title: Identification of a novel intertypic recombinant species D human adenovirus in a pediatric stem cell transplant recipient.
abstract: BACKGROUND
  Human adenoviruses (HAdV) are known opportunistic pathogens in hematopoietic stem cell transplant (SCT) recipients. The detection of HAdV infection in children after SCT has been implicated as a determinant of poor outcome but specific associations between HAdV species or individual HAdV types and disease are poorly understood.
  
  
  OBJECTIVE
  Characterization of a HAdV-D strain isolated from multiple clinical specimens of an 11-year-old female recipient of a matched unrelated donor peripheral SCT for T-cell lymphoma and case report.
  
  
  METHODS
  Archived HAdV PCR-positive plasma, urine, and stool specimens were processed for virus isolation and detailed molecular typing. Complete genomic sequencing was carried out on 2 isolates.
  
  
  RESULTS
  The patient tested positive for HAdV DNA by real-time PCR of a stool specimen at 44 days after initiation of a SCT conditioning regimen. In the subsequent 3 months, HAdV was detected in plasma, urine and stool specimens in association with symptoms of gastroenteritis and hemorrhagic cystitis. A novel HAdV-D with a HAdV20-like hexon gene was isolated from both urine and stool specimens. All isolates yielded identical restriction profiles with endonucleases BamHI, BglII, BstEII, HindIII, PstI and SmaI. Analysis of 2 complete genomic sequences further identified the virus as a novel intertypic recombinant HAdV-D (P20/H20/F42) closely related to HAdV42.
  
  
  CONCLUSIONS
  This case highlights the identification of a previously unknown HAdV-D from an immunocompromised host. In this patient, the course of adenovirus infection is compatible with reactivation of a latent virus or a primary opportunistic infection. Adenoviremia in this patient resolved without definitive adenovirus-directed antiviral therapy.
authors.affiliation: Infectious Disease Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA. Electronic address: akajon@lrri.org.
authors.forename: Adriana E
authors.initials: AE
authors.lastname: Kajon
authors.affiliation: Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
authors.forename: Daryl
authors.initials: D
authors.lastname: Lamson
authors.affiliation: Applied Genomics Technologies Core, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shudt
authors.affiliation: Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Zacharoula
authors.initials: Z
authors.lastname: Oikonomopoulou
authors.affiliation: Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Fisher
authors.affiliation: Division of Infectious Diseases, and The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Klieger
authors.affiliation: Virology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: St George
authors.affiliation: Department of Pathology and Laboratory Medicine and Clinical Virology Laboratory, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hodinka
mesh_terms: D000258:Adenovirus Infections, Human / Q000821:virology*; D000260:Adenoviruses, Human / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D005243:Feces / Q000821:virology; D005260:Female; D016679:Genome, Viral; D006801:Humans; D008969:Molecular Sequence Data; D010949:Plasma / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D066027:Transplant Recipients; D014556:Urine / Q000821:virology
chemical_list: D004279:DNA, Viral
keywords: Adenovirus; Genomic sequence; Species D; Transplant