Disseminated adenovirus infection in kidney transplant recipient

Abstract

ABSTRACT:Adenoviruses are common pathogens that have the potential to cause opportunistic infections with significant morbidity and mortality in immunocompromised hosts. The significance of adenoviral infection and disease is incompletely known in the setting of kidney transplantation. Reported adenovirus infections in renal transplant recipients have typically manifested as haemorrhagic cystitis and tubulointerstitial nephritis. Pneumonia, hepatitis and enteritis are often seen in other solid organ recipients. However, disseminated or severe adenovirus infections, including fatal cases, have been described in renal transplant recipients. There is uncertainty regarding monitoring and treatment of this virus. Although not supported by randomized clinical trials, cidofovir is used for the treatment of adenovirus disease not responding to reduction of immunosuppression. We present a case series of 2 patients with disseminated adenovirus infection in our centre who presented at different times from the time of transplantation.

Respiratory Viruses: Influenza, RSV, and Adenovirus in Kidney Transplantation

“…73,101 Common presentations of disease in renal allograft patients include hemorrhagic cystitis and interstitial nephritis. 102 Symptoms of hemorrhagic cystitis typically include fever and hematuria, with or without dysuria or suprapubic pain. In interstitial nephritis, allograft biopsy findings are variable and can include interstitial infiltrates of lymphocytes, monocytes, plasma cells, and neutrophils.…”

“…and disseminated disease, in which two or more organs are effected, all have been described in renal transplant recipients as well. 96,100,102 Treatment Asymptomatic viremia may occur frequently and most AdV infections in renal transplant patients are minor and self-limiting. The mainstay of treatment remains reduction of immunosuppression, although the optimal changes to the immunosuppressive regimen are not known.…”

Cystite hémorragique à adénovirus chez le transplanté rénal : à propos d’un premier cas en Afrique noire survenu dans un tout débutant programme de greffe rénale et revue de la littérature

“…Quatre-vingts (80) cas d'infections par l'adé novirus ont é té rapporté s chez le transplanté ré nal [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Tableau 1). Il s'agit d'une affection qui touche aussi bien les hommes que les femmes, avec une lé gè re pré dominance fé minine (35 hommes pour 44 femmes), et survient à tout âge (âge moyen 39 ans ; extrêmes allant de 5 à 80 ans).…”

“…Les signes cliniques se ré sument pour l'essentiel à une fiè vre, une dysurie et/ou une hé maturie, et une insuffisance du greffon ré nal ré alisant une triade caracté ristique [6,8,10,14,19,20]. Alors que l'hé maturie n'apparaît qu'une fois sur huit, l'insuffisance ré nale semble en revanche quasi constante.…”

“…Bien souvent, elles se ré solvent suite à une ré duction de l'immunosuppression [5,7,8,10,12,[14][15][16]20]. Dans les formes graves, les antiviraux que sont le gancyclovir, la ribavirine, le cidofovir et la vidarabine ont é té utilisé s, tout comme les immunoglobulines intraveineuses.…”