Hemorrhagic Cystitis Due to Adenovirus Infection Following Bone Marrow Transplantation

Abstract

Immunocompromised patients are at significant risk for infection with adenovirus. We report 3 cases of hemorrhagic cystitis in patients following bone marrow transplantation. Of the patients 2 had positive viral urine cultures and 1 had positive stool culture but negative urine culture and biopsy proved viral cystitis. Diagnosis of adenovirus should be considered when gross hematuria follows bone marrow transplantation even when urine culture is negative for adenovirus.

Adenovirus infection after pediatric bone marrow transplantation

“…3 In this population, adenovirus infection leads to disseminated disease with myriad manifestations including hemorrhagic cystitis, pneumonia, nephritis, hepatitis, colitis and pancreatitis. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The incidence of adenovirus infection in BMT recipients has varied widely. In a review of 1051 patients from 6 to 55 years old undergoing autologous or allogeneic BMT for leukemia or aplastic anemia, the incidence of adenovirus infection was 4.9%.…”

“…Serotypes 11 and 35 have a propensity for the urinary tract. 3,9,11,13,18 In the Milwaukee study, three patients developed hemorrhagic cystitis, two of whom were infected with serotype 35. 19 The most common clinical problem due to adenovirus infection in our series was hemorrhagic cystitis.…”

“…In addition to the manifestations already described, adenovirus can cause hepatitis with or without hepatic necrosis, pancreatitis, nephritis and disseminated disease in immunodeficient hosts. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Consequently, mortality rates are high, ranging from 18 to 60%, with outcome dependent on patient age, type of immunosuppression, and adenovirus serotype. 3 Adenovirus infection in patients undergoing bone marrow transplantation, first described in 1985, can be severe with virus recoverable from many sites and often accompanied by significant morbidity and mortality.…”

Adenovirus Types 11p and 35p Show High Binding Efficiencies for Committed Hematopoietic Cell Lines and Are Infective to These Cell Lines

“…Ad4p and Ad5v are epitheliotropic viruses causing airway infections, and Ad11p and Ad35p have been described as causing infections of the kidneys and urinary tract (20,31). Many isolates from patients with acute hemorrhagic cystitis after bone marrow or renal transplants have been identified as Ad11p (25,34). The ability of these viruses to replicate and form new infectious particles in hematopoietic cells was also investigated by immunostaining for viral structural proteins, 35 S labeling of proteins after adenovirus infection, and titrations in A549 cells of lysates collected at different time points after infection.…”

Diagnóstico de vírus por microscopia eletrônica em urina de pacientes com hematúrias/cistite hemorrágica após transplante de medula óssea: associação com aspectos clínicos

“…O adenovírus (ADV), um patógeno comum de infecções do trato respiratório superior e gastrointestinal, é considerado causa significativa de morbidade e mortalidade em pacientes imunocomprometidos (19,34,54) e tem sido responsabilizado por H/CH em receptores de transplante renal (16) , bem como também contribuidor/causador importante de H/CH no TMO (2,19,43,45,48,54,58) . Neste, o ADV tem sido demonstrado em infecções desde assintomáticas e localizadas até disseminadas e fatais (19,28) .…”