Nosocomial BK Polyomavirus Infection Causing Hemorrhagic Cystitis Among Patients With Hematological Malignancies After Hematopoietic Stem Cell Transplantation

Abstract

BK polyomavirus (BKPyV) is recognized as a pathogen that causes diseases such as hemorrhagic cystitis and nephritis after allogeneic hematopoietic stem cell transplantation (HSCT) or renal transplantation. BKPyV-associated disease is thought to occur through reactivation under immunosuppression. However, the possibility of its nosocomial transmission and the clinical significance of such transmission have not been elucidated. During a 6-month period, nine adult patients (median age: 47 years) who had hematological disorders and who were treated with HSCT (n = 7) or chemotherapy (n = 2) in a single hematology department developed hemorrhagic cystitis due to BKPyV infection. The polymerase chain reaction products of BKPyV DNA obtained from each patient were sequenced. Of the nine patients, six had subtype I, 2 had subtype IV, and 1 had subtype II or III. In the alignment of sequences, four and two of the six subtype I strains were completely homologous (100%). These results strongly suggest that BKPyV has the potential to cause nosocomial infection within a medical facility, especially among recipients of HSCT. Further studies are clearly warranted to elucidate the route(s) of BKPyV transmission in order to establish optimal infection control.

Prevalence and viral loads of polyomaviruses BKPyV, JCPyV, MCPyV, TSPyV and NJPyV and hepatitis viruses HBV, HCV and HEV in HIV-infected patients in China

“…In HIV-positive individuals, positivity for anti-JCPyV IgG was also significantly associated with HEV seropositivity (Table 3). Not only fecal-oral, oral, and respiratory routes but other routes such as bloodborne routes are implicated in the transmission of human PyVs 26,27 . Further association analysis indicated that HBsAg positivity was significantly associated with seroprevalence of BKPyV, JCPyV, MCPyV and TSPyV (P < 0.05).…”

IPSE, a urogenital parasite-derived immunomodulatory protein, ameliorates ifosfamide-induced hemorrhagic cystitis through downregulation of pro-inflammatory pathways

“…Hemorrhagic cystitis is a serious and difficult to manage complication resulting from exposure to certain chemotherapeutic agents 1 , radiation therapy 2 and various viruses in immunosuppressed patients 3,4 . Indeed, anticancer doses of oxazaphosphorines, such as cyclophosphamide and ifosfamide, are limited in part due to the risks of this complication 1 .…”

BK Polyomavirus—Biology, Genomic Variation and Diagnosis

“…Another possibility is that replication may be induced by the mutation or rearrangements in NCCR region or alternatively viral replication may be result of the transmission of BKPyV from the donor to the recipient [ 77 ]. There are also studies suggesting replication of BKPyV as a result of the nosocomial transmission via medical personnel, medical instruments, or common toilets [ 78 , 79 ].…”