Emerging Infections: Adenovirus Infections in Transplant Recipients

Abstract

Adenoviruses are increasingly recognized as contributors to morbidity and mortality among stem cell and solid-organ transplant recipients. Clinical presentations range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. The limited clinical data available support the use of cidofovir for many of these illnesses. Prospective studies are needed to better understand the pathogenesis of and therapeutic options for adenoviral infections in this patient population.

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos

“…En TOS esta estrategia no está definida y es necesario el desarrollo de nuevos métodos rápidos para detectar y cuantificar ADV en fluidos corporales y evaluar el rol potencial de seguir la carga viral en sangre periférica para identificar aquellos pacientes con alto riesgo de desarrollar enfermedad 1 .…”

“…En niños se ha usado un régimen modificado de 1 mg/kg, tres veces a la semana, observándose menor nefrotoxicidad 37,38,40 . Experiencias preliminares sugieren que la RPC cuantitativa en sangre puede tener significancia pronóstica y que su determinación pudiera ser usada para monitorear la respuesta terapéutica 1,17,41 .…”

“…Los virus más frecuentemente involucrados son virus respiratorio sincicial (VRS), influenza (FLU), parainfluenza (PI) y adenovirus (ADV) [1][2][3][4][5][6][7][8] . Con el uso más rutinario de métodos diagnósticos moleculares en la actualidad, han emergido también otros virus respiratorios como causa de infección en inmunocomprometidos, tales son metapneumovirus humano (MVH), coronavirus, bocavirus, poliomavirus 9-13 y enterovirus (parechovirus), cuya relevancia dentro de esta población está aún en definición.…”

Hexadecyloxypropyl-cidofovir, CMX001, prevents adenovirus-induced mortality in a permissive, immunosuppressed animal model

“…Recently, Ad14, a species B Ad, emerged as a pathogen causing severe respiratory illness (2). Ads cause serious, often life-threatening illnesses in immunocompromised people (1,(3)(4)(5)(6). The most severely affected group is pediatric hematopoietic stem cell transplant recipient patients.…”

“…Animal models exist to investigate topical Ad infection (7)(8)(9)(10), but no systematic study has been performed in animals or in clinical trials to assess the effects of antiviral drug treatment on Ad replication and the pathology resulting from disseminated Ad infection. Most data on the efficacy of antiviral compounds against Ad come from tissue culture experiments, individual case reports (3,(11)(12)(13), or smallscale prospective clinical studies (14). A promising anti-Ad drug in humans appears to be cidofovir, an acyclic nucleotide phosphonate cytosine analogue that acts as a chain terminator during DNA replication (15).…”