Adenovirus infection and treatment with cidofovir in children after liver transplantation.
In a retrospective study, serum samples from 21 pediatric liver transplant recipients were analysed by quantitative real-time PCR for ADV infection up to 24 wk after Tx. ADV DNA was detected in serum of eight children after Tx, one of whom developed life-threatening fulminant hepatitis and sepsis. None of these children were symptomatic at the time of first detection of ADV DNA in serum after Tx. Seven children with positive ADV PCR had low adenoviral loads, showed no increase in viral load and remained clinically asymptomatic in the follow-up period of 24 wk. After 10 wk under immunosuppression one child presented clinically with adenoviral sepsis and severe necrotizing hepatitis. This patient revealed a dramatic increase of ADV from baseline titers up to 1.3 x 10(9 )copies/mL serum within 10 wk after Tx. ADV was also detected in a liver biopsy of this child at 1.2 x 10(4) copies/cell and typed by sequence analysis as human ADV species C, type 6, a rarely detected ADV type and first described in a liver transplant patient. Immunosuppression was reduced in this patient immediately and the antiviral drug cidofovir administered intravenously followed by viral suppression and clinical improvement of the child.
Engelmann
Guido
G
Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.
Heim
Albert
A
Greil
Johann
J
Schmitt
Claus Peter
CP
Flechtenmacher
Christa
C
Daum
Edith
E
Küsters
Uta
U
Schmidt
Jan
J
Meyburg
Jochen
J
Schnitzler
Paul
P
D000256:Adenoviridae / Q000302:isolation & purification*; D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000188:drug therapy*; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir