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Powell EA, Hata DJ, Starolis MW. Viral pathogen detection using multiplex gastrointestinal molecular panels: The pros and cons of viral target inclusion. J Clin Virol 2023; 169:105612. [PMID: 37866093 DOI: 10.1016/j.jcv.2023.105612] [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] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
Diagnosis of gastrointestinal infections has been revolutionized by the development of in vitro diagnostic (IVD) multiplex molecular panels for the detection of viral nucleic acids. In addition to a high degree of accuracy, these panels are commercially available and relatively simple to perform in the clinical laboratory. However, use of these panels must be carefully considered owing to the laboratory costs of the test, limited reimbursement, and potential for overuse. In this review from the Pan American Society for Clinical Virology, we focus on the viral components of GI multiplex panels (GIPs), presenting a brief overview of pathogens included on most panels and a discussion of advantages and challenges of the inclusion of viral targets on GIPs that should be considered before implementation in the clinical laboratory.
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Affiliation(s)
- Eleanor A Powell
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, 234 Goodman St., Cincinnati, OH 45219, United States.
| | - D Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32266, United States
| | - Meghan W Starolis
- Quest Diagnostics, 14225 Newbrook Dr., Chantilly, VA 20155, United States
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2
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A Prolonged Outbreak of Human Adenovirus A31 (HAdV-A31) Infection on a Pediatric Hematopoietic Stem Cell Transplantation Ward with Whole Genome Sequencing Evidence of International Linkages. J Clin Microbiol 2022; 60:e0066522. [PMID: 36222515 PMCID: PMC9667772 DOI: 10.1128/jcm.00665-22] [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: 11/20/2022] Open
Abstract
A surge in hematopoietic stem cell transplantation (HSCT) human adenovirus A31 (HAdV-A31) infections was initially observed in late 2014/2015 at SickKids (SK) Hospital, Toronto, Canada. In response, enhanced laboratory monitoring for all adenovirus infections was conducted. Positive samples underwent genotyping, viral culture, and, in selected cases, whole-genome sequencing (WGS). HAdV-A31 specimens/DNA obtained from four international pediatric HSCT centers also underwent WGS. During the SK outbreak period (27 October 2014 to 31 October 2018), 17/20 HAdV-A31 isolates formed a distinct clade with 0 to 8 mutations between the closest neighbors. Surveillance before and after the outbreak detected six additional HAdV-A31 HSCT cases; three of the four sequenced cases clustered within the outbreak clade. Two SK outbreak isolates were identical to sequences from two patients in an outbreak in England. Three SK non-outbreak sequences also had high sequence similarity to strains from three international centers. Environmental PCR testing of the HSCT ward showed significant adenovirus contamination. Despite intense infection control efforts, we observed re-occurrence of infection with the outbreak strain. Severe but nonfatal infection was observed more commonly with HAdV-A31 compared to other genotypes, except HAdV-C1. Our findings strongly implicate nosocomial spread of HAdV-A31 over 10 years on a HSCT unit and demonstrate the value of WGS in defining and mapping the outbreak. Close linkages among strains in different countries suggest international dissemination, though the mechanism is undetermined. This large, extended outbreak emphasizes the pre-eminent role of HAdV-A31 in causing intractable pediatric HSCT outbreaks of severe illness worldwide.
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Robins K, Leonard AFC, Farkas K, Graham DW, Jones DL, Kasprzyk-Hordern B, Bunce JT, Grimsley JMS, Wade MJ, Zealand AM, McIntyre-Nolan S. Research needs for optimising wastewater-based epidemiology monitoring for public health protection. JOURNAL OF WATER AND HEALTH 2022; 20:1284-1313. [PMID: 36170187 DOI: 10.2166/wh.2022.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use.
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Affiliation(s)
- Katie Robins
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Anne F C Leonard
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; University of Exeter Medical School, European Centre for Environment and Human Health, University of Exeter, Cornwall TR10 9FE, UK
| | - Kata Farkas
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - David W Graham
- School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - David L Jones
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; SoilsWest, Centre for Sustainable Farming Systems, Food Futures Institute, Murdoch University, Murdoch, WA 6105, Australia
| | | | - Joshua T Bunce
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Jasmine M S Grimsley
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail:
| | - Matthew J Wade
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; School of Engineering, Newcastle University, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK
| | - Andrew M Zealand
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail:
| | - Shannon McIntyre-Nolan
- Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail: ; Her Majesty's Prison and Probation Service, Ministry of Justice, London, SW1H 9AJ, UK
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4
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Adenovirus Infection in Pediatric Hematopoietic Cell Transplantation: A Challenge Still Open for Survival. J Clin Med 2022; 11:jcm11164827. [PMID: 36013066 PMCID: PMC9410345 DOI: 10.3390/jcm11164827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Human Adenovirus (HAdV) infection occurs in 14−16% of patients in the early months after pediatric hematopoietic cell transplantation (HCT) and this correlates with a higher risk of developing HAdV disease and overall 6-month mortality. The main risk factors for HAdV infection are T-cell depletion of the graft by ex vivo CD34+ selection or in vivo use of alemtuzumab or anti-thymocyte serum, the development of grade III-IV graft versus host disease (GVHD), the type of donor (unrelated donor, cord blood, haploidentical, or HLA mismatched parent), and severe lymphopenia (<0.2 × 109/L). The prevention of HAdV disease is based on early intervention with antivirals in the asymptomatic patient when the permitted viral load threshold in the blood (≥102−3 copies/mL) and/or in the stool (109 copies/g stool) is exceeded. Cidofovir, a monophosphate nucleotide analog of cytosine, is the primary drug for preemptive therapy, used at 5 mg/kg/week for 2 weeks followed by 3−5 mg/kg every 2 weeks. The alternative schedule is 1 mg/kg every other day (three times/week). Enhancing virus-specific T-cell immunity in the first months post-HCT by donor-derived or third-party-derived virus-specific T cells represents an innovative and promising way of intervention, applicable both in prevention and therapeutic settings.
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Perruccio K, Menconi M, Galaverna F, Pagliara D, Carraro F, Fagioli F, Calore E, Biffi A, Baretta V, Massei MS, Capolsini I, Faraci M, Verna M, Soncini E, Caniglia M, Locatelli F, Cesaro S. Safety and efficacy of brincidofovir for Adenovirus infection in children receiving allogeneic stem cell transplantation: an AIEOP retrospective analyses. Bone Marrow Transplant 2021; 56:3104-3107. [PMID: 34608274 DOI: 10.1038/s41409-021-01285-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Katia Perruccio
- Pediatric Oncology-Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy.
| | | | - Federica Galaverna
- Pediatric Oncology-Hematology Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Daria Pagliara
- Pediatric Oncology-Hematology Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Francesca Carraro
- Pediatric Oncology-Hematology, Regina Margherita Hospital, Torino, Italy
| | - Franca Fagioli
- Pediatric Oncology-Hematology, Regina Margherita Hospital, Torino, Italy
| | | | - Alessandra Biffi
- Pediatric Oncology-Hematology, University of Padova, Padova, Italy
| | | | - Maria Speranza Massei
- Pediatric Oncology-Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Ilaria Capolsini
- Pediatric Oncology-Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maura Faraci
- HSCT Unit-Pediatric Oncology-Hematology, Istituto G. Gaslini, Genova, Italy
| | | | - Elena Soncini
- Pediatric Oncology-Hematology, Spedali Civili of Brescia, Brescia, Italy
| | - Maurizio Caniglia
- Pediatric Oncology-Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Franco Locatelli
- Pediatric Oncology-Hematology Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Simone Cesaro
- Pediatric Oncology-Hematology, University of Verona, Verona, Italy
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Biserni GB, Scarpini S, Dondi A, Biagi C, Pierantoni L, Masetti R, Sureshkumar S, Rocca A, Lanari M. Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults. Viruses 2021; 13:1885. [PMID: 34578465 PMCID: PMC8472906 DOI: 10.3390/v13091885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 01/03/2023] Open
Abstract
Human Adenoviruses (HAdV) are known to be potentially associated with strong inflammatory responses and morbidity in pediatric patients. Although most of the primary infections are self-limiting, the severity of clinical presentation, the elevation of the white blood cell count and inflammatory markers often mimic a bacterial infection and lead to an inappropriate use of antibiotics. In infections caused by HAdV, rapid antigen detection kits are advisable but not employed routinely; costs and feasibility of rapid syndromic molecular diagnosis may limit its use in the in-hospital setting; lymphocyte cultures and two-sampled serology are time consuming and impractical when considering the use of antibiotics. In this review, we aim to describe the principal diagnostic tools and the immune response in HAdV infections and evaluate whether markers based on the response of the host may help early recognition of HAdV and avoid inappropriate antimicrobial prescriptions in acute airway infections.
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Affiliation(s)
- Giovanni Battista Biserni
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (G.B.B.); (S.S.)
| | - Sara Scarpini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (G.B.B.); (S.S.)
| | - Arianna Dondi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (L.P.); (A.R.); (M.L.)
| | - Carlotta Biagi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (L.P.); (A.R.); (M.L.)
| | - Luca Pierantoni
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (L.P.); (A.R.); (M.L.)
| | - Riccardo Masetti
- Pediatric Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant Orsola Hospital, 40138 Bologna, Italy;
| | | | - Alessandro Rocca
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (L.P.); (A.R.); (M.L.)
| | - Marcello Lanari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (L.P.); (A.R.); (M.L.)
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Bhatt A, Arora P, Prajapati SK. Occurrence, fates and potential treatment approaches for removal of viruses from wastewater: A review with emphasis on SARS-CoV-2. JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING 2020; 8:104429. [PMID: 32895629 PMCID: PMC7467108 DOI: 10.1016/j.jece.2020.104429] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 05/03/2023]
Abstract
The world is combating the emergence of Coronavirus disease 2019 (COVID-19) caused by novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further, due to the presence of SARS-CoV-2 in sewage and stool samples, its transmission through water routes cannot be neglected. Thus, the efficient treatment of wastewater is a matter of utmost importance. The conventional wastewater treatment processes demonstrate a wide variability in absolute removal of viruses from wastewater, thereby posing a severe threat to human health and environment. The fate of SARS-CoV-2 in the wastewater treatment plants and its removal during various treatment stages remains unexplored and demands immediate attention; particularly, where treated effluent is utilised as reclaimed water. Consequently, understanding the prevalence of pathogenic viruses in untreated/treated waters and their removal techniques has become the topical issue of the scientific community. The key objective of the present study is to provide an insight into the distribution of viruses in wastewater, as well as the prevalence of SARS-CoV-2, and its possible transmission by the faecal-oral route. The review also gives a detailed account of the major waterborne and non-waterborne viruses, and environmental factors governing the survival of viruses. Furthermore, a comprehensive description of the potential methods (physical, chemical, and biological) for removal of viruses from wastewater has been presented. The present study also intends to analyse the research trends in microalgae-mediated virus removal and, inactivation. The review also addresses the UN SDG 'Clean Water and Sanitation' as it is aimed at providing pathogenically safe water for recycling purposes.
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Key Words
- ASP, Activated Sludge Process
- COVID-19
- COVID-19, Coronavirus Disease 2019
- DUV-LED, Deep Ultraviolet Light-Emitting Diode
- E.coli, Escherichia coli
- EPS, Exopolysaccharide
- LRV, Log Reduction Value
- MBR, Membrane Bioreactor
- MERS-CoV, Middle East Respiratory Syndrome Coronavirus
- MLSS, Mixed Liquor Suspended Solids
- Microalgaee
- PMR, Photocatalytic Membrane Reactor
- Phycoremediationn
- RH, Relative Humidity
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SBBGR, Sequencing Batch Biofilter Granular Reactor
- SEM, Scanning Electron Microscopy
- SSF, Slow Sand Filtration
- UASB, Upflow Anaerobic Sludge Blanket
- UN SDG, United Nations Sustainable Development Goal
- UV, Ultraviolet
- WHO, World Health Organisation
- WWTP, Wastewater Treatment Plant
- Waterbornee
- dsDNA, Double stranded Deoxyribonucleic Acid
- dsRNA, Double stranded Ribonucleic acid
- ssRNA, Single stranded Ribonucleic Acid
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Affiliation(s)
- Ankita Bhatt
- Environment and Biofuel Research Lab (EBRL), Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
| | - Pratham Arora
- Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
| | - Sanjeev Kumar Prajapati
- Environment and Biofuel Research Lab (EBRL), Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
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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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Sciandra I, Piccioni L, Coltella L, Ranno S, Giannelli G, Falasca F, Antonelli G, Concato C, Turriziani O. Comparative analysis of 2 commercial molecular tests for the detection of gastroenteric viruses on stool samples. Diagn Microbiol Infect Dis 2019; 96:114893. [PMID: 31677959 DOI: 10.1016/j.diagmicrobio.2019.114893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/14/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our purpose was to compare the performance of 2 recently introduced molecular tests for the identification of gastrointestinal viral infections. METHODS One hundred fecal samples from pediatric patients were analyzed using 2 workflows, each including nucleic acids extraction and multiplex Real-Time PCR: Allplex™ GI-Virus Assay and FTD Viral gastroenteritis. The agreement was evaluated calculating Cohen's kappa and applying McNemar's test. RESULTS AND CONCLUSION Allplex and FTD assays showed 100% overall agreement for Norovirus GI/GII and Sapovirus (κ: 1.00), and 99% for Astrovirus (κ: 0.66). A lower agreement was detected for Adenovirus (89%; κ: 0.72) and Rotavirus (91%, k: 0.53), owing to samples resulted positive only with FTD test. The discrepancies were attributed to a different efficiency of extraction/amplification and to the different Adenovirus serotype specificity of the tests since Allplex detects only AdVF40 and AdVF41. FTD test should be used when non enteric adenovirus could have a clinical significance.
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Affiliation(s)
- I Sciandra
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - L Piccioni
- Virology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - L Coltella
- Virology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Ranno
- Virology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - G Giannelli
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - F Falasca
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - G Antonelli
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - C Concato
- Virology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - O Turriziani
- Department of Molecular Medicine, Sapienza University, Rome, Italy.
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Lion T. Adenovirus persistence, reactivation, and clinical management. FEBS Lett 2019; 593:3571-3582. [PMID: 31411731 DOI: 10.1002/1873-3468.13576] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/28/2022]
Abstract
Adenoviral infections continue posing a major threat in severely immunocompromised patients including particularly allogeneic stem cell transplant recipients. Although exogenous infections occur in some instances, the majority of invasive events appear to arise from viral reactivation. In the pediatric setting, adenoviruses were demonstrated to persist in the gastrointestinal tract, and the intestinal epithelium serves as the main site of viral replication preceding invasive infection. Regular monitoring of serial stool samples for the presence and load of adenoviruses has therefore become a routine diagnostic tool for post-transplant patient surveillance, and can serve as a trigger for early initiation of treatment. In the adult setting, the source of infection or reactivation is less clear, and monitoring of peripheral blood specimens is the predominant approach for patient surveillance. Timely initiation of antiviral treatment is reportedly required for prevention or successful control of disseminated disease mediated by adenoviruses, and appropriate diagnostic monitoring is therefore of paramount importance. Currently available antiviral agents and immune therapeutic approaches have not been able to entirely overcome the life-threatening courses of invasive adenoviral infections in the immunocompromised clinical setting.
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Affiliation(s)
- Thomas Lion
- St.Anna Children's Cancer Research Institute (CCRI), Department of Pediatrics, Medical University of Vienna, Austria
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11
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Kosulin K. Intestinal HAdV Infection: Tissue Specificity, Persistence, and Implications for Antiviral Therapy. Viruses 2019; 11:v11090804. [PMID: 31480296 PMCID: PMC6783822 DOI: 10.3390/v11090804] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
Human adenovirus (HAdV) causes infections predominantly in early childhood and the tissue tropism of specific HAdV species determines the clinical manifestation, including infections of the gastrointestinal tract, respiratory tract, and keratoconjunctivitis. Why HAdV shows such a tropism has not yet been fully elucidated, but in the intestine different mechanisms for virus entry or resistence to immune modulatory factors have been described. Recently identified antiviral strategies by interferons provide evidence about the repression of E1A and maybe even promote HAdV persistence. The presence of HAdV in a persistent status in the gut is of importance in the setting of pediatric stem cell transplant recipients where HAdV detection in stool usually preceds clinical signs and severe infections are related to mortality. The reactivation of persistent intestinal HAdV infections in these patients needs further investigation also with regard to successful therapy options. In addition, several newly identified recombinant HAdV types have been isolated from stool samples, thus raising the question of possible recombination events in the gut. In this review, intestinal HAdV infections are discussed in relation to the tissue tropism, persistence, recombination, and new in-vitro models to enhance the knowledge about virus–host interactions and support the development of new treatment approaches.
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Affiliation(s)
- Karin Kosulin
- Molecular Microbiology, Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria.
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12
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Disseminated adenovirus infection in a patient with a hematologic malignancy: a case report and literature review. Future Sci OA 2019; 5:FSO412. [PMID: 31534780 PMCID: PMC6745594 DOI: 10.2144/fsoa-2019-0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Human adenoviruses cause a wide spectrum of illnesses, including invasive infections, in immunocompromised hosts. We report a case of disseminated adenovirus infection following unrelated cord–blood transplantation in a 46-year-old male with a lymphoma. A review of the literature on disseminated adenovirus infections in adult patients with hematopoietic stem cell transplantation has also been included. Despite antiviral therapy, the mortality rate in hematopoietic stem cell transplantation recipients with a disseminated adenovirus infection is as high as 72%, and estimating the risk of human adenovirus infection in a timely manner is crucial to improving outcomes. Human adenoviruses are common viruses that cause a range of illness such as bronchitis, gastroenteritis and conjunctivitis. We recently experienced a case of disseminated adenovirus infection following hematopoietic stem cell transplantation in a patient with a lymphoma who received chemotherapy. Although disseminated adenovirus infection is not a rare disease in immunocompromised patients, it is noteworthy that its mortality remains high and it may not frequently occur. Therefore, this work provides a case presentation and a review of disseminated adenovirus infection in patients with hematopoietic stem cell transplantation in order to aid our understanding of the nature of illness of human adenovirus infections in immunocompromised patients.
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Abstract
The immense global burden of infectious disease outbreaks and the need to establish prediction and prevention systems have been recognized by the World Health Organization (WHO), the National Institutes of Health (NIH), the United States Agency of International Development (USAID), the Bill and Melinda Gates Foundation, and the international scientific community. Despite multiple efforts, this infectious burden is still increasing. For example, it has been reported that between 1.5 and 12 million people die each year from waterborne diseases and diarrheal diseases are listed within the top 15 leading causes of death worldwide. Rapid population growth, climate change, natural disasters, immigration, globalization, and the corresponding sanitation and waste management challenges are expected to intensify the problem in the years to come.
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Kosulin K, Pichler H, Lawitschka A, Geyeregger R, Lion T. Diagnostic Parameters of Adenoviremia in Pediatric Stem Cell Transplant Recipients. Front Microbiol 2019; 10:414. [PMID: 30853954 PMCID: PMC6396503 DOI: 10.3389/fmicb.2019.00414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
Despite recent progress in the diagnostic risk assessment of human adenovirus (HAdV) infections in immunocompromised patients, clinical complications mediated by these viruses continue contributing to significant morbidity and mortality, particularly in the pediatric hematopoietic allogeneic stem cell transplant (HSCT) setting. Current data highlight the importance of monitoring stool samples to assess the risk of invasive HAdV infections in children undergoing HSCT. The advent of novel, more effective antiviral treatment options might permit successful virus control even at the stage of systemic infection, thus increasing the interest in optimized HAdV monitoring in peripheral blood (PB). We have screened over 300 pediatric HCST recipients by serial monitoring of stool and PB specimens, and identified 31 cases of invasive HAdV infection by quantitative pan-adenovirus RQ-PCR analysis of consecutive PB specimens. The diagnostic parameters assessed included HAdV peak levels (PL) and the time-averaged area under the curve (AAUC) of virus copy numbers. The predictive value for patient outcome reflected by non-relapse and HAdV-related mortality was determined. The patients were assigned to quartiles based on their PL and AAUC, and the readouts were highly correlated (p < 0.0001). Non-relapse mortality in patients by AAUC quartile (lowest to highest) was 26, 50, 75, and 86%, respectively, and AAUC was strongly correlated with non-relapse mortality (p < 0.0001), while the association between PL and non-relapse mortality was less pronounced (p = 0.013). HAdV-related mortality was absent or very low in patients within the two lower quartiles of both PL and AAUC, and increased to ≥70% in the upper two quartiles. Despite the significant correlation of PL and AAUC with patient outcome, it is necessary to consider that the risk of non-relapse mortality even within the lowest quartile was still relatively high, and it might be difficult therefore to translate the results into differential treatment approaches. By contrast, the correlation with HAdV-related mortality might permit the identification of a low-risk patient subset. Nevertheless, the well-established correlation of HAdV shedding into the stool and intestinal expansion of the virus with the risk of invasive infection will expectedly remain an essential diagnostic parameter in the pediatric HSCT setting.
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Affiliation(s)
- Karin Kosulin
- Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - Herbert Pichler
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Vienna, Austria
| | - Anita Lawitschka
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Vienna, Austria
| | - René Geyeregger
- Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - Thomas Lion
- Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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Wong SSY, Yip CCY, Sridhar S, Leung KH, Cheng AKW, Fung AMY, Lam HY, Chan KH, Chan JFW, Cheng VCC, Tang BSF, Yuen KY. Comparative evaluation of a laboratory-developed real-time PCR assay and RealStar® Adenovirus PCR Kit for quantitative detection of human adenovirus. Virol J 2018; 15:149. [PMID: 30261891 PMCID: PMC6161464 DOI: 10.1186/s12985-018-1059-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Human adenoviruses are common causes of community-acquired respiratory tract and enteric infections. Severe disseminated infections with high mortality rates may be seen in immunocompromised individuals. An accurate and cost-effective quantitative assay is essential not only for laboratory diagnosis of adenoviral infections, but also for monitoring of response to antiviral treatment. The diagnostic performance of an in-house quantitative polymerase chain reaction assay was compared to a commercial system. Methods The analytical sensitivity, specificity, linearity, precision and accuracy of an in-house adenovirus quantitative polymerase chain reaction assay were evaluated against the RealStar® Adenovirus PCR Kit (Altona Diagnostics GmbH, Hamburg, Germany), using 122 clinical specimens and 18 proficiency testing samples. Results Linear regression analysis of the quantitative results by the in-house assay showed the dynamic range from 2.60 to 9 log10 (plasma) and 2.94 to 9 log10 (viral transport medium) copies/mL, with the coefficient of determination (R2) of 0.996 and 0.998, respectively. A dilution series demonstrated the limits of detection and lower limits of quantification for plasma were 2.06 log10 and 2.60 log10 copies/mL and those for viral transport medium were 2.31 log10 and 2.94 log10 copies/mL respectively. The precision of the in-house assay was highly reproducible among runs with coefficients of variance ranging from 0.07 to 3.21% for plasma and 0.17% to 2.11% for viral transport medium. A comparison of 52 matched samples showed an excellent correlation between the quantitative viral loads measured by the in-house assay and the RealStar® Adenovirus PCR Kit (R2 = 0.984), with an average bias of − 0.16 log10 copies/mL. Conclusions The in-house adenovirus assay is a sensitive and reliable assay with lower cost for the detection and quantification of adenoviral DNA when compared to the RealStar® Adenovirus PCR Kit. Electronic supplementary material The online version of this article (10.1186/s12985-018-1059-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samson S Y Wong
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Cyril C Y Yip
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Siddharth Sridhar
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Kit-Hang Leung
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Andrew K W Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Ami M Y Fung
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China
| | - Ho-Yin Lam
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
| | - Jasper F W Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | | | - Bone S F Tang
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Hong Kong, China. .,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China. .,Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong, China. .,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. .,Department of Microbiology, Queen Mary Hospital, Hong Kong, China. .,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China.
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16
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Hum RM, Deambrosis D, Lum SH, Davies E, Bonney D, Guiver M, Turner A, Wynn RF, Hiwarkar P. Molecular monitoring of adenovirus reactivation in faeces after haematopoietic stem-cell transplantation to predict systemic infection: a retrospective cohort study. LANCET HAEMATOLOGY 2018; 5:e422-e429. [DOI: 10.1016/s2352-3026(18)30130-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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17
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Hiwarkar P, Kosulin K, Cesaro S, Mikulska M, Styczynski J, Wynn R, Lion T. Management of adenovirus infection in patients after haematopoietic stem cell transplantation: State-of-the-art and real-life current approach: A position statement on behalf of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation. Rev Med Virol 2018; 28:e1980. [PMID: 29663594 DOI: 10.1002/rmv.1980] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
The important insights gained over the past years in diagnosis and treatment of invasive adenoviral infections provide new paradigms for the monitoring and clinical management of these life-threatening complications. A meeting was held to discuss and subsequently disseminate the current advances in our understanding of the aetiology/pathogenesis and future treatment options facilitating effective control or prevention of adenovirus-related diseases in the allogeneic haematopoietic stem cell transplant setting. Invited experts in the field discussed recent progress with leading members of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation at the "State-of-the-art" Meeting in Poznan, Poland, in October 2017. In this review article, the panel of experts presents a concise summary of the current evidence based on published data from the last 15 years and on recent achievements resulting from real-life practice. The present position statement reflects an expert opinion on current approaches to clinical management of adenovirus infections in patients undergoing allogeneic haematopoietic stem cell transplant and provides graded recommendations of the panel for diagnostic approaches and preemptive therapy reflecting the present state of knowledge.
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Affiliation(s)
- Prashant Hiwarkar
- Department of Haematology and Bone Marrow Transplantation, Royal Manchester Children's Hospital, Manchester, UK
| | - Karin Kosulin
- Division of Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - Simone Cesaro
- Paediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - Jan Styczynski
- Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Robert Wynn
- Department of Haematology and Bone Marrow Transplantation, Royal Manchester Children's Hospital, Manchester, UK
| | - Thomas Lion
- Division of Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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18
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Kosulin K, Berkowitsch B, Matthes S, Pichler H, Lawitschka A, Pötschger U, Fritsch G, Lion T. Intestinal Adenovirus Shedding Before Allogeneic Stem Cell Transplantation Is a Risk Factor for Invasive Infection Post-transplant. EBioMedicine 2018; 28:114-119. [PMID: 29339099 PMCID: PMC5835548 DOI: 10.1016/j.ebiom.2017.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022] Open
Abstract
Human adenoviruses (HAdV) are a major cause of morbidity and mortality in pediatric human stem cell transplant (HSCT) recipients. Our previous studies identified the gastrointestinal tract as a site of HAdV persistence, but the role of intestinal virus shedding pre-transplant for the risk of ensuing invasive infection has not been entirely elucidated. Molecular HAdV monitoring of serial stool samples using RQ-PCR was performed in 304 children undergoing allogeneic HSCT. Analysis of stool and peripheral blood specimens was performed pre-transplant and at short intervals until day 100 post-HSCT. The virus was detected in the stool of 129 patients (42%), and 42 tested positive already before HSCT. The patients displaying HAdV shedding pre-transplant showed a significantly earlier increase of intestinal HAdV levels above the critical threshold associated with high risk of invasive infection (p<0.01). In this subset of patients, the occurrence of invasive infection characterized by viremia was significantly higher than in patients without HAdV shedding before HSCT (33% vs 7%; p<0.0001). The data demonstrate that intestinal HAdV shedding before HSCT confers a greatly increased risk for invasive infection and disseminated disease post-transplant, and highlights the need for timely HAdV monitoring and pre-emptive therapeutic considerations in HSCT recipients.
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Affiliation(s)
- Karin Kosulin
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria.
| | - Bettina Berkowitsch
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Susanne Matthes
- St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria
| | - Herbert Pichler
- St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria
| | - Anita Lawitschka
- St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria
| | - Ulrike Pötschger
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Gerhard Fritsch
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria
| | - Thomas Lion
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090 Vienna, Austria; Department of Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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19
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Kosulin K, Dworzak S, Lawitschka A, Matthes-Leodolter S, Lion T. Comparison of different approaches to quantitative adenovirus detection in stool specimens of hematopoietic stem cell transplant recipients. J Clin Virol 2016; 85:31-36. [DOI: 10.1016/j.jcv.2016.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/28/2016] [Accepted: 10/30/2016] [Indexed: 01/25/2023]
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20
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César Pereira Santos H, Nunes Vieira Almeida T, Souza Fiaccadori F, das Dôres de Paula Cardoso D, de Moraes Arantes A, Delleon da Silva H, Resende Alo Nagib P, Souza M. Adenovirus infection among allogeneic stem cell transplant recipients. J Med Virol 2016; 89:298-303. [PMID: 27197569 DOI: 10.1002/jmv.24579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/06/2022]
Abstract
The human adenovirus (HAdV) infection can cause severe disease in immunocompromised patients, such as those undergoing allogeneic hematopoietic stem cell transplant (ASCT). The main objective of this study was to prospectively monitor ASCT recipients for HAdV occurrence in a reference center in Brazil, and also to correlate viral positivity, viral load, molecular variant, clinical symptoms, and patients' prognosis. From October/2012 to October/2014, blood and feces of 21 ASCT recipients were screened for HAdV by Nested-PCR. Viral loads were determined by real-time PCR. In total, 57% of the patients had at least one positive sample (serum or feces) for HAdV. Patients presented significantly higher viral load in feces when compared to serum. Positive samples were characterized as HAdVs of species HAdV-C, -D, and -F. The main clinical symptom presented by infected patients was diarrhea, and Graft-versus-host disease (GVHD) was the main intercurrence. An association was observed between HAdV-positivity and diarrhea and also between HAdV-positivity and GVHD. Results from this study may contribute to a better understanding of the HAdV infection pattern in patients submitted to ASCT. Data therein highlight the importance of including HAdV testing during all routine laboratory exams performed on ASCT patients. J. Med. Virol. 89:298-303, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | - Hugo Delleon da Silva
- Laboratory of Molecular Genetics and Cytogenetics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Menira Souza
- Laboratory of Virology, Federal University of Goiás, Goiânia, Goiás, Brazil
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21
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Occurrence, risk factors and outcome of adenovirus infection in adult recipients of allogeneic hematopoietic stem cell transplantation. J Clin Virol 2016; 82:33-40. [DOI: 10.1016/j.jcv.2016.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/25/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
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22
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Mitchell SL, Kajon AE, Kaplan SL, Kim J, Cárdenas AM. An unusual case of disseminated adenovirus infection in a cystic fibrosis, liver transplant patient. J Clin Virol 2016; 81:64-7. [PMID: 27331823 DOI: 10.1016/j.jcv.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Stephanie L Mitchell
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, Philadelphia, PA, United States
| | - Adriana E Kajon
- Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Summer L Kaplan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jason Kim
- Department of Pediatrics, The Perelman School of Medicine, Philadelphia, PA, United States; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ana María Cárdenas
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, Philadelphia, PA, United States; Infectious Diseases Diagnostics Laboratory, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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23
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Abstract
ABSTRACT
Gastrointestinal infections in the immunocompromised host are caused by the common bacterial, viral, fungal, and parasitic agents that also cause infections in the immunocompetent host. Of special consideration is that immunocompromised patients may be at increased risk for infection or disease severity and by pathogens not seen in the competent host. This chapter reviews the various agents, risk factors, and diagnostic approaches to detect gastrointestinal infections in this patient population.
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24
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Kosulin K, Geiger E, Vécsei A, Huber WD, Rauch M, Brenner E, Wrba F, Hammer K, Innerhofer A, Pötschger U, Lawitschka A, Matthes-Leodolter S, Fritsch G, Lion T. Persistence and reactivation of human adenoviruses in the gastrointestinal tract. Clin Microbiol Infect 2015; 22:381.e1-381.e8. [PMID: 26711435 DOI: 10.1016/j.cmi.2015.12.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022]
Abstract
Reactivation of persistent human adenoviruses (HAdVs) is associated with high morbidity and mortality in paediatric haematopoietic stem cell transplant (HSCT) recipients. Although invasive HAdV infections mainly arise from the gastrointestinal (GI) tract, the specific sites of HAdV persistence are not well characterised. We prospectively screened biopsies from 143 non-HSCT paediatric patients undergoing GI endoscopy and monitored serial stool specimens from 148 paediatric HSCT recipients for the presence of HAdV by real-time PCR. Persistence of HAdV in the GI tract was identified in 31% of children, with the highest prevalence in the terminal ileum. In situ hybridisation and immunohistochemistry identified HAdV persistence in lymphoid cells of the lamina propria, whereas biopsies from five transplant recipients revealed high numbers of replicating HAdV in intestinal epithelial cells. The prevalence of HAdV species, the frequencies of persistence in the GI tract and reactivations post transplant indicated a correlation of intestinal HAdV shedding pre-transplant with high risk of invasive infection. HAdV persistence in the GI tract is a likely origin of infectious complications in immunocompromised children. Intestinal lymphocytes represent a reservoir for HAdV persistence and reactivation, whereas the intestinal epithelium is the main site of viral proliferation preceding dissemination. The findings have important implications for assessing the risk of life-threatening invasive HAdV infections.
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Affiliation(s)
- K Kosulin
- Children's Cancer Research Institute, Vienna, Austria
| | - E Geiger
- Children's Cancer Research Institute, Vienna, Austria
| | - A Vécsei
- St Anna Children's Hospital, Vienna, Austria
| | - W-D Huber
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - M Rauch
- Children's Cancer Research Institute, Vienna, Austria
| | - E Brenner
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - F Wrba
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - K Hammer
- St Anna Children's Hospital, Vienna, Austria
| | | | - U Pötschger
- Children's Cancer Research Institute, Vienna, Austria
| | | | | | - G Fritsch
- Children's Cancer Research Institute, Vienna, Austria
| | - T Lion
- Children's Cancer Research Institute, Vienna, Austria; Department of Paediatrics, Medical University of Vienna, Vienna, Austria.
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25
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Abstract
BACKGROUND Adenoviremia adversely affects prognosis in the post-hematopoietic stem cell transplant setting. METHODS We sought to determine retrospectively the cutoff load of adenovirus in the stool as a predictor of adenoviremia, in children who underwent an allogeneic hematopoietic stem cell transplant. The prevalence of sapovirus, norovirus and astrovirus in the stool was also studied. RESULTS The study cohort consisted of 117 patients, of which 71 (60%) had diarrhea. Adenovirus was detected in the stool in 39 of 71 (55%) patients. Age ≤10 years (P = 0.05; odds ratio: 2.57; 95% confidence interval: 0.98-6.75) and male sex (P = 0.04; odds ratio: 2.67; 95% confidence interval: 1.02-6.99) increased risk for detection of adenovirus in stool on univariate analysis. Coinfections with enteric pathogens were infrequent. Viral load >10 copies/g stool predicted adenoviremia with a sensitivity and specificity of 82%. Sapovirus, norovirus and astrovirus were detected in 3, 4 and 1 patient, respectively. CONCLUSIONS Quantitative detection of adenovirus in stool may have implications for preemptive therapy. Testing for other enteric viruses may have implications for infection control.
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26
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Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment. Clin Microbiol Infect 2015; 21:701-9. [PMID: 25882354 DOI: 10.1016/j.cmi.2015.03.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/02/2015] [Accepted: 03/09/2015] [Indexed: 02/05/2023]
Abstract
Human adenovirus (HAdV) infections constitute a major cause of morbidity in paediatric haematopoietic stem cell transplant (HSCT) patients. New antiviral treatments offer promising perspectives. However, it remains challenging to identify patients at risk for disseminated infection, and who should receive early antiviral intervention. We conducted a longitudinal study of allogeneic HSCT recipients, including weekly HAdV monitoring, to determine the risks factors associated with HAdV infection and dissemination, and to assess whether HAdV loads in stools may be used as surrogate markers for HAdV dissemination. Between September 2010 and December 2011, out of 72 patients, the cumulative incidence rates at day 100 of HAdV digestive infection, systemic infection and related disease were 35.9%, 24.0%, and 18.3%, respectively. In multivariate analysis, the risk factors for HAdV digestive and systemic infection were cord blood and in vitro T-cell depletion. Graft-versus-host disease (GVHD) grade >2 was also associated with systemic infection. In patients with HAdV digestive shedding, GVHD grade >2 and HAdV load in stools were the only risk factors for systemic infection. The median peak levels of HAdV in stool were 7.9 and 4.0 log10 copies/mL, respectively, in patients with HAdV systemic infection and in those without. HAdV monitoring in stools of paediatric HSCT recipients receiving cord blood or in vitro T-cell depleted transplants helps to predict patients at risk for HAdV systemic infection. Our results provide a rationale for randomized controlled trials to evaluate the benefit of anti-HAdV pre-emptive treatments based on HAdV DNA levels in stools.
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27
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Abstract
Human adenoviruses (HAdVs) are an important cause of infections in both immunocompetent and immunocompromised individuals, and they continue to provide clinical challenges pertaining to diagnostics and treatment. The growing number of HAdV types identified by genomic analysis, as well as the improved understanding of the sites of viral persistence and reactivation, requires continuous adaptions of diagnostic approaches to facilitate timely detection and monitoring of HAdV infections. In view of the clinical relevance of life-threatening HAdV diseases in the immunocompromised setting, there is an urgent need for highly effective treatment modalities lacking major side effects. The present review summarizes the recent progress in the understanding and management of HAdV infections.
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28
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Bonot S, Ogorzaly L, El Moualij B, Zorzi W, Cauchie HM. Detection of small amounts of human adenoviruses in stools: comparison of a new immuno real-time PCR assay with classical tools. Clin Microbiol Infect 2014; 20:O1010-6. [PMID: 25041100 PMCID: PMC7162227 DOI: 10.1111/1469-0691.12768] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 06/02/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Abstract
The detection of low virus concentrations in biological matrices, especially stool samples, is facing significant limitations as far as common diagnostic methods (enzyme-linked-immunosorbent assay (ELISA) or quantitative real-time PCR (qPCR)) are considered. Here the development of a new immuno real-time PCR (iPCR) is described and its performance in the detection of human adenoviruses (HAdVs) in spiked stools is compared with those of ELISA and qPCR assays. For the iPCR, detection of the sandwich formed by the complexation of capture antibody-antigen-detection antibody was performed by qPCR thanks to the substitution of peroxydase by a chimeric DNA. This modification increased the detection sensitivity 200-fold compared to ELISA. The direct qPCR results revealed that only 0.3–9.5% of the spiked HAdV were detectable, resulting from important losses of DNA occurring at the extraction step. This step was not necessary in the iPCR workflow, avoiding this drawback. The losses of viral particles occurred at the elution step from the stool only. The recovery rate of the iPCR was thus better and ranged between 21 and 54%. As a result, iPCR enabled the detection of lower virus concentrations in stool samples compared to those detected by ELISA and qPCR. The iPCR could be considered as a ‘hyper sensitive ELISA’ for early detection of HAdV infections, especially in the case of immunocompromised patients after haematopoietic stem cell transplant.
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Affiliation(s)
- S Bonot
- Centre de Recherche Public-Gabriel Lippmann, Department of Environment and Agro-biotechnologies (EVA), Belvaux, Luxembourg
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29
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Broad-range PCR-electrospray ionization mass spectrometry for detection and typing of adenovirus and other opportunistic viruses in stem cell transplant patients. J Clin Microbiol 2013; 51:4186-92. [PMID: 24108617 DOI: 10.1128/jcm.01978-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hematopoietic stem cell transplant patients are highly susceptible to viral infections. Follow-up after transplantation includes weekly screening using single, virus-specific real-time PCR tests, mainly for viruses in the families Herpesviridae and Adenoviridae that contribute to a high morbidity, especially in pediatric populations. The Abbott PLEX-ID platform combines broad-range PCR with electrospray ionization mass spectrometry to enable the simultaneous detection of multiple pathogens in a single assay. The Viral IC Spectrum assay detects human adenoviruses, viruses from the family Herpesviridae (herpes simplex virus 1 [HSV-1], HSV-2, cytomegalovirus [CMV], Epstein-Barr virus [EBV], varicella-zoster virus [VZV], and human herpesvirus 8 [HHV-8]), human enterovirus, polyomaviruses (BK and JC), and parvovirus B19. We evaluated the performance of the Viral IC Spectrum assay with samples from 16 adult and 36 pediatric stem cell transplant patients. The sensitivity of the Viral IC Spectrum assay compared to real-time PCR quantification using the adenovirus Rgene kit for the detection of adenovirus was 96.7% from plasma samples (n = 92) and 78% from stool samples (n = 100). No adenovirus was detected in samples from noninfected patients (n = 30). PLEX-ID species identification was perfectly concordant with species-specific real-time PCR assays. In plasma and stool samples, the level of amplified products measured by PLEX-ID and the quantity in copies/ml (r = 0.82 and 0.78, respectively) were correlated up to 6 log10 copies/ml. In 67.4% of adenovirus-positive plasma samples, at least one other viral infection was detected; these included BK virus (n = 41), CMV (n = 30), EBV (n = 26), JC virus (n = 9), and HSV-1 (n = 6). The results of this study suggest that the Viral IC Spectrum assay performed on the PLEX-ID platform is reliable for adenovirus infection diagnosis in immunocompromised patients.
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Matthes-Martin S, Boztug H, Lion T. Diagnosis and treatment of adenovirus infection in immunocompromised patients. Expert Rev Anti Infect Ther 2013; 11:1017-28. [PMID: 24073835 DOI: 10.1586/14787210.2013.836964] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In immunocompromised patients, human adenovirus (HAdV) infections can cause life-threatening multiorgan disease. This review summarizes the incidence and risk factors of invasive human adenovirus infections in immunocompromised patients as well as the recently developed standards for diagnostic methods and strategies according to the predominant risk factors in adults and children. Recommendations for preemptive and therapeutic treatment strategies and the outcome in different risk groups are presented. Novel therapeutic approaches including CMX001, a new orally bioavailable lipid conjugate of cidofovir and the transfer of adenovirus-specific donor T cells in the context of allogeneic stem cell transplantation are discussed.
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Affiliation(s)
- Susanne Matthes-Martin
- St Anna Children's Hospital, Stem cell transplantation, Medical University of Vienna, Vienna, Austria
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Current world literature. Curr Opin Organ Transplant 2013; 18:241-50. [PMID: 23486386 DOI: 10.1097/mot.0b013e32835f5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Berciaud S, Rayne F, Kassab S, Jubert C, Faure-Della Corte M, Salin F, Wodrich H, Lafon ME. Adenovirus infections in Bordeaux University Hospital 2008-2010: clinical and virological features. J Clin Virol 2012; 54:302-7. [PMID: 22608365 DOI: 10.1016/j.jcv.2012.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/06/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transversal epidemiological data on adenovirus infections in a hospital setting, including both immuno-competent and transplanted patients, are limited and rarely contain the application of molecular virology. OBJECTIVES To describe the clinical characteristics and molecular epidemiology of adenovirus infections in Bordeaux University Hospital from 2008 to 2010 (clinical data, viral load and adenovirus species distribution). STUDY DESIGN Adenovirus DNA quantification (qPCR) and typing (sequencing of hexon and protein VI genes and protein VI polymerase chain reaction (PCR) product analysis) were applied retrospectively to 215 clinical samples from 105 adenovirus-infected patients (2008-2010, Bordeaux University Hospital). Clinical data were recovered and analysed for 73 children and 25 adults. RESULTS Viral loads were measured in stools, upper and lower respiratory fluids, blood, urine and digestive tract biopsies; the highest values were observed in stools and respiratory samples. Stool viral loads were comparable whatever the immune status. Adenovirus was typed in 57 patients: species Human adenovirus (HAdV) C dominated (n=36), followed by B (n=15), F (n=5) and D (n=1). We could demonstrate no association between HAdV species and load or clinical severity (observed in most patients). In the immuno-compromised, in contrast to immuno-competent patients, adenovirus infections presented no seasonal variation. Co-infections were frequent: mostly bacterial in immuno-competent children (33%) and viral in immuno-compromised people (34%). CONCLUSIONS The species HAdV C dominates the local ecology, in both respiratory and digestive tract infections, independently of the patient's immune status. Adenovirus infections, often associated with co-infection of bacterial or viral agents, frequently lead to severe clinical consequences in hospital patients.
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Affiliation(s)
- S Berciaud
- Centre Hospitalier Universitaire de Bordeaux, Pediatrics Department, France
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Henke-Gendo C, Ganzenmueller T, Kluba J, Harste G, Raggub L, Heim A. Improved quantitative PCR protocols for adenovirus and CMV with an internal inhibition control system and automated nucleic acid isolation. J Med Virol 2012; 84:890-6. [DOI: 10.1002/jmv.23285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Watson T, MacDonald D, Song X, Bromwich K, Campos J, Sande J, DeBiasi RL. Risk factors for molecular detection of adenovirus in pediatric hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 2012; 18:1227-34. [PMID: 22281300 DOI: 10.1016/j.bbmt.2012.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
Abstract
Adenovirus (AdV) infections are a major cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). To evaluate the use of molecular AdV testing in HSCT at our institution and identify risk factors for AdV viremia and disease, we performed a retrospective cohort study of all HSCT recipients who had undergone AdV polymerase chain reaction testing over a 2-year period. Two cohorts were identified: cohort 1, comprising patients testing positive for AdV (n = 7) and cohort 2, comprising patients testing negative (n = 36). Overall patient characteristics were not statistically significantly different between the 2 cohorts. A comparison of cohort 1 and cohort 2 identified the following medication exposures as risk factors influencing AdV status: preparatory regimens using fludarabine (relative risk [RR], 8.73; 95% confidence interval [CI], 1.18-64.27; P = .006), melphalan (RR, 3.47; 95% CI, 0.76-15.94: P = .08), and/or cyclophosphamide (RR, 0.18; 95% CI, 0.02-1.4; P = .05), and GVHD prophylaxis with methylprednisone (RR, 3.73; 95% CI, 1.01-13.9; P = .04). AdV-positive patients had higher grades of GVHD and higher rates of GVHD of the gastrointestinal tract (RR, 4; 95% CI, 1.18-13.5; P = .03) compared with AdV-negative patients. Four of the 7 AdV-positive patients had concomitant clinical manifestations of disease, including pneumonia, diarrhea, and/or disseminated disease. Clinical outcomes in symptomatic patients included resolution of disease in 2 patients and death in 2 patients. All 7 AdV-positive patients received antiviral therapy, including 1 patient with severe disseminated disease that resolved after administration of liposomal cidofovir. Our study at a large pediatric HSCT center provides important preliminary data for the development of a prospective trial destined to identify specific HCST patient subpopulations that might benefit most from molecular screening and early preemptive therapy.
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Affiliation(s)
- Theresa Watson
- Division of Cancer and Blood Disorders, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA
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