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Borrie AE, Pike M, Villeneuve S, Verma N. Severe non-hepatic hyperammonaemic encephalopathy in an immunocompromised adolescent with enterocolitis. BMJ Case Rep 2024; 17:e256225. [PMID: 38901854 PMCID: PMC11191012 DOI: 10.1136/bcr-2023-256225] [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] [Accepted: 05/26/2024] [Indexed: 06/22/2024] Open
Abstract
Non-hepatic causes of hyperammonaemia are uncommon relative to hepatic aetiologies. An adolescent female was admitted to the hospital with a diagnosis of very severe aplastic anaemia. During her treatment with immunosuppressive therapy, she developed neutropenic enterocolitis, pseudomonal bacteraemia and hyperammonaemia. A combination of intermittent haemodialysis and high-volume continuous veno-venous haemodiafiltration (CVVHDF) was required to manage the hyperammonaemia. Despite a thorough investigation, there were no hepatic, metabolic or genetic aetiologies identified that explained the hyperammonaemia. The hyperammonaemia resolved only after the surgical resection of her inflamed colon, following which she was successfully weaned off from the renal support. This is a novel case report of hyperammonaemia of non-hepatic origin secondary to widespread inflammation of the colon requiring surgical resection in an immunocompromised patient. This case also highlights the role of high-volume CVVHDF in augmenting haemodialysis in the management of severe refractory hyperammonaemia.
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Affiliation(s)
| | - Meghan Pike
- Medicine, Dalhousie Medical School, Halifax, Nova Scotia, Canada
- Pediatric Oncology/Hematology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Stephanie Villeneuve
- Medicine, Dalhousie Medical School, Halifax, Nova Scotia, Canada
- Pediatric Oncology/Hematology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Neeraj Verma
- Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
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2
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Lin L, Tang M, Li D, Fei H, Zhang H. Combined intravenous ribavirin and recombinant human interferon α1b aerosol inhalation for adenovirus pneumonia with plastic bronchitis in children: a case report and review of literature. Front Pediatr 2024; 12:1295133. [PMID: 38379910 PMCID: PMC10876891 DOI: 10.3389/fped.2024.1295133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Abstract
Background Human adenovirus (HAdV) infections in children can lead to profound pulmonary injury and are frequently associated with severe complications, particularly in cases concomitant with plastic bronchitis. Managing this condition presents significant challenges and carries an exceptionally high fatality rate. Regrettably, there are currently no specific antiviral agents that have demonstrated efficacy in treating severe adenovirus pneumonia in children. Case presentation We report a 10-month-old infant suffering from severe adenovirus pneumonia combined with plastic bronchitis (PB). He received intravenous ribavirin combined with recombinant human interferon α1b (INFα1b) aerosol inhalation and his condition eventually improved. No side effects occurred during the treatment, and the long-term prognosis was favorable. Conclusion In this case, the combination therapy of intravenous ribavirin and INFα1b seems to have contributed to the resolution of illness and may be considered for similar cases until stronger evidence is generated.
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Affiliation(s)
- Liangkang Lin
- Department of Pediatrics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Maoting Tang
- Department of Pediatrics, West China Second UniversityHospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Sichuan University, Ministry of Education, Chengdu, China
| | - Deyuan Li
- Department of Pediatrics, West China Second UniversityHospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Sichuan University, Ministry of Education, Chengdu, China
| | - Haotian Fei
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Haiyang Zhang
- Department of Pediatrics, West China Second UniversityHospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Sichuan University, Ministry of Education, Chengdu, China
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3
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Kühne Escolà J, Theysohn JM, Li Y, Forsting M, Capetian P, Volkmann J, Lange C, Quesada CM, Köhrmann M, Frank B, Kleinschnitz C. Extrahepatic portosystemic shunts as an unusual but treatable cause of hyperammonemic encephalopathy in a noncirrhotic patient - a case report. Ther Adv Neurol Disord 2022; 15:17562864221097614. [PMID: 35586833 PMCID: PMC9109486 DOI: 10.1177/17562864221097614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/11/2022] [Indexed: 01/18/2023] Open
Abstract
We report a case of hyperammonemic encephalopathy due to extrahepatic portosystemic shunts in a noncirrhotic patient. A 79-year-old woman suffered from episodic confusion, disorientation, dysphasia and fluctuating level of consciousness. Electroencephalography (EEG) showed encephalopathic changes and serum levels of ammonia were elevated. Further investigation revealed mesenterorenal and mesenterocaval shunts, which had possibly evolved after pancreatic surgery 5 years ago. After shunt obliteration, the symptoms completely resolved, ammonia levels dropped to the normal range and EEG findings normalized. Clinicians should be aware of this rare but treatable cause of encephalopathy in noncirrhotic patients.
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Affiliation(s)
- Jordi Kühne Escolà
- Department of Neurology and Center for
Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital
Essen, Essen, Germany
| | - Jens M. Theysohn
- Institute for Diagnostic and Interventional
Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany
| | - Yan Li
- Institute for Diagnostic and Interventional
Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional
Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital
Würzburg and Julius-Maximilian-University Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital
Würzburg and Julius-Maximilian-University Würzburg, Würzburg, Germany
| | - Christian Lange
- Department of Gastroenterology and Hepatology,
University Hospital Essen, Essen, Germany
| | - Carlos M. Quesada
- Department of Neurology and Center for
Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital
Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for
Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital
Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology and Center for
Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital
Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for
Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital
Essen, Hufelandstr. 55, 45147 Essen, Germany
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4
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Koya Y, Shibata M, Senju M, Honma Y, Hiura M, Ishii M, Matsumoto S, Harada M. Hyperammonemia in a Woman with Late-onset Ornithine Transcarbamylase Deficiency. Intern Med 2019; 58:937-942. [PMID: 30449781 PMCID: PMC6478997 DOI: 10.2169/internalmedicine.1851-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/12/2018] [Indexed: 01/09/2023] Open
Abstract
A 52-year-old woman developed vomiting and disturbance of consciousness after consuming raw fish and sushi on a trip. A blood test showed hyperammonemia (310 μg/dL) with a normal liver function. She fell into a deep coma, and her serum ammonia level increased to 684 μg/dL. L-arginine was administered as a diagnostic treatment for urea cycle disorder (UCD) and serum ammonia, and her consciousness levels improved. She was diagnosed with ornithine transcarbamylase deficiency (OTCD) by analyses of plasma amino acids, urinary orotic acid, and the OTC gene mutation. UCD should be considered for patients with hyperammonemia without severe liver function abnormalities.
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Affiliation(s)
- Yudai Koya
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Michio Senju
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yuichi Honma
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Masaaki Hiura
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Masahiro Ishii
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shirou Matsumoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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5
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Intravenous and Oral Hyperammonemia Management. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Hyperammonemia: What Urea-lly Need to Know: Case Report of Severe Noncirrhotic Hyperammonemic Encephalopathy and Review of the Literature. Case Rep Med 2016; 2016:8512721. [PMID: 27738433 PMCID: PMC5050374 DOI: 10.1155/2016/8512721] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/28/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose. A 66-year-old man who presented with coma was found to have isolated severe hyperammonemia and diagnosed with a late-onset urea-cycle disorder. He was treated successfully and had full recovery. Methods. We report a novel case of noncirrhotic hyperammonemia and review the literature on this topic. Selected literature for review included English-language articles concerning hyperammonemia using the search terms “hyperammonemic encephalopathy”, “non-cirrhotic encephalopathy”, “hepatic encephalopathy”, “urea-cycle disorders”, “ornithine transcarbamylase (OTC) deficiency”, and “fulminant hepatic failure”. Results. A unique case of isolated hyperammonemia diagnosed as late-onset OTC deficiency is presented. Existing evidence about hyperammonemia is organized to address pathophysiology, clinical presentation, diagnosis, and treatment. The case report is discussed in context of the reviewed literature. Conclusion. Late-onset OTC deficiency presenting with severe hyperammonemic encephalopathy and extensive imaging correlate can be fully reversible if recognized promptly and treated aggressively.
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Muraleedharan A, Palappallil DS, Gangadhar R, Das S. Valproate Induced Hyperammonemic Delirium. J Clin Diagn Res 2015; 9:FR01-3. [PMID: 26816916 DOI: 10.7860/jcdr/2015/15562.6883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
Abstract
Sodium valproate induced hyperammonaemic delirium with normal liver function tests is a relatively uncommon adverse effect. It may be mistaken for psychosis or worsening of mania leading to wrong diagnosis and improper management. Plasma ammonia levels should be monitored in all patients developing altered mental status after receiving valproate therapy. This is a case series of hyperammonaemic delirium due to valproate reported to the Department of Pharmacology from Department of Psychiatry over a period of one year.
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Affiliation(s)
- Anupama Muraleedharan
- Junior Resident, Department of Pharmacology, Government TDMC , Alappuzha, Kerala, India
| | | | - Reneega Gangadhar
- Professor, Department of Pharmacology, Sree Mookambika Institute of Medical Science , Kulasekharam, Tamil Nadu, India
| | - Soumitra Das
- Junior Resident, Department of Psychiatry, Government TDMC , Alappuzha, Kerala, India
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8
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Hiperamonemia en pacientes adultos sin cirrosis. Med Clin (Barc) 2013; 141:494-500. [DOI: 10.1016/j.medcli.2013.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 01/09/2023]
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9
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Pillai U, Kahlon R, Sondheimer J, Cadnapaphorncai P, Bhat Z. A rare case of hyperammonemia complication of high-protein parenteral nutrition. JPEN J Parenter Enteral Nutr 2012; 37:134-7. [PMID: 22610979 DOI: 10.1177/0148607112447815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hyperammonemia is a metabolic derangement that can be potentially fatal. Primary hyperammonemia due to urea cycle enzyme deficiency is usually discovered in neonates but rarely can present in adulthood. Late-onset manifestations of urea cycle disorders can go unnoticed, until they become life threatening. The authors report a 28-year-old man who developed hyperammonemia in the hospital following parenteral nutrition (PN), leading to cerebral edema, which was fatal despite resolution of the hyperammonemia with cessation of PN and the use of continuous renal replacement therapy.
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10
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Mayeur N, Srairi M, Tetu L, Guilbeau Frugier C, Fourcade O, Dahan M. Lethal hemorrhagic alveolitis after adenovirus pneumonia in a lung transplant recipient. Heart Lung 2011; 41:401-3. [PMID: 22054722 DOI: 10.1016/j.hrtlng.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/26/2011] [Accepted: 09/10/2011] [Indexed: 11/16/2022]
Abstract
Viral infections are frequent and severe in lung transplant recipients. They frequently occur during the first year after transplantation. We report on a rare case of bilateral adenovirus necrotizing pneumonia with a diffuse alveolar hemorrhage, 4 years after bilateral lung transplantation. The medical evolution was lethal in 72 hours because of respiratory, renal, and cardiac failure. Considering this case and the growing evidence on the severity of adenoviral infections, we call for controlled studies and therapeutic recommendations.
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Affiliation(s)
- Nicolas Mayeur
- Département d'Anesthésie Réanimation, Université Paul Sabatier Toulouse III, Hôpital Purpan, Toulouse, France.
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11
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Abstract
Adult hyperammonaemia is associated with severe liver disease in 90% of cases. In the remainder, noncirrhotic causes should be considered. Measurements of serum ammonia level must be part of the basic work-up in all patients presenting with encephalopathy of unknown origin, even when liver function is normal. Clinician awareness of noncirrhotic hyperammonaemic encephalopathy can contribute to early diagnosis and the initiation of sometimes life-saving treatment. This review focuses on the physiology, aetiology and underlying mechanisms of noncirrhotic hyperammonaemic encephalopathy and discusses the available treatment modalities.
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Affiliation(s)
- Ido Laish
- Department of Internal Medicine A and Rabin Medical Center, Beilinson Hospital, Petah Tiqwa, Israel
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12
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Abstract
BACKGROUND La Crosse viral encephalitis (LACVE) is associated with residual epilepsy and neurocognitive deficits in survivors. This report summarizes 3 phases of clinical studies of children treated with intravenous (IV) ribavirin (RBV), each one exploring a different phase (I, IIA, IIB) of clinical trial development. METHODS In phase I, 7 children with life-threatening LACVE were treated with emergency use RBV using a moderate IV dose (8.33 mg/kg/dose q 8 hours day 1, 5 mg/kg/dose q 8 hours days 2-10). In phase IIA, 12 children with severe LACVE were enrolled: 8 treated with RBV (same dose as phase I) and 4 with placebo. In phase IIB an escalated dose was used (33 mg/kg dose 1, then 16 mg/kg/dose q 6 hours for 4 days, and 8 mg/kg/dose q 8 hours for 3 days). RESULTS In a group of 15 children treated in phase I and phase IIA, RBV appeared safe at moderate dose, but based on steady-state RBV levels of 9.3 μM, estimated cerebrospinal fluid levels were less than 20% of the EC50 of RBV for LACVE. At the escalated dose used in phase IIB, adverse events occurred, likely related to RBV, and therefore the trial was discontinued. Nevertheless, valuable pharmacokinetic (PK) and safety data were obtained at moderate dose, with potential treatment implications for other indications. CONCLUSIONS Although the results do not support the use of RBV for LACVE, this nevertheless is the largest study of antiviral treatment for LACVE to date and the largest pharmacokinetic analysis of IV RBV in children for any indication.
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Abstract
Patients experiencing acute elevations of ammonia present to the ICU with encephalopathy, which may progress quickly to cerebral herniation. Patient survival requires immediate treatment of intracerebral hypertension and the reduction of ammonia levels. When hyperammonemia is not thought to be the result of liver failure, treatment for an occult disorder of metabolism must begin prior to the confirmation of an etiology. This article reviews ammonia metabolism, the effects of ammonia on the brain, the causes of hyperammonemia, and the diagnosis of inborn errors of metabolism in adult patients.
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Affiliation(s)
- Alison S Clay
- Department of Surgery and Medicine, Duke University Medical Center, Box 2945, Durham, NC 27710, USA.
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14
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Ison MG. Adenovirus infections in transplant recipients. Clin Infect Dis 2006; 43:331-9. [PMID: 16804849 DOI: 10.1086/505498] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 03/27/2006] [Indexed: 12/13/2022] Open
Abstract
Adenoviruses are increasingly recognized as contributors to morbidity and mortality among stem cell and solid-organ transplant recipients. Clinical presentations range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. The limited clinical data available support the use of cidofovir for many of these illnesses. Prospective studies are needed to better understand the pathogenesis of and therapeutic options for adenoviral infections in this patient population.
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Affiliation(s)
- Michael G Ison
- Division of Infectious Diseases, Transplant Infectious Diseases Service, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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15
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Kampmann B, Cubitt D, Walls T, Naik P, Depala M, Samarasinghe S, Robson D, Hassan A, Rao K, Gaspar H, Davies G, Jones A, Cale C, Gilmour K, Real M, Foo M, Bennett-Rees N, Hewitt A, Amrolia P, Veys P. Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation. Br J Haematol 2005; 130:595-603. [PMID: 16098075 DOI: 10.1111/j.1365-2141.2005.05649.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.
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Affiliation(s)
- B Kampmann
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Kinchington PR, Romanowski EG, Jerold Gordon Y. Prospects for adenovirus antivirals. J Antimicrob Chemother 2005; 55:424-9. [PMID: 15743895 DOI: 10.1093/jac/dki057] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Adenoviruses cause a number of self-limiting but often highly infectious diseases that affect multiple organs, most commonly those associated with respiratory, genitourinary and gastrointestinal tracts and the ocular surface. Many factors have driven a search for effective topical and systemic antivirals to adenoviruses. These include patient morbidity, economic losses and chronic visual disturbances associated with epidemic keratoconjunctivitis; and the startling recent trend of high morbidity and rising mortality associated with systemic adenoviral infections in the immunosuppressed, particularly paediatric bone marrow transplant recipients. The development of effective antivirals has proven to be a complex task, owing to the fact that multiple and often genetically divergent adenovirus serotypes can cause similar diseases. Currently, there remains no licensed systemic or topical treatment in the USA or Europe. However, many compounds have been explored for activity against adenoviruses, and some have been evaluated clinically in either a topical setting for ocular disease or in the setting of systemic treatment in the face of life-threatening adenovirus infections. This article outlines such compounds, discusses the potential for their clinical development, and highlights some problems that may be faced in evaluating their efficacy clinically.
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Affiliation(s)
- Paul R Kinchington
- Ophthalmology and Visual Sciences Research Centre, University of Pittsburgh, Pittsburgh, PA, USA.
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Ison MG, Hayden FG. Viral infections in immunocompromised patients: what's new with respiratory viruses? Curr Opin Infect Dis 2002; 15:355-67. [PMID: 12130931 DOI: 10.1097/00001432-200208000-00002] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The leading cause of death in solid organ and hematopoietic stem cell transplant recipients is infection. The respiratory viruses, particularly respiratory syncytial virus, influenza, parainfluenza, adenovirus, and picornaviruses, are increasingly recognized as significant pathogens in these populations. RECENT FINDINGS Respiratory syncytial virus has again been found to be the most common of the respiratory viruses causing severe infections in transplant recipients. Advances in prevention, particularly with regard to infection control practices, and to lesser extent treatment have had a substantial impact on the frequency and outcomes of this infection. New studies have clarified the impact of influenza in the hematopoietic stem cell transplant recipients and have provided evidence to support the use of M2 and neuraminidase inhibitors for early treatment. The epidemiology of parainfluenza and adenovirus in transplant recipients has been clarified, although therapeutic modalities are still limited and understudied. New antiviral medications may bring improved outcomes of picornavirus infections in this population. Finally, a new virus, the human metapneumovirus, has recently been described and may be a significant respiratory pathogen in immunocompromised transplant recipients. SUMMARY Studies published over the past year have documented a new respiratory pathogen. They have also resulted in improved understanding of the epidemiology of all of the respiratory virus pathogens, and have contributed to improve management of respiratory syncytial virus and influenza infection in hematopoietic stem cell transplant and solid organ transplant recipients.
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Affiliation(s)
- Michael G Ison
- Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia 22908, USA.
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