Disseminated Adenovirus Infection with Hepatic Necrosis in Patients with Human Immunodeficiency Virus Infection and Other Immunodeficiency States

Krilov, Leonard R.; Rubin, Lorry G.; Frogel, Michael; Gloster, Elizabeth S.; Ni, Kai; Kaplan, Martin M.; Lipson, Steven M.

doi:10.1093/clinids/12.2.303

Cited by 106 publications

(57 citation statements)

References 17 publications

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Section: Discussionmentioning

confidence: 74%

“…Over a quarter of the children had a new oxygen requirement. This finding, along with the occasional severe illness seen in normal hosts 10 as well as lifethreatening disease in the immunocompromised 18,19 highlights the clinical importance of ADV disease in children.One significant finding in our study was that 5 children were admitted with suspected KD. All had prolonged fever and conjunctivitis; 4 of 5 had rash and elevated CRP and/or ESR, 3 had mucous membrane changes and 3 had lymphadenopathy, and 2 had swelling of the hands and feet.…”

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confidence: 74%

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Adenoviral Infections in Children: The Impact of Rapid Diagnosis

et al. 2004

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ABSTRACT. Background. Adenovirus (ADV) infections were difficult to diagnose in the past, and many infections were unrecognized. Direct fluorescent assay (DFA) for the rapid diagnosis of ADV infection, as part of a viral respiratory panel, became available at Primary Children's Medical Center (Salt Lake City, UT) in December 2000.Objective. To describe children with ADV infection diagnosed by DFA and viral culture and document the impact of rapid ADV testing on patient care.Methods. DFA testing for respiratory viruses including ADV was performed on nasal wash specimens with parallel viral culture. Chart review was performed for all ADV-positive patients identified from microbiology records between December 2000 and May 2002.Results. Of 1901 patients positive for respiratory viruses, 143 (7.5%) were ADV-positive by DFA or culture. The mean age of ADV-positive children was 23 months; 90% were <60 months old. Eighty percent were previously healthy, and 56% required admission with a mean length of stay of 3.4 days. The most common diagnoses included fever (31%), bronchiolitis (24%), and pneumonia (14%). Other conditions included suspected Kawasaki disease (KD) and hepatitis. Forty-six percent of ADV-positive children were given antibiotics at presentation, but only 2 (1.4%) had documented bacterial infection (one had Escherichia coli urinary tract infection and one had Moraxella catarrhalis bacteremia). Thirty-six percent of children had a change in management based on positive ADV DFA. In children with suspected KD (n ‫؍‬ 5), 100% had positive ADV DFA, and immune globulin was withheld in 4. One immunocompetent patient with fulminant liver failure received cidofovir treatment after a positive ADV DFA and recovered before liver transplant.Conclusions. ADV is a common infection in young children and often results in admission and unnecessary antibiotic therapy. Identifying ADV as the cause of illness can favorably impact care and in some instances may be life-saving. DFA testing for ADV should be considered for infants and children requiring admission for fever, respiratory illness, suspected KD, and hepatitis. Pediatrics 2004;113:e51-e56. URL: http://www.pediatrics. org/cgi/content/full/113/1/e51; adenovirus, rapid diagnosis, Kawasaki disease.ABBREVIATIONS. ADV, adenovirus; PCMC, Primary Children's Medical Center; DFA, direct fluorescent assay; ED, emergency department; RSV, respiratory syncytial virus; KD, Kawasaki disease; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; IVIG, intravenous immune globulin.A denovirus (ADV) is a well-known cause of respiratory illness in children. [1][2][3][4] It may produce upper or lower respiratory infection including bronchiolitis and pneumonia. 5 In addition, ADV infection is frequently associated with entities such as pharyngoconjunctival fever and epidemic conjunctivitis that are often diagnosed based on clinical examination alone. 6 Although most infections are self-limited, ADV can be associated with severe or lethal infection in both immunocompromised and healt...

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Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 74%

Adenoviral Infections in Children: The Impact of Rapid Diagnosis

et al. 2004

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“…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%.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

Adenovirus infection after pediatric bone marrow transplantation

Hale

Heslop

Krance

et al. 1999

Bone Marrow Transplant

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Summary:Retrospective analysis of 206 patients undergoing 215 consecutive bone marrow transplants (BMT) at St Jude Children's Research Hospital between November 1990 and December 1994 identified 6% (seven male, six female) with adenovirus infection. The affected patients had a median age of 7.9 years (range 3-24 years) at time of transplantation. Although transplants were performed for hematologic malignancies, solid tumors or nonmalignant conditions, only patients with hematologic malignancies had adenoviral infections. Adenovirus was first detected at a median of 54 days (range ؊4 to ؉333) after BMT. Adenovirus developed in eight of 69 (11.6%) patients receiving grafts from matched unrelated or mismatched related donors, in four of 52 (7.7%) receiving grafts from HLA-matched siblings, and in one of 93 (1.1%) receiving autografts. The most common manifestation of adenovirus infection was hemorrhagic cystitis, followed by gastroenteritis, pneumonitis and liver failure. The incidence of adenovirus infection in pediatric BMT patients at our institution is similar to that reported in adult patients. Using univariate analysis, use of total body irradiation and type of bone marrow graft were significant risk factors for adenovirus infection. Only use of total body irradiation remained as a factor on multiple logistic regression analysis.

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“…1 B) that can be propagated in a cell line (293) that expresses the El gene products (Fig. 1 C) [48]. Adenoviruses may also be excreted by oro-faecal and respiratory routes for months or years following infection.…”

Section: Adenovirusesmentioning

confidence: 99%