Incidence and clinical manifestations of adenoviral infection among children undergoing allogeneic stem cell transplantation.
BACKGROUND
Adenoviral infection in children undergoing stem cell transplantation is associated with significant morbidity and mortality. Identification of adenoviral infection by polymerase chain reaction from blood facilitates accurate and rapid diagnosis and surveillance. The incidence of adenoviral infection among children undergoing SCT in Israel is not known.


OBJECTIVE
To estimate the incidence of adenoviral infection in pediatric SCT patients and to characterize the morbidity associated with proven infection.


METHODS
Blood samples obtained weekly from children who underwent allogeneic SCT were retrospectively tested for adenovirus using standard PCR. A total of 657 samples collected from 32 patients were examined. Correlation was made between the presence of adenovirus in samples and clinical records.


RESULTS
Of the 32 patients 4 had adenoviral infection by PCR (12.5%). Clinical disease was present in all four patients concurrent with positive PCR. Gastrointestinal complaints and abnormal hepatocellular enzymes were uniformly present. One patient died due to disseminated disease. T cell depletion was a significant risk factor for adenoviral infection (P = 0.03).


CONCLUSIONS
In the patient population studied, the incidence of adenoviral infection in children undergoing SCT was 12.5%. The combination of gastrointestinal symptoms and abnormal hepatocellular enzymes should raise the suspicion of adenoviral infection, especially when occurring during the first few months after SCT.
Ephros
Moshe
M
Department of Pediatrics, Carmel Medical Center, Haifa, Israel. mefrat@tx.technion.ac.il
Friedman
Bat-chen
BC
Elhasid
Ronit
R
Kra-Oz
Zipi
Z
Shaked-Mishan
Pninit
P
Sattinger
Judith
J
Kassis
Imad
I
D000257:Adenoviridae Infections / Q000201:enzymology / Q000453:epidemiology* / Q000503:physiopathology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous