Impact of adenoviral stool load on adenoviremia in pediatric hematopoietic stem cell transplant recipients.
BACKGROUND
Adenoviremia adversely affects prognosis in the post-hematopoietic stem cell transplant setting.


METHODS
We sought to determine retrospectively the cutoff load of adenovirus in the stool as a predictor of adenoviremia, in children who underwent an allogeneic hematopoietic stem cell transplant. The prevalence of sapovirus, norovirus and astrovirus in the stool was also studied.


RESULTS
The study cohort consisted of 117 patients, of which 71 (60%) had diarrhea. Adenovirus was detected in the stool in 39 of 71 (55%) patients. Age ≤10 years (P = 0.05; odds ratio: 2.57; 95% confidence interval: 0.98-6.75) and male sex (P = 0.04; odds ratio: 2.67; 95% confidence interval: 1.02-6.99) increased risk for detection of adenovirus in stool on univariate analysis. Coinfections with enteric pathogens were infrequent. Viral load >10 copies/g stool predicted adenoviremia with a sensitivity and specificity of 82%. Sapovirus, norovirus and astrovirus were detected in 3, 4 and 1 patient, respectively.


CONCLUSIONS
Quantitative detection of adenovirus in stool may have implications for preemptive therapy. Testing for other enteric viruses may have implications for infection control.
From the *Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN; †Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; ‡University of Toledo, Toledo, OH; §Department of Biostatistics, and ¶Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN.
Ashok
A
Srinivasan
Corie
C
Klepper
Anusha
A
Sunkara
Guolian
G
Kang
Jeanne
J
Carr
Zhengming
Z
Gu
Wing
W
Leung
Randall T
RT
Hayden
D000256:Adenoviridae / Q000302:isolation & purification*; D000257:Adenoviridae Infections / Q000821:virology*; D000293:Adolescent; D001769:Blood / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000821:virology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D001257:Mamastrovirus / Q000302:isolation & purification; D029322:Norovirus / Q000302:isolation & purification; D012189:Retrospective Studies; D029341:Sapovirus / Q000302:isolation & purification; D019562:Viral Load; D014766:Viremia / Q000821:virology*; D055815:Young Adult