Prolonged Enteroviral Infection in a Patient Who Developed Pericarditis and Heart Failure After Bone Marrow Transplantation

Galama, J.M.D.; Leeuw, Nicole de; Wittebol, Shulamit; Peters, H. M.; Melchers, Willem J. G.

doi:10.1093/clinids/22.6.1004

Cited by 31 publications

(9 citation statements)

References 21 publications

(17 reference statements)

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“…Two BMT recipients had an enterovirus (non-polio enterovirus in one and echovirus 11 in another) isolated from various organs in the setting of fatal pericarditis and pneumonitis. 9,10 In a prospective study of infectious gastroenteritis in BMT recipients, a coxsackievirus was isolated in the stools of four patients, all of whom died from this complication; 11 these same investigators reported an epidemic of coxsackie A1 gastroenteritis affecting seven patients with six fatalities.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary enterovirus infections in stem cell transplant recipients

González

Martino

Badell

et al. 1999

Bone Marrow Transplant

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Summary:In recent years, it has been recognised that the community respiratory viruses are a frequent cause of upper and lower respiratory tract infections in immunocompromised hosts such as bone marrow transplant recipients. By contrast, infections by non-polio enteroviruses have rarely been reported after stem cell transplantation. We present four cases of acute respiratory illness with enterovirus isolated as the sole pathogen from bronchoalveolar lavage. All four patients developed pneumonia and three died of progressive pneumonia, which reflects the severity of this complication. We conclude that enteroviral pulmonary infections may be a cause of severe pneumonia in immunocompromised hosts. Keywords: enterovirus; pulmonary infection; immunocompromised host Pneumonia is a frequent infectious complication in patients with hematologic malignancies, particularly following stem cell transplantation (SCT). Most viral pneumonias in these patients have been traditionally associated with herpes viruses. In recent years, however, an increasing number of reports have shown the importance of upper and lower respiratory tract infections in SCT recipients and other immunocompromised hosts caused by community respiratory viruses, mainly respiratory syncytial virus, influenza A and B, parainfluenza, adenovirus and picornaviruses. [1][2][3][4][5][6] The human picornaviruses (family Picornaviridae) which cause respiratory infections include rhinoviruses and enteroviruses, which in turn are classified into polioviruses, coxsackieviruses A and B, echoviruses and enterovirus 68-71. Infections by non-polio enteroviruses have rarely been reported in SCT recipients. Herein, we describe the presentation and clinical course of four highly immunocompromised SCT recipients with an acute respiratory illness who had enterovirus isolated from the bronchoalveolar lavage (BAL). Case reportsOne hundred and forty-four patients with hematologic malignancies received an allogeneic SCT and 414 patients received an autologous SCT between January 1990 and November 1997 at our institution. During this period, 190 BAL were performed in SCT recipients with an acute lower respiratory illness. All specimens were submitted for virological studies including antigen detection of respiratory viruses and tissue culture inoculation for cytomegalovirus, herpes simplex virus, enteroviruses and conventional respiratory viruses. An enterovirus was isolated as the sole pathogen in the BAL from four patients, whose characteristics are summarized in Table 1. UPN 463A 6-year-old male underwent an autologous bone marrow transplant (ABMT) for acute lymphocytic leukemia (ALL) in second complete remission (CR). The leukemia relapsed 9 months post-ABMT, and he received salvage chemotherapy with ICE (idarubicin, standard-dose cytarabine and etoposide). On day 20 of chemotherapy, neutropenic fever developed and empiric treatment with ceftazidime and amikacin was begun. Fever persisted and on day 24 he developed a nonproductive cough with a normal chest Xray, and on subse...

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Section: Discussionmentioning

confidence: 99%

Pulmonary enterovirus infections in stem cell transplant recipients

González

Martino

Badell

et al. 1999

Bone Marrow Transplant

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“…However, enteric viruses such as adenovirus, rotavirus and enteroviruses have been reported to cause serious infection in these patients. [1][2][3][4][5][6] The role of enteric viruses has been prospectively investigated in only a few studies to date. 7,8 Previous studies have indicated a high incidence of viral gastro-enteritis in bone marrow transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] The role of cell-mediated immunity in the genesis of enteroviral infections is not clear. It is predominantly observed in patients with defects in the humoral arm of the immune system manifesting often as meningoencephalitis.…”

Section: Disseminated Echovirus and Othermentioning

confidence: 99%

“…Systemic bacterial and fungal infections and infections caused by herpes viruses have been implicated during both early and late post-transplant periods. Enteric viruses such as adenoviruses [1][2][3] and enteroviruses [4][5][6] have been reported to cause both localised and systemic disease in these patients, but only a few prospective studies have addressed the role of enteric pathogens in causing post-transplant infection and disease. Viral pathogens have been isolated from stools of both autologous and allogeneic BMT recipients.…”

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confidence: 99%

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Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study

Chakrabarti

Collingham

Stevens

et al. 2000

Bone Marrow Transplant

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Summary:We prospectively examined stool specimens for enteric viruses in 75 stem cell transplant recipients (autologous 48, allogeneic 27) to determine the frequency and significance of these infections. Only six patients (8%) had a positive isolate. Five of these were allograft recipients (18%) compared to one autograft recipient (2%) (P = 0.02). Unrelated donor BMT recipients were at the highest risk for a viral isolate (OR = 10.5). Adenovirus was the commonest isolate (four patients). One patient each had an echovirus, enterovirus and small round structured virus identified. No correlation was found between the severity of gastro-intestinal symptoms and detection of a viral pathogen. There was no correlation with GVHD or CMV status. The only risk factor identified for isolation of an enterovirus was allogeneic BMT from an unrelated donor. There was a negative correlation with PBSC grafts. All the patients infected with an enteric virus had concomitant infection with other pathogens, compared to only 18% of uninfected patients (P = 0.001). The non-relapse mortality of the infected patients was 50% and only 7% in the uninfected patients (P = 0.01, OR = 12.5), although the isolated virus was the direct cause of death in one patient only. This study indicates a low rate of enteric virus isolation in recipients of PBSC grafts, both autologous and allogeneic. However, unrelated donor BMT is associated with a higher risk of enteric virus infection and an adverse outcome. Bone Marrow Transplantation (2000) 25, 277-282.

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“…Anecdotal reports have implicated that enteroviruses might be responsible for serious complications in the post transplant period. [4][5][6][7][8] Some stool surveillance studies have reported on the isolation of these viruses in post transplant patients with diarrhoea, but none have investigated the incidence and outcome of enterovirus infections in a comprehensive manner. [9][10][11] Tcell depletion of the graft results in an increase in the incidence of several viral infections, but whether the same is true for enterovirus infections is not known.…”

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confidence: 99%