Adenovirus Infections in Hematopoietic Stem Cell Transplant Recipients

Abstract

We report a 12% incidence of adenovirus infections among 532 recipients of hematopoietic stem cell transplant (HSCT) from January 1986 through March 1997. The median time from day of stem cell infusion to first positive culture was 41 days. Recipients of allogeneic stem cells, as opposed to autologous stem cell recipients, were more likely to have a culture positive for adenovirus (16% vs. 3%; P<.0001). Pediatric patients were also more likely than adults to have a positive culture (23% vs. 9%; P<.0001). Among stem cell recipients with partially matched related donors, pediatric recipients appear to be at significantly greater risk for infection than adult recipients (P<.001). Positive cultures were associated with evidence of invasion in 64% of cases (41 of 64). A multiple logistic regression analysis showed that isolating adenovirus from more than 1 site correlated with greater risk for invasive infections (P=.002). Invasive infections were associated with poorer chance of survival.

Evaluation of a surveillance strategy for early detection of adenovirus by PCR of peripheral blood in hematopoietic SCT recipients: incidence and outcome

“…3,5 The probable cause is an increase in the number of high-risk patients undergoing HSCT. Subsequently, newfound awareness of AdV may have led to more intense surveillance strategies reinforced by the application of new sensitive methods for molecular diagnosis.…”

“…Subsequently, newfound awareness of AdV may have led to more intense surveillance strategies reinforced by the application of new sensitive methods for molecular diagnosis. Several risk factors for AdV infection have been identified with different levels of effect on incidence: younger age, 5,[23][24][25] usage of T cell-depleted grafts, 13,26,27 grafts from an unrelated donor, 23 GVHD or its therapy 28 and a slow lymphocyte recovery. 13,27 In particular, transplantation of CD34 þ selected grafts were related to an increased incidence of AdV infection.…”

“…The most feared sequelae in immunocompromised individuals include enteritis, hemorrhagic cystitis, nephritis, fulminant hepatitis and disseminated disease; the mortality rate can be as great as 80%. [1][2][3][4][5][6][7][8] The risk of disseminated disease has been shown to correlate positively with viral load as measured by quantitative PCR methods. [9][10][11] Cidofovir has emerged as the primary therapy for AdV infection.…”

Comparison of HSV-1 thymidine kinase-dependent and -independent inhibition of replication-competent adenoviral vectors by a panel of drugs

“…42 In some cases therapy was successful, [43][44][45][46][47][48] but many patients died despite RBV treatment. [49][50][51][52][53][54][55][56] Furthermore, cidofovir (CDV), an acyclic nucleoside phosphonate that has activity against virtually all DNA viruses including adenovirus, 57,58 has been evaluated for disseminated adenovirus disease with limited success. [59][60][61] Reports of successful alternative strategies are less common and include an apparent beneficial effect of donor leukocyte infusion, 53,54 intravenous immunoglobulin, 62 and ganciclovir(GCV) treatment.…”

Adenovirus Fulminant Hepatic Failure: Disseminated Adenovirus Disease after Unrelated Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukemia

“…Bordigoni et al (7) revised the Wisconsin criteria, which defines definite ADV disease as the presence of typical ADV nuclear inclusion in routine histopathology and/or a positive culture from affected tissue, originally described by Flomenberg et al (12) (2, 8, 11-13, 21, 39), the intensity of immunosuppressive therapy (38), the isolation of ADV from two or more sites (12,39), HLA-mismatched or unrelated transplants (1,21), T-cell depletion transplants (11) with/ without ATG, CD34+ positive selection transplant, lymphocytopenia (11), ADV antibody status of the donors (2), allogeneic transplantation (38,39), and a conditioning regimen with TBI (8). No (17,19), 5 (14-16, 18), and 32 (40) (41), serum (42,43), or urine (42,44) (41).…”