title: High lethality of human adenovirus disease in adult allogeneic stem cell transplant recipients with high adenoviral blood load.
abstract: BACKGROUND
  Human adenoviruses (HAdV) can cause disseminated disease as a severe complication after haematopoietic stem cell transplantation (SCT) and may originate from the reactivation of latent infections. However, data about the clinical relevance of HAdV DNAaemia and disease in adults are scarce.
  
  
  OBJECTIVE
  To retrospectively analyse the outcome of adult allogeneic SCT recipients with high HAdV loads in peripheral blood.
  
  
  METHODS
  Our diagnostic database was screened for allogeneic SCT recipients with peak HAdV DNAaemia above 1.0×10(4)copies/ml (tested by quantitative real-time PCR) and medical records were reviewed retrospectively.
  
  
  RESULTS
  From 1674 adult allogeneic SCT recipients 539 (32.2%) received HAdV DNAaemia testing. In twenty-seven of these HAdV blood loads above 1.0×10(4) (range: 1.6×10(4)-1.8×10(9))copies/ml were observed. Seven of these 27 succumbed to HAdV disease and their median peak HAdV DNAaemia was significantly higher than in patients without HAdV-associated death (1.0×10(8) vs. 3×10(5)copies/ml, p<0.001). T-cell depletion was a risk factor for fatal HAdV disease. HAdV of species C predominated (66.7%) and were of high virulence (6 of 7 fatal cases). HAdV of species B were observed more frequently (n=6) in our study than reported for paediatrics, indicating a different pattern of HAdV reactivation in adults.
  
  
  CONCLUSIONS
  The presence of several HAdV-associated deaths in adult SCT recipients with high-level HAdV DNAaemia confirmed the clinical relevance of HAdV DNAaemia testing in adults. Quantitative HAdV DNAaemia testing is a promising tool to predict the outcome of HAdV disease.
authors: Institute of Virology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany. Ganzenmueller.Tina@mh-hannover.de
authors: Tina
authors: T
authors: Ganzenmueller
authors: Stefanie
authors: S
authors: Buchholz
authors: Gabi
authors: G
authors: Harste
authors: Elke
authors: E
authors: Dammann
authors: Rudolf
authors: R
authors: Trenschel
authors: Albert
authors: A
authors: Heim
mesh_terms: D000258:Adenovirus Infections, Human / Q000097:blood / Q000401:mortality / Q000821:virology*; D000260:Adenoviruses, Human / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D014180:Transplantation; D014184:Transplantation, Homologous / Q000009:adverse effects; D019562:Viral Load
chemical_list: D004279:DNA, Viral