Improved outcome from invasive adenovirus infection in pediatric patients after hemopoietic stem cell transplantation using intensive clinical surveillance and early intervention.
Adenovirus is a common cause of morbidity and mortality after hemopoietic stem cell transplantation in children. Recently the incidence, risk factors, and outcome of such infections have been better defined using improved virologic detection methods, in particular polymerase chain reaction. We have introduced intensive virologic surveillance for adenovirus in our institution including at least weekly polymerase chain reaction testing of blood and stool samples. We report on 71 prospectively monitored transplants, including 40 from unrelated donors. In total, there were 8 cases of invasive adenovirus infection, 3 of whom died. Mortality was less than in previous studies as cases were managed with antiviral chemotherapy and reduction of immune suppression. In fatal cases, there was concurrent difficult graft versus host disease making withdrawal of immune suppression therapy impossible. We describe 2 cases of graft failure in association with adenovirus viremia and its treatment that were successfully managed with further donor cell infusion.
Sivaprakasam
Ponni
P
Departments of Haematology/BMT, Central Manchester and Manchester Children's Hospitals NHS Trust, Manchester, UK.
Carr
Trevor F
TF
Coussons
Mary
M
Khalid
Tasneem
T
Bailey
Andrew S
AS
Guiver
Malcolm
M
Mutton
Kenneth J
KJ
Turner
Andrew J
AJ
Grainger
John D
JD
Wynn
Robert F
RF
D000258:Adenovirus Infections, Human / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology*; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001769:Blood / Q000821:virology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D002648:Child; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005243:Feces / Q000821:virology; D005260:Female; D005455:Fluorescent Antibody Technique; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D008297:Male; D046529:Microscopy, Electron, Transmission; D063065:Organophosphonates / Q000627:therapeutic use; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D063065:Organophosphonates; D012254:Ribavirin; D003596:Cytosine; D000077404:Cidofovir