Analysis of rotavirus antigenemia in hematopoietic stem cell transplant recipients

Abstract

Systemic rotavirus infection, such as rotavirus antigenemia, has been found in immunocompetent rotavirus gastroenteritis patients. However, the pathogenesis of rotavirus infection in immunocompromised transplant recipients remains unclear. Enzyme-linked immunosorbent assay was used to measure rotavirus antigen levels in serially collected serum samples obtained from 62 pediatric patients receiving allogeneic hematopoietic stem cell transplants (HSCT). Rotavirus antigen was detected in 43 (6.8%) of 633 serum samples (8 of 62 patients). The duration of rotavirus antigenemia ranged between 1 and 10 weeks, and diarrhea was concurrent with rotavirus antigenemia in Cases 3, 6, 7, and 8. The level of viral antigen in the transplant recipients (0.19 ± 0.20) was significantly lower than that observed in serum samples collected from immunocompetent patients on either day 1 (0.49 ± 0.18, P = 0.0011) or day 3 (0.63 ± 0.09, P = 0.0005). A patient who received a graft from a human leukocyte antigen (HLA)-mismatched donor was at significant risk for rotavirus antigenemia (P = 0.024; odds ratio = 9.44) in comparison to patients who received grafts from HLA-matched donors. Although the duration of antigenemia was clearly longer in HSCT patients than in immunocompetent rotavirus gastroenteritis patients, the levels of viral antigen were not as high. Therefore, mismatched HLA may be a risk factor for rotavirus antigenemia after HSCT.

Gastrointestinal infections after transplantation

“…In a Japanese cohort of pediatric HSCT, rotavirus antigenemia in blood was present in 8 of 62 recipients and correlated with diarrhea in 50% [29]. In a Japanese cohort of pediatric HSCT, rotavirus antigenemia in blood was present in 8 of 62 recipients and correlated with diarrhea in 50% [29].…”

Literature Review on Rotavirus: Disease and Vaccine Characteristics

“…Persistent antigenemia (up to 11 weeks) has been seen in immunocompromised children. (35) Primary infections are associated with higher viral loads. (36), (37) Antigenemia was associated with G1 strains and lower levels of serum IgG.…”

“…(3) In 1998 an RV vaccine consisting of a Rhesus-human reassortant (Rotashield™, Wyeth) was licensed in the U.S., but was withdrawn in 1999 after only a few months of usage following reports in post-marketing surveillance of intussusception among vaccine recipients. The shadow cast by these safety concerns is highlighted, although the new RV vaccine has undergone extensive safety testing in approximately 35,000 recipients to estimate the risk of intussusception in vaccinees.…”

Rotavirus in Organ Transplantation: Drug-Virus-Host Interactions

“…Data were collected and extracted from published cohort and case studies dated back from 1982 until recently and originated from Australia , Austria , Canada , France , Germany , India , Iran , Italy , Japan , Netherlands , Turkey , UK and USA (Table ). These patients were ranged in different age categories from very young to very old.…”

“…Intriguingly, epidemics of rotavirus infection in young children have seasonality and often occur in winter and spring . It is inconclusive whether this is similar in organ transplant patients, although five studies observed a preferential incidence in winter and spring in their cohorts . It is still a mystery how these patients get infected.…”