus hepatitis including biopsy and autopsy specimens. There were 8 pediatric patients, 7 of which had received orthotropic liver transplants and 1 of which was receiving chemotherapy for lymphoblastic leukemia. There were 4 adult patients, of which 1 was actively receiving chemotherapy for chronic lymphocytic leukemia and 2 had undergone hematopoietic stem cell transplantation for hematologic malignancies. One patient had lymphoplasmacytic lymphoma and had received chemotherapy over a year prior but was not receiving therapy at the time he contracted adenovirus hepatitis. In all cases, histologic sections showed nonzonal coagulative hepatocyte necrosis and characteristic intranuclear inclusions. Hepatocyte necrosis ranged from spotty to massive. The majority of cases (7/12; 58%) had no associated inflammation. If present, inflammation was focal and lymphohistiocytic. In 1 case, findings were focal within the liver, requiring an image-guided biopsy. This patient underwent a simultaneous nontargeted liver biopsy that lacked histologic evidence of adenovirus. Among the pediatric patients, 63% (5/8) died secondary to organ failure, while there was 100% (4/4) mortality in the adult population.
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24
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Abstract
Similarly to the general population, genitourinary tract infections are common conditions in theimmunocompromised host. They can be furthermore divided into infections of the urinary tract and genital tract infections. Transplant recipients are more likely to have infections of the urinary tract infections while persons with human immunodeficiency virus (HIV) are at higher risk for the second group of infections, especially sexually transmitted infections (STIs). Manifestations of these diseases can be associated with more complications and can be more severe. We provide an overview of manifestations, diagnosis, and management of these disorders.
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25
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Abstract
Adenoviruses are a highly prevalent infection that can cause a range of clinical syndromes in immunocompromised patients, ranging from localized disease of the respiratory tract, gastrointestinal tract, or urinary tract to disseminated disease. Adenovirus infections may develop in this unique population as the result of primary infection or reactivation of latent virus. Disease can be potentially progressive with high rates of mortality in patients with pneumonia and disseminated disease. Fortunately, cidofovir and its lipid ester, brincidofovir, appear to be effective for the treatment of adenovirus, although neither is specifically approved for this indication. Adenovirus should always be considered when immunocompromised patients present with any clinical syndrome that could be compatible with adenoviral infection. Once disease is suspected, cultures or molecular testing of appropriate specimens should be obtained and blood should be sent for adenovirus polymerase chain reaction (PCR) whenever adenovirus is suspected. Monitoring of quantitative viral loads in blood is helpful in predicting response to therapy with a significant drop (>1 log) associated with a higher probability of clinical response.
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26
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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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27
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Affiliation(s)
- Raj D Shah
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 14-045, Chicago, IL 60611, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 14-045, Chicago, IL 60611, USA.
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28
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Ghosh N, Malik FA, Daver RG, Vanichanan J, Okhuysen PC. Viral associated diarrhea in immunocompromised and cancer patients at a large comprehensive cancer center: a 10-year retrospective study. Infect Dis (Lond) 2016; 49:113-119. [PMID: 27620005 DOI: 10.1080/23744235.2016.1224384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Viral associated diarrhea (VAD) due to Norovirus (NV), Rotavirus (RV) and Adenovirus (AV) is common in immunocompromised and cancer patients. We sought to determine if the clinical characteristics, morbidity and seasonality of infection differed according to the type of enteric virus identified. METHODS Cases of NV, RV and AV were identified in stool specimens submitted to the clinical microbiology laboratory between November 2005 and February 2015. Clinical characteristics of patients, potential risk factors and outcomes were compared. RESULTS A total of 97 VAD cases were identified: NV (n = 49), RV (n = 34) and AV (n = 14). The majority of cases were in patients with leukemia and lymphoma. NV (59%), RV (74%) and AV (78%) were identified in hematopoietic stem cell transplant (HSCT) recipients; and in patients with graft versus host disease (GVHD): NV (34%), RV (46%) and AV (57%). Nine cases of NV were genotyped; all were due to genotype II. Nine of 49 (18%) cases of NV, 7 of 34 (20%) cases of RV and 2 of 14 (14%) cases of AV were considered to be health care acquired (HCA). In multivariate analysis, immunosuppression (OR 2.8 95% CI 1.26-6.60, p = .01) and neutropenia (OR 4.8 95% CI 1.27-18.5, p = .01) were identified as risk factors for NV diarrhea compared to RV and AV. CONCLUSIONS In our study, agents responsible for VAD occurred year round but predominated in the winter time; caused prolonged illness and were frequently health care associated. Presentations were atypical in many cases without upper gastrointestinal symptoms such as nausea and vomiting.
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Affiliation(s)
- Natasha Ghosh
- a Department of Infectious Diseases , Infection Control and Employee Health University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b University of Texas School of Public Health , Houston , TX , USA
| | - Farida A Malik
- a Department of Infectious Diseases , Infection Control and Employee Health University of Texas MD Anderson Cancer Center , Houston , TX , USA.,c McGovern Medical School , Houston , TX , USA
| | - Roshni G Daver
- a Department of Infectious Diseases , Infection Control and Employee Health University of Texas MD Anderson Cancer Center , Houston , TX , USA.,c McGovern Medical School , Houston , TX , USA
| | - Jakapat Vanichanan
- a Department of Infectious Diseases , Infection Control and Employee Health University of Texas MD Anderson Cancer Center , Houston , TX , USA.,c McGovern Medical School , Houston , TX , USA
| | - Pablo C Okhuysen
- a Department of Infectious Diseases , Infection Control and Employee Health University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b University of Texas School of Public Health , Houston , TX , USA.,c McGovern Medical School , Houston , TX , USA
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Saxena R, Tovey D, Dhawan A, Ellis D, Portmann B. Acute Liver Failure Due to Adenoviral Hepatitis in a Pediatric Liver Transplant. Int J Surg Pathol 2016. [DOI: 10.1177/106689699500300307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adenoviral infection is a significant cause of morbidity and mortality in immunocompromised patients in the pediatric age group, hepatitis caused by the serotype 5 being the most common manifestation in the liver transplant recipient. The authors report a case of a 3 1/2-year-old child in whom fatal adenoviral hepatitis developed after liver transplantation for syndromic paucity of the intrahepatic bile ducts. Allograft biopsy at 14 days showed early changes of microabscesses in the parenchyma but no inclusions. Immunohistochemistry using an adenovirus-group antibody (MAB805, Chemicon International, Harrow, England), however, demonstrated nuclear positivity in hepatocytes related to and at a distance from the lesions. As antibody titers are unreliable in an immunocompromised patient and culture results take time, immunohistochemistry for adenovirus offers a rapid diagnosis. The technique is economic and has a clear advantage on the more demanding electron microscopic screening, which was performed in the case as additional evidence. Immunohistochemistry for adenovirus should be done routinely in the presence of microabscesses to differentiate the lesion from hepatitis due to cytomegalovirus. Int J Surg Pathol 3(3) :189-194, 1996
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Affiliation(s)
- R. Saxena
- Institute of Liver Studies, King's College School of Medicine and Dentistry
| | - D.G. Tovey
- Electron Microscopy Unit, London School of Hygiene and Tropical Medicine
| | - A. Dhawan
- Institute of Child Health, King's College School of Medicine and Dentistry, London, United Kingdom
| | - D.S. Ellis
- Electron Microscopy Unit, London School of Hygiene and Tropical Medicine
| | - B.C. Portmann
- Institute of Liver Studies, King's College School of Medicine and Dentistry
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Kurosaki K, Miwa N, Yoshida Y, Kurokawa M, Kurimoto M, Endo S, Shiraki K. Therapeutic Basis of Vidarabine on Adenovirus-Induced Haemorrhagic Cystitis. ACTA ACUST UNITED AC 2016; 15:281-5. [PMID: 15535050 DOI: 10.1177/095632020401500507] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
When adenovirus causes haemorrhagic cystitis in immunocompromised patients, vidarabine is used for its treatment because therapeutic choice is limited. Although vidarabine has been reported to be effective for these patients, its therapeutic basis has not yet been established. Vidarabine dose-dependently inhibited viral replication as assessed by a yield reduction assay. Viral protein synthesis was dose-dependently inhibited by vidarabine but not at all by acyclovir, and the degree of inhibition by vidarabine was different for each of the viral proteins, ranging from 0–40% of the untreated control. These results indicated the specificity and mechanism of action of vidarabine against adenovirus. The concentration of vidarabine and its metabolite in the bladder is suggested to exhibit effective anti-adenoviral activity in suppressing the replication of adenovirus. Thus, our results support vidarabine therapy as a possible candidate for adenovirus-induced haemorrhagic cystitis in immunocompromised patients.
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Affiliation(s)
- Kunikazu Kurosaki
- Department of Virology, Toyama Medical and Pharmaceutical University, Toyama, Japan
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Matsumura-Kimoto Y, Inamoto Y, Tajima K, Kawajiri A, Tanaka T, Hirakawa T, Ino K, Asao Y, Tamogami H, Kono C, Takeda W, Okinaka K, Fuji S, Kurosawa S, Kim SW, Tanosaki R, Yamashita T, Fukuda T. Association of Cumulative Steroid Dose with Risk of Infection after Treatment for Severe Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant 2016; 22:1102-1107. [PMID: 26968790 DOI: 10.1016/j.bbmt.2016.02.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/29/2016] [Indexed: 12/21/2022]
Abstract
This study aimed to characterize the incidence and risk factors of invasive fungal disease, cytomegalovirus infection, other viral diseases, and gram-negative rod infection after glucocorticoid treatment for severe acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation and to elucidate the associations of cumulative steroid dose with the risks of individual infections. The study cohort included 91 consecutive patients who developed maximum grades III and IV acute GVHD at our center. The mean cumulative prednisolone-equivalent dose was 41 mg/kg during the first 4 weeks. The cumulative incidence rates of fungal disease, cytomegalovirus disease, other viral diseases, and gram-negative rod infection at 6 months after glucocorticoid treatment were remarkably high, at 14%, 21%, 28%, and 20%, respectively. GVHD within 26 days after transplantation and low lymphocyte count at GVHD treatment were associated with increased risks of several infections. Cumulative prednisolone-equivalent steroid doses ≥ 55 mg/kg during the first 4 weeks were associated with an increased risk of fungal disease (hazard ratio, 3.65; P = .03) and cumulative doses ≥ 23 mg/kg were associated with an increased risk of non-cytomegalovirus viral diseases (hazard ratio, 4.14; P = .02). Strategies to reduce the risk of infectious complications are needed, particularly for patients who have risk factors and those who receive high cumulative steroid doses.
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Affiliation(s)
- Yayoi Matsumura-Kimoto
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan; Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
| | - Kinuko Tajima
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Akihisa Kawajiri
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Tanaka
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tsuneaki Hirakawa
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuko Ino
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yu Asao
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Tamogami
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Chika Kono
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Takeda
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Keiji Okinaka
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeo Fuji
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Saiko Kurosawa
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sung-Won Kim
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ryuji Tanosaki
- Department of Blood Transfusion and Cellular Therapy, National Cancer Center Hospital, Tokyo, Japan
| | - Takuya Yamashita
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
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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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Kawashima N, Muramatsu H, Okuno Y, Torii Y, Kawada JI, Narita A, Nakanishi K, Hama A, Kitamura A, Asai N, Nakamura S, Takahashi Y, Ito Y, Kojima S. Fulminant adenovirus hepatitis after hematopoietic stem cell transplant: Retrospective real-time PCR analysis for adenovirus DNA in two cases. J Infect Chemother 2015; 21:857-63. [PMID: 26423689 DOI: 10.1016/j.jiac.2015.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/21/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Viral infection is one of the major causes of mortality in patients undergoing hematopoietic stem cell transplant (HSCT). Systemic infection of adenovirus (AdV) has emerged as a not uncommon viral infection with significant morbidity and mortality as with cytomegalovirus and Epstein-Barr virus infection. Routine surveillance for these viruses has become a clinical practice and subsequent preemptive therapy improves patients' outcomes; however, the effectiveness of preemptive therapy for AdV has not been fully investigated in patients with a lethal form of AdV infection. METHODS Sequential AdV loads were retrospectively analyzed in children with fulminant AdV hepatitis after HSCT. RESULTS The AdV DNA became detectable (1 × 10(4) copies/mL) as early as 2 weeks after HSCT. These levels reached >1 × 10(8) copies/mL at the onset of fulminant hepatitis. However, we determined that γ-glutamyltransferase levels were elevated to >100 IU/L at least 2 weeks before the diagnosis of hepatitis. CONCLUSIONS Our observation raises the possibility that elevated γ-glutamyltransferase could be a sentinel marker for AdV hepatitis, which prompts elaborated monitoring of AdV load and targeted treatment.
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Affiliation(s)
- Nozomu Kawashima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Okuno
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Nakanishi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahito Hama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Kitamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Naoya Asai
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Prostaglandin E2 Production and T Cell Function in Mouse Adenovirus Type 1 Infection following Allogeneic Bone Marrow Transplantation. PLoS One 2015; 10:e0139235. [PMID: 26407316 PMCID: PMC4583312 DOI: 10.1371/journal.pone.0139235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
Adenovirus infections are important complications of bone marrow transplantation (BMT). We demonstrate delayed clearance of mouse adenovirus type 1 (MAV-1) from lungs of mice following allogeneic BMT. Virus-induced prostaglandin E2 (PGE2) production was greater in BMT mice than in untransplanted controls, but BMT using PGE2-deficient donors or recipients failed to improve viral clearance, and treatment of untransplanted mice with the PGE2 analog misoprostol did not affect virus clearance. Lymphocyte recruitment to the lungs was not significantly affected by BMT. Intracellular cytokine staining of lung lymphocytes demonstrated impaired production of INF-γ and granzyme B by cells from BMT mice, and production of IFN-γ, IL-2, IL-4, and IL-17 following ex vivo stimulation was impaired in lymphocytes obtained from lungs of BMT mice. Viral clearance was not delayed in untransplanted INF-γ-deficient mice, suggesting that delayed viral clearance in BMT mice was not a direct consequence of impaired IFN-γ production. However, lung viral loads were higher in untransplanted CD8-deficient mice than in controls, suggesting that delayed MAV-1 clearance in BMT mice is due to defective CD8 T cell function. We did not detect significant induction of IFN-β expression in lungs of BMT mice or untransplanted controls, and viral clearance was not delayed in untransplanted type I IFN-unresponsive mice. We conclude that PGE2 overproduction in BMT mice is not directly responsible for delayed viral clearance. PGE2-independent effects on CD8 T cell function likely contribute to the inability of BMT mice to clear MAV-1 from the lungs.
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Detrait M, De Prophetis S, Delville JP, Komuta M. Fulminant isolated adenovirus hepatitis 5 months after haplo-identical HSCT for AML. Clin Case Rep 2015; 3:802-5. [PMID: 26509010 PMCID: PMC4614643 DOI: 10.1002/ccr3.347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 11/12/2022] Open
Abstract
The principal limitation of allogeneic hematopoietic stem cell transplantation except relapse remains the transplant-related mortality (TRM). In addition to graft-versus-host disease (GvHD), infections contribute to TRM in many patients. We describe herein a case of an adult patient presenting 5 months after haplo-identical transplantation an isolated fulminant hepatitis due to adenovirus.
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Affiliation(s)
- Marie Detrait
- Onco-Hematology Department, Notre-Dame Hospital, Grand Hopital De Charleroi Charleroi, Belgium ; Bone Marrow Transplantation Program, Hematology Department, CHU de Nancy, Hôpitaux de Brabois Vandoeuvre les Nancy, France
| | - Stephanie De Prophetis
- Onco-Hematology Department, Notre-Dame Hospital, Grand Hopital De Charleroi Charleroi, Belgium
| | - Jean-Pierre Delville
- Onco-Hematology Department, Notre-Dame Hospital, Grand Hopital De Charleroi Charleroi, Belgium
| | - Mina Komuta
- Division of Pathology, Hepatology, Cliniques Universitaires St-Luc, UCL Brussels, Belgium
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36
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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37
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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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38
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Han TT, Xu LP, Liu DH, Liu KY, Fu HX, Zhao XY, Zhao XS, Huang XJ. Cytomegalovirus is a potential risk factor for late-onset hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation. Am J Hematol 2014; 89:55-61. [PMID: 24009106 DOI: 10.1002/ajh.23584] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/21/2013] [Accepted: 08/24/2013] [Indexed: 11/07/2022]
Abstract
Late-onset hemorrhagic cystitis (LOHC) is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is primarily associated with viral infection. We prospectively quantified cytomegalovirus (CMV), BK virus (BKV), and adenovirus in urine and plasma using Q-RT-PCR in 50 consecutive patients to define the relationship between virus and LOHC. Of the 50 patients, 21 developed LOHC at a median of 29 days (range 4-64 days), with a cumulative incidence of 42% (±7.1%). The cumulative incidence of LOHC on day 100 in patients with and without CMV viremia (prior to or at the onset of LOHC) were 56.3% (±8.9%) and 16.7% (±9.1%) (P = 0.018), respectively, and it was 59.3% (±9.8%) and 21.7% (±8.8%) in patients with and without CMV viruria (prior to or at the onset of LOHC) (P = 0.021), respectively. The cumulative incidence of LOHC was also higher in patients with a plasma BKV load increased ≥3 log10 or with a urine BKV load increased ≥4 log10 than those without the increase (P < 0.001). Only one patient with LOHC was tested positive for ADV. Both the univariate and multivariate analyses showed that CMV viremia (HR = 3.461, 95% CI: 1.005-11.922, P = 0.049) and a plasma BKV load that was increased ≥3 log10 (HR = 10.705, 95%CI: 2.469-46.420, P = 0.002) were independent risk factors for the development of LOHC. We conclude that both CMV viremia and an increase of plasma BKV are independent risk factors for LOHC. And the role of CMV viremia was firstly demonstrated.
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Affiliation(s)
- Ting-Ting Han
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Lan-Ping Xu
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Dai-Hong Liu
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Kai-Yan Liu
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Hai-Xia Fu
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Xiang-Yu Zhao
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Xiao-Su Zhao
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
| | - Xiao-Jun Huang
- Peking University People's Hospital; Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing 100044 P.R. China
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Management of adenovirus in children after allogeneic hematopoietic stem cell transplantation. Adv Hematol 2013; 2013:176418. [PMID: 24288536 PMCID: PMC3830830 DOI: 10.1155/2013/176418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/06/2013] [Indexed: 11/18/2022] Open
Abstract
Adenovirus (ADV) can cause significant morbidity and mortality in children following haematopoietic stem cell transplantation (HSCT), with an incidence of up to 27% and notable associated morbidity and mortality. T-cell depleted grafts and severe lymphopenia are major risk factors for the development of adenovirus disease after HSCT. Current antiviral treatments are at best virostatic and may have significant side effects. Adoptive transfer of donor-derived virus-specific T cells has been shown to be an effective strategy for the prevention and treatment of ADV infection after HSCT. Here we review progress in the field and present a pathway for the management of adenovirus in the posttransplant setting.
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40
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Abstract
A pneumonia de origem viral é uma causa prevalente de infecção respiratória em adultos imunocompetentes. Tem apresentação variada, ocasionando desde formas leves a quadros graves de insuficiência respiratória com necessidade de ventilação mecânica. Contudo, em nosso país, há poucos estudos a respeito da apresentação clínica e diagnóstico dessa infecção. Dessa forma, os autores do presente artigo têm por objetivo revisar os principais agentes virais causadores de pneumonia na comunidade e discutir as modalidades diagnósticas e terapêuticas disponíveis atualmente.
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Affiliation(s)
- Ozéas Galeno da Rocha Neto
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
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41
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Smith FO, Reaman GH, Racadio JM. Pulmonary and Hepatic Complications of Hematopoietic Cell Transplantation. ACTA ACUST UNITED AC 2013. [PMCID: PMC7123560 DOI: 10.1007/978-3-642-39920-6_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Judy M. Racadio
- Division of Hematology/Oncology, Dept. of Internal Medicine, University of Cincinnati College of Medicine, Madeira, Ohio USA
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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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43
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Yilmaz M, Chemaly RF, Han XY, Thall PF, Fox PS, Tarrand JJ, De Lima MJ, Hosing CM, Popat UR, Shpall E, Champlin RE, Qazilbash MH. Adenoviral infections in adult allogeneic hematopoietic SCT recipients: a single center experience. Bone Marrow Transplant 2013; 48:1218-23. [PMID: 23503529 DOI: 10.1038/bmt.2013.33] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/29/2013] [Accepted: 02/09/2013] [Indexed: 01/28/2023]
Abstract
Disseminated adenoviral infection (AI) is associated with profound immunosuppression and poor outcome after allogeneic hematopoietic SCT (allo-HSCT). A better understanding of AI in allo-HSCT recipients can serve as a basis to develop more effective management strategies. We evaluated all adult patients who received allo-HSCT at MD Anderson Cancer Center between 1999 and 2008. Among the 2879 allo-HSCT patients, 73 (2.5%) were diagnosed with AI. Enteritis (26%) and pneumonia (24%) were the most common clinical manifestations; pneumonia was the most common cause of adenovirus-associated death. A multivariable Bayesian logistic regression showed that when the joint effects of all covariates were accounted for, cord blood transplant, absolute lymphocyte count (ALC) ≤ 200/mm(3) and male gender were associated with a higher probability of disseminated AI. The OS was significantly worse for patients with AI that was disseminated rather than localized (median of 5 months vs median of 28 months, P<0.001) and for patients with ALC ≤ 200/mm(3) (P<0.001). Disseminated AI, in patients who received allo-HSCT, is a significant cause of morbidity and mortality. Strategies for early diagnosis and intervention are essential, especially for high-risk patients.
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Affiliation(s)
- M Yilmaz
- Department of Leukemia, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
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44
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Rocha Neto OGD, Leite RF, Baldi BG. Update on viral community-acquired pneumonia. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA (ENGLISH EDITION) 2013. [PMCID: PMC7147884 DOI: 10.1016/s2255-4823(13)70433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Viral pneumonia is a prevalent cause of respiratory infection in immunocompetent adults. It has varied presentation, from mild to severe respiratory failure, requiring mechanical ventilation. However, in Brazil, there have been few studies on the clinical presentation and diagnosis of this infection. Thus, the authors of the present article intend to review the main viral agents that cause community-acquired pneumonia and to discuss the currently available diagnostic and therapeutic methods.
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45
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Arai Y, Maeda T, Sugiura H, Matsui H, Jo T, Ueda T, Okada K, Kawata T, Onishi T, Mizutani C, Ueda Y. Risk factors for and prognosis of hemorrhagic cystitis after allogeneic stem cell transplantation: retrospective analysis in a single institution. ACTA ACUST UNITED AC 2012; 17:207-14. [PMID: 22944099 DOI: 10.1179/1607845412y.0000000010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Hemorrhagic cystitis (HC) is a major complication after allogeneic stem cell transplantation (allo-SCT) and can be life threatening. To analyze risk factors and prognosis, we retrospectively reviewed 249 cases receiving allo-SCT in our institution. Median age was 47 years (13-72 years). Disease status at SCT was progressive in 73 cases. Conditioning was myeloablative (MAC) in 146 cases. Acute graft-versus-host disease (aGVHD) grade II-IV treated with prednisolone occurred in 82 cases, and cytomegalovirus (CMV) was reactivated in 91 cases. HC was reported in 47 cases at a median of 35 days (7-469 days) after SCT, and 34 (72.3%) cases recovered after a median of 19.5 days (2-252 days). In univariate analysis, the identified risk factors for HC included age over 45 years, progressive disease status, MAC, aGVHD treated with prednisolone, and CMV reactivation. In multivariate analysis, older age, MAC, and CMV remained independent predictors (hazard ratios: 2.35, 3.50, and 2.87). In patients with severe HC, percentage recovery was lower (3 in 13 cases; 23.1%) and the median duration was longer (54 days) than in those with moderate HC (31 in 36 cases; 86.1%, 17 days, P < 0.01). Treatment-related mortality was also higher (59.1%, P = 0.03) and overall survival was poorer (16.7%, P < 0.01) at 1 year after SCT. Prospective studies should be started considering prophylactic antiviral administration in high-risk patients such as those identified in this study.
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Affiliation(s)
- Yasuyuki Arai
- Department of Haematology/Oncology, Kurashiki Central Hospital, Okayama, Japan.
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46
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Matthes-Martin S, Feuchtinger T, Shaw P, Engelhard D, Hirsch H, Cordonnier C, Ljungman P. European guidelines for diagnosis and treatment of adenovirus infection in leukemia and stem cell transplantation: summary of ECIL-4 (2011). Transpl Infect Dis 2012; 14:555-63. [DOI: 10.1111/tid.12022] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/15/2012] [Accepted: 08/15/2012] [Indexed: 11/27/2022]
Affiliation(s)
- S. Matthes-Martin
- Department of Pediatrics; Stem Cell Transplantation Unit; St Anna Children's Hospital; Medical University; Vienna; Austria
| | - T. Feuchtinger
- Department of Pediatrics; University Hospital; Tübingen; Germany
| | - P.J. Shaw
- Oncology Unit; The Children's Hospital at Westmead; Sydney; Australia
| | - D. Engelhard
- Department of Pediatrics; Hadassah University Hospital; Jerusalem; Israel
| | - H.H. Hirsch
- Department of Virology; University Hospital; Basel; Switzerland
| | - C. Cordonnier
- Department of Hematology; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris, and Université Paris-Est Créteil; Creteil; France
| | - P. Ljungman
- Department of Hematology; Karolinska University Hospital, and Department of Medicine Huddinge; Section of Hematology; Karolinska Institutet; Stockholm; Sweden
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47
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2-[4,5-Difluoro-2-(2-fluorobenzoylamino)-benzoylamino]benzoic acid, an antiviral compound with activity against acyclovir-resistant isolates of herpes simplex virus types 1 and 2. Antimicrob Agents Chemother 2012; 56:5735-43. [PMID: 22908173 DOI: 10.1128/aac.01072-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) are responsible for lifelong latent infections in humans, with periods of viral reactivation associated with recurring ulcerations in the orofacial and genital tracts. In immunosuppressed patients and neonates, HSV infections are associated with severe morbidity and, in some cases, even mortality. Today, acyclovir is the standard therapy for the management of HSV infections. However, the need for novel antiviral agents is apparent, since HSV isolates resistant to acyclovir therapy are frequently isolated in immunosuppressed patients. In this study, we assessed the anti-HSV activity of the antiadenoviral compounds 2-[2-(2-benzoylamino)-benzoylamino]benzoic acid (benzavir-1) and 2-[4,5-difluoro-2-(2-fluorobenzoylamino)-benzoylamino]benzoic acid (benzavir-2) on HSV-1 and HSV-2. Both compounds were active against both viruses. Importantly, benzavir-2 had potency similar to that of acyclovir against both HSV types, and it was active against clinical acyclovir-resistant HSV isolates.
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48
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Cesario TC. Viruses associated with pneumonia in adults. Clin Infect Dis 2012; 55:107-13. [PMID: 22423119 PMCID: PMC7107903 DOI: 10.1093/cid/cis297] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/24/2012] [Indexed: 02/06/2023] Open
Abstract
Viral pneumonia, which is typically associated with disease in childhood, is increasingly recognized as causing problems in adults. Certain viruses, such as influenza virus, can attack fully immunocompetent adults, but many viruses take advantage of more-vulnerable patients. The latter include patients receiving immunosuppressive therapy and elderly subjects, particularly those residing in long-term care facilities. The range of viruses producing pneumonia in adults includes common agents, such as varicella-zoster virus and influenza virus, as well as respiratory syncytial virus, human metapneumovirus, adenoviruses, picornaviruses, and coronaviruses. The roles played by other agents, such as rhinoviruses and human bocaviruses, in pneumonia are still under study. While therapy for most of theses agents, at least in adults, has not yet been fully clarified, it is reasonable to assume antivirals may work in certain situations if they are introduced early enough in the course of infection.
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49
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Keddis M, Leung N, Herrmann S, El-Zoghby Z, Sethi S. Adenovirus-induced interstitial nephritis following umbilical cord blood transplant for chronic lymphocytic leukemia. Am J Kidney Dis 2012; 59:886-90. [PMID: 22405484 DOI: 10.1053/j.ajkd.2011.10.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022]
Abstract
We present a case of a 27-year-old man who received an unrelated donor umbilical cord blood transplant for chronic lymphocytic leukemia. His postsurgery course was complicated by acute kidney injury, hemorrhagic cystitis, and pancytopenia. Transjugular kidney biopsy showed interstitial nephritis. Viral inclusions were present in tubular epithelial cells, and in situ hybridization studies confirmed the presence of adenovirus. Kidney function improved after a short course of cidofovir. Adenovirus-induced interstitial nephritis should be considered in the differential diagnosis in all cases of interstitial nephritis occurring in immunocompromised patients.
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Affiliation(s)
- Mira Keddis
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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50
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Terasako K, Oshima K, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Machishima T, Nakasone H, Kimura SI, Kikuchi M, Okuda S, Kako S, Yamazaki R, Takeuchi K, Nishida J, Yamada S, Tanaka O, Kanda Y. Fulminant hepatic failure caused by adenovirus infection mimicking peliosis hepatitis on abdominal computed tomography images after allogeneic hematopoietic stem cell transplantation. Intern Med 2012; 51:405-11. [PMID: 22333378 DOI: 10.2169/internalmedicine.51.6432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Disseminated adenovirus disease after allogeneic hematopoietic stem cell transplantation (HSCT) is lethal in most cases, especially when it develops as fulminant hepatic failure. We encountered a patient who developed fulminant hepatic failure caused by adenovirus infection. She did not show manifestations of graft-versus-host disease and the results of serum tests for viral infection were all negative. Abdominal computed tomography (CT) findings were consistent with peliosis hepatitis. She died of fulminant hepatic failure, however, and pathological examinations of the liver specimen obtained after her death revealed adenovirus infection. In this report, we review the clinical characteristics and imaging findings of fulminant hepatic failure caused by adenovirus infection.
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Affiliation(s)
- Kiriko Terasako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan
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