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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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Thorne P, Arroyo JP, Concepcion BP. Fever and Gross Hematuria in a Kidney Transplant Recipient. KIDNEY360 2020; 1:712-713. [PMID: 35372939 PMCID: PMC8815547 DOI: 10.34067/kid.0000732020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Peter Thorne
- Vanderbilt University Medical Center, Nashville, Tennessee
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Gu J, Su QQ, Zuo TT, Chen YB. Adenovirus diseases: a systematic review and meta-analysis of 228 case reports. Infection 2020; 49:1-13. [PMID: 32720128 DOI: 10.1007/s15010-020-01484-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The clinical characteristics of various adenovirus (ADV) infection are underexplored up till now. To investigate the risk factors, manifestation, current status of ADV species, treatment and prognosis of this disease. METHODS We performed a Pubmed and Embase systematic review for case report reporting the ADV infection to analyze the clinical characteristics of disease. RESULTS Initial database searched identified articles of which 168 (228 cases) were included in the final analysis. Previous solid organ transplantation [odds ratio (OR) = 3.45, 95% CI 1.31-9.08, P = 0.01], hematopoietic stem cell transplant (OR = 4.24, 95% CI 1.33-13.51, P = 0.01) and hematological malignancy (OR = 4.78, 95% CI 1.70-13.46, P = 0.01) were associated with increased risk of disseminated ADV infection. Use of corticosteroids (OR = 3.86, 95% CI 1.21-12.24, P = 0.02) was a significant risk factor for acquiring urinary tract infections. A total of six species (21 types) of ADV infection have been identified in 100/228 (43.9%) cases. ADV B was the most common species. ADV B species (26/60, 52.0% or 5/41, 12.2% P = 0.001) were more isolated in patients with ADV pneumonia. ADV C (13/15, 86.7% versus 35/86, 40.7% P = 0.001) species were more identified in patients with disseminated disease. The species associated with keratoconjunctivitis is only ADV D in our analysis. Urinary tract ADV infections were observed in ADV A/B/D species. Cidofovir (CDV) (82/228, 36.0%) remained the most commonly antiviral therapy in our cases, followed by ribavirin (15/228, 6.6%), ganciclovir (18/228, 7.9%), and brincidofovir (12/228, 5.3%). Brincidofovir was administered as salvage therapy in 10 cases. Death was reported in 81/228 (35.5%) patients. Mortality rate was higher among patients with gastrointestinal (GI) ADV infection (5/10, 50.0%), ADV pneumonia (20/45, 44.4%) and disseminated ADV infection (53/122, 43.4%). CONCLUSION Previous solid organ transplantation, hematopoietic stem cell transplant and hematological malignancy were risk factors for disseminated ADV infection. Use of corticosteroids was significant for urinary tract ADV infection. Different species correlated with different clinical manifestations of infection. Mortality rate was higher among patients with GI disease, pneumonia and disseminated disease. Our review clarified the current treatment of ADV infections, and more treatment required further investigation.
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Affiliation(s)
- Jie Gu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Qing-Qing Su
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Ting-Ting Zuo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899# Pinghai Road, Suzhou, 215000, China.
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Sudhindra P, Knoll B, Nog R, Singh N, Dhand A. Brincidofovir (CMX001) for the Treatment of Severe Adenoviral Pneumonia in Kidney Transplant Recipient. Cureus 2019; 11:e5296. [PMID: 31579636 PMCID: PMC6768614 DOI: 10.7759/cureus.5296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Adenovirus causes significant morbidity and mortality in solid organ and hematological transplant recipients. Treatment of adenovirus infections includes supportive care, reduction of immune suppression, and in patients with severe disease, intravenous cidofovir. Brincidofovir (CMX001) is a lipid conjugate of cidofovir, with good oral bioavailability, no associated nephrotoxicity, and higher intracellular levels of the active drug compared to cidofovir. We describe a case of severe adenoviral pneumonia in an adult renal transplant recipient who was successfully treated with oral brincidofovir after developing renal insufficiency with intravenous cidofovir. Brincidofovir (CMX001) along with other supportive therapy, may offer an efficacious, safe, and well-tolerated treatment for severe adenoviral infections in solid organ transplant recipients.
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Affiliation(s)
| | - Bettina Knoll
- Infectious Diseases, Westchester Medical Center, Valhalla, USA
| | - Rajat Nog
- Infectious Diseases, Westchester Medical Center, Valhalla, USA
| | - Nandita Singh
- Nephrology, Westchester Medical Center, Valhalla, USA
| | - Abhay Dhand
- Infectious Diseases, Westchester Medical Center, Valhalla, USA
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Pettengill MA, Babu TM, Prasad P, Chuang S, Drage MG, Menegus M, Lamson DM, Lu X, Erdman D, Pecora N. Probable Donor-Derived Human Adenovirus Type 34 Infection in 2 Kidney Transplant Recipients From the Same Donor. Open Forum Infect Dis 2018; 6:ofy354. [PMID: 30882008 PMCID: PMC6411205 DOI: 10.1093/ofid/ofy354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Human adenovirus type 34 (HAdV-34) infection is a recognized cause of transplant-associated hemorrhagic cystitis and, in rare cases, tubulointerstitial nephritis. The source of such infections is often difficult to assess, that is, whether acquired as a primary infection, exposure to a pathogen in the transplanted organ, or reactivation of an endogenous latent infection. We present here 2 cases of likely transplant-acquired HAdV-34 infection from the same organ donor, manifesting as tubulointerstitial nephritis in 1.
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Affiliation(s)
- Matthew A Pettengill
- University of Rochester Medical Center, Rochester, New York.,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tara M Babu
- University of Rochester Medical Center, Rochester, New York
| | | | - Sally Chuang
- University of Rochester Medical Center, Rochester, New York
| | | | | | - Daryl M Lamson
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Xiaoyan Lu
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dean Erdman
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Pecora
- University of Rochester Medical Center, Rochester, New York
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Hemmersbach-Miller M, Bailey ES, Kappus M, Prasad VK, Gray GC, Alspaugh JA. Disseminated Adenovirus Infection After Combined Liver-Kidney Transplantation. Front Cell Infect Microbiol 2018; 8:408. [PMID: 30524972 PMCID: PMC6256197 DOI: 10.3389/fcimb.2018.00408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022] Open
Abstract
Human adenovirus (HAdV) infections are well-described after hematopoietic stem cell transplantation but less well understood in solid organ transplantation (SOT). We describe a case of disseminated HAdV type 21 infection 5 months after combined liver-kidney transplantation, expanding the limited literature describing this infection in the SOT population.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Emily S Bailey
- Division of Infectious Diseases, School of Medicine and Global Health Institute, Duke University School of Medicine, Durham, NC, United States
| | - Matthew Kappus
- Division of Hepatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Vinod K Prasad
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Gregory C Gray
- Division of Infectious Diseases, School of Medicine and Global Health Institute, Duke University School of Medicine, Durham, NC, United States
| | - J Andrew Alspaugh
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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Abstract
Although advances in immunosuppression and antimicrobial prophylaxis have led to improved patient and graft survival, respiratory viruses continue to be a common cause of morbidity and mortality in immunocompromised populations. We describe the clinical manifestations, diagnosis and treatment options for influenza, respiratory syncytial virus and adenovirus infection in the kidney transplant population.
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Affiliation(s)
- Dana J Hawkinson
- Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL; Transplant and Immunocompromised Host Infectious Diseases Service, Northwestern University Comprehensive Transplant Center, Chicago, IL
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9
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Veer M, Abdulmassih R, Como J, Min Z, Bhanot N. Adenoviral nephritis in a renal transplant recipient: Case report and literature review. Transpl Infect Dis 2017; 19. [PMID: 28467620 DOI: 10.1111/tid.12716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/06/2017] [Accepted: 02/06/2017] [Indexed: 11/27/2022]
Abstract
Adenovirus (AdV) infections in transplant recipients may cause invasive disease. We present a case of granulomatous interstitial nephritis secondary to AdV infection in a renal transplant recipient that was initially interpreted as acute graft rejection on histopathology. Specific testing based on clinical suspicion, however, aided in making an accurate diagnosis. We present a retrospective review of all cases of AdV infection in renal transplant recipients to date, and analyze outcomes based on different treatment modalities for this disease.
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Affiliation(s)
- Manik Veer
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Rasha Abdulmassih
- Division of Infectious Disease, Allegheny General Hospital, Pittsburgh, PA, USA
| | - James Como
- Division of Infectious Disease, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Zaw Min
- Division of Infectious Disease, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nitin Bhanot
- Division of Infectious Disease, Allegheny General Hospital, Pittsburgh, PA, USA
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Seo YM, Hwang-Bo S, Kim SK, Han SB, Chung NG, Kang JH. Fatal systemic adenoviral infection superimposed on pulmonary mucormycosis in a child with acute leukemia: A case report. Medicine (Baltimore) 2016; 95:e5054. [PMID: 27749571 PMCID: PMC5059074 DOI: 10.1097/md.0000000000005054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although adenovirus (ADV) infection usually causes self-limiting respiratory disorders in immune competent children; severe and systemic ADV infection in children undergoing chemotherapy for leukemia has been continuously reported. Nevertheless, there has been no consensus on risk factors and treatment strategies for severe ADV infection in children undergoing chemotherapy. CASE SUMMARY We report a case of a 15-year-old boy with a fatal systemic ADV infection. He had received reinduction chemotherapy for relapsed acute lymphoblastic leukemia under continuing antifungal therapy for previously diagnosed fungal pneumonia. He complained of fever and right shoulder pain 4 days after completing the reinduction chemotherapy. In spite of appropriate antibiotic and antifungal therapy, pneumonia was aggravated and gross hematuria was accompanied. A multiplex polymerase chain reaction test for respiratory viruses was positive for ADV in a blood sample, and a urine culture was positive for ADV. He received oral ribavirin, intravenous immunoglobulin, and intravenous cidofovir therapy; however, he eventually died. Relapsed leukemia, concurrent fungal pneumonia, and delayed cidofovir administration were considered the cause of the grave outcome in this patient. CONCLUSION ADV may cause severe infections not only in allogeneic hematopoietic cell transplant recipients, but also in patients undergoing chemotherapy for acute leukemia. The risk factors for severe ADV infection in patients undergoing chemotherapy should be determined in the future studies, and early antiviral therapy should be administered to immune compromised patients with systemic ADV infection.
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Affiliation(s)
| | | | - Seong koo Kim
- Department of Pediatrics
- The Catholic Blood and Marrow Transplantation Center
| | - Seung Beom Han
- Department of Pediatrics
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Seung Beom Han, Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (e-mail: )
| | - Nack-Gyun Chung
- Department of Pediatrics
- The Catholic Blood and Marrow Transplantation Center
| | - Jin Han Kang
- Department of Pediatrics
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Park UJ, Hyun SK, Kim HT, Cho WH, Han SY. Successful treatment of disseminated adenovirus infection with ribavirin and intravenous immunoglobulin in an adult renal transplant recipient: a case report. Transplant Proc 2015; 47:791-3. [PMID: 25891733 DOI: 10.1016/j.transproceed.2014.11.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
Disseminated adenovirus infection in recipients of renal transplants is a rare but often fatal complication. We present a case of a 32-year-old woman who underwent renal transplantation from a deceased donor. Ten months after transplantation, she presented with dysuria, hematuria, and febrile illness. Despite the use of antibiotics, the patient's symptoms continued and worsened and the serum creatinine level was increased. The results of urine and serum polymerase chain reaction were positive for adenovirus. Renal biopsy revealed viral interstitial nephritis. The patient was treated with ribavirin, intravenous immunoglobulin, and reduction in immunosuppression. Her symptoms progressively improved from 7 days after the treatment. Serum and urine polymerase chain reaction for adenovirus became negative 10 and 21 days after the treatment, respectively. She remained in good health with excellent allograft function 6 months later.
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Affiliation(s)
- U J Park
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea.
| | - S K Hyun
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - H T Kim
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - W H Cho
- Division of Vascular and Transplantation Surgery, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - S Y Han
- Division of Nephrology, Keimyung University, Dongsan Medical Center, Daegu, Korea
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Ackoundou-N'Guessan C, Coulibaly N, Guei CM, Aye D, N'guessan FY, N'Dah JK, Lagou DA, Tia MW, Coulibaly PA, Nzoue S, Konan S, Gnionsahe DA. [Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature]. Nephrol Ther 2015; 11:104-10. [PMID: 25684056 DOI: 10.1016/j.nephro.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently.
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Affiliation(s)
| | - Noël Coulibaly
- Unité pilote de transplantation rénale, service d'urologie, institut de cardiologie, CHU de Treichville, Km 1 boulevard de Marseille, BP V 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Cyr Monley Guei
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Denis Aye
- Service d'anesthésie et de réanimation, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Francis Yapi N'guessan
- Service d'anesthésie et de réanimation, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | - Justin Kouame N'Dah
- Service d'anatomie pathologique, CHU de Cocody, université Félix Houphouët-Boigny, Abidjan, Cocody, BP V 32 Abidjan, Abidjan, Côte d'Ivoire
| | | | - Mélanie Weu Tia
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Sita Nzoue
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Serges Konan
- Service de néphrologie et hémodialyse, CHU de Yopougon, Abidjan, Côte d'Ivoire
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