Monitoring of adenovirus infection in pediatric transplant recipients by quantitative PCR: report of six cases and review of the literature.
Adenoviral (AdV) infections after transplantation remain a challenge in pediatric patients. Qualitative and quantitative PCR offer new approaches to early diagnosis and monitoring. However, their role in the management of AdV infections in pediatric transplant recipients remains to be determined. We report six children with positive qualitative serum-PCR for AdV on routine follow-up after transplantation (liver n = 4, hematopoetic stem cells (HSCT) n = 1, combined liver and HSCT n = 1). None of these children were symptomatic at the time of first detection of AdV. Two patients remained asymptomatic, one developed hemorrhagic cystitis and enteritis. Three children with positive PCR developed high viral load on quantitative PCR, all developed clinical AdV sepsis with further rising virus load. Despite antiviral therapy with cidofovir, these three patients died of septic multiorgan failure. Positive qualitative AdV-PCR from blood after pediatric transplantation is not necessarily followed by clinical disease. In case of positive AdV-PCR, monitoring by serial quantitative PCR is useful regarding treatment decision and prevention of fatal disease.
Seidemann
Kathrin
K
Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Germany. Kseidemann@web.de
Heim
Albert
A
Pfister
Eva D
ED
Köditz
Harald
H
Beilken
Andreas
A
Sander
Annette
A
Melter
Michael
M
Sykora
Karl-Walter
KW
Sasse
Michael
M
Wessel
Armin
A
D000257:Adenoviridae Infections / Q000175:diagnosis* / Q000209:etiology*; D000293:Adolescent; D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D017931:DNA Primers; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D016133:Polymerase Chain Reaction / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D017211:Treatment Failure; D016896:Treatment Outcome
D017931:DNA Primers