Incidence of Adenoviral DNAemia in Polish Adults Undergoing Allogeneic Haematopoietic Stem Cell Transplantation

Abstract

Human adenoviruses (HAdV) are important viral pathogens recognized increasingly in immunocompromised hosts, especially in allogeneic haematopoietic stem cell transplant recipients (alloHSCT). The clinical spectrum of HAdV disease ranges from asymptomatic viraemia and mild self-limiting disease to lower respiratory tract infection, multi-organ involvement and even death. Early detection and quantification of HAdV in peripheral blood using real-time PCR (qPCR) assay has been suggested as a useful monitoring tool, but is seldom used for regular surveillance of HAdV in haematology centers. A group of 112 alloHSCT recipients from two hospitals in Warsaw (Poland) was examined in the early post-transplant period using a quantitative qPCR assay. A total of 1,245 serum samples were evaluated for presence of HAdV DNA in patients where 66 (59 %) patients received grafts from unrelated donors whereas the other 46 (41 %) from sibling donors. HAdV sequences were detected in 64 (57 %) of the 112 patients. In 22 of all patients (20 %) HAdV DNA was detected only in a single positive sample, while 42 (37 %) had positive results in two or more subsequent sera. In total, DNAemia was present in 202 sera samples (16 %) with median time to observation of 47 days. Graft-versus-host disease (GvHD) was observed in 18 (28 %) adenovirus-infected transplant recipients and a significant correlation between HAdV infections and GvHD clinical presentation was found (p = 0.018). There is a high prevalence of HAdV infections in HSCT recipients in Poland during early post-transplant period. In consequence, we could only speculate if HAdV DNAemia could be also related to GvHD symptoms, enforcing the important pathogenic role of these viral infections in clinical complications post-alloHSCT.

Adenovirus infection among allogeneic stem cell transplant recipients

“…Viral loads in serum usually vary from 10 2 copies/ml [Rynans et al, ] to 10 10 copies/ml during ASCT HAdV infections [Kalpoe et al, ]. Despite the high viral loads detected in this study when compared to other studies, this was generally not related to bad prognosis or the worsening of clinical symptoms, even though high viral loads have been related to bad prognosis in some investigations [Ganzenmueller et al, ; Mynarek et al, ].…”

“…The HAdV was detected in stool and/or serum samples from 57% of the patients. Data from the literature reveal that HAdV‐positivity in stool and/or serum from ASCT adults varies from 4.7 to 57% [Baldwin et al, ; Kalpoe et al, ; Ganzenmueller et al, ; Jeulin et al, ; Rynans et al, ]. However, data on fecal monitoring remain scarce.…”

“…None of them have prospectively monitored the patients using feces or serum samples nor performed HAdV molecular characterization. The HAdV DNA monitoring in serum is extremely important for helping medical staff take timely preventive measures against systemic disease and nosocomial viral dissemination [Lion et al, ; Rynans et al, ]. The complete lack of routine HAdV monitoring and treatment of ASCT patients could therefore result in higher mortality rates [Ohrmalm et al, ].…”

“…The mean day of HAdV‐positivity found in the study was day 37 after the transplant, and 70% of the positive samples were detected before day 50. Previous studies’ mean day of HAdV‐positivity have varied from 18 to 47 days after the procedure [Baldwin et al, ; Rynans et al, ]. The HAdV viremia before day 50 has also been related to higher viral load and higher risk of death, when compared to viral positivity at different times in infection [Mynarek et al, ].…”

Viral etiologies in adult patients with encephalitis in Poland: A prospective single center study

“…For the detection of Tick-borne encephalitis virus (TBEV) and West Nile virus (WNV) qualitative Reverse Transcription PCR (RT-PCR) were used. The limit of detection (LOD) of each assay was determined by analysis of serial dilutions in the range of 10 1 −10 6 viral copies or viral copy equivalents in the case of synthetic control templates [17–21]. Each dilution was prepared and analyzed in six independent replications.…”