Polyoma BK virus: an emerging opportunistic infectious agent of the human central nervous system

Silva, Rodrigo Lopes da

doi:10.1016/s1413-8670(11)70189-1

Cited by 9 publications

(8 citation statements)

References 51 publications

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“…Of those with known outcomes nine passed away. Regarding typical radiological features, BK virus encephalitis has a predilection for periventricular white matter similar to HIV or cytomegalovirus (CMV) and also for pial surfaces and in general was cortex sparing ( Silva, 2011 ). Regarding PLWH, 12 were identified in a review of published cases by Antoniolli et al.…”

Section: Discussionmentioning

confidence: 99%

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BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

O’Kelly

Keane

Devitt

et al. 2021

Brain, Behavior, & Immunity - Health

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Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the white matter central nervous system occurring in immunocompromised patients particularly those with T cell deficiency such as in HIV, haematological and solid organ malignancies and those taking immunomodulatory medications. PML is caused by JC virus however in rare cases BK virus has been isolated in the cerebral spinal fluid of patients presenting with PML. In this case we describe a 49 year old man who presented to the emergency department with a 2 week history of progressive right sided weakness and dysarthria. His background history included HIV diagnosed in 2005, he had not engaged with care in the past 2 years and had not been taking anti-retroviral therapy (ART). Other past medical history included untreated hepatitis C. His CD4 count was 90 (11%) cells/mm 3 on admission and his HIV viral load VL) was 141,000 copies/ml. Magnetic resonance imaging(MRI) showed a hypointense lesion on T1, hyperintense on T2 and FLAIR without diffusion restriction and without mass effect. A lumbar puncture was performed which confirmed JC virus was positive (PCR <50 copies/ml) and also revealed BK virus was positive (PCR 46,511 copies/ml). The patient was commenced on tenofovir alafenamide fumarate/emtricitabine/darunavir/cobicistat in combination with dolutegravir 50mg twice daily. On day 40 post commencement of ART the patient was readmitted with worsening of his right arm weakness and dysarthria. A repeat MRI was performed which showed the hyperdense lesion on T2 and FLAIR appeared slightly larger with some slight enhancement with gadolinium contrast but no other features suggesting PML immune reconstitution inflammatory syndrome (IRIS). The CD4 count had increased to 141(17%) and HIV VL had decreased to 85 copies/ml. A clinical diagnosis of PML IRIS was made and the patient was commenced on prednisolone 30mg BD which lead to an initial improvement in symptoms. Interestingly in this case, both JC virus and BK virus were detected in the CSF of this patient with the level of JC virus being too low to quantify. BK virus was not detectable on peripheral serum sampling suggesting that BK virus is replicating in the CNS independent of other body sites. There have been 5 case reports in the literature of BK virus as the cause of PML. Testing for BK virus should be considered in patients presenting with signs and symptoms of PML and encephalitis particularly when no other cause is found.

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Section: Discussionmentioning

confidence: 99%

“…Given the similarities between these viruses it does appear that in some immunocompromised patients BK virus can acquire neurotropic properties and has been found in the CSF and brain tissue of patients with encephalitis, meningitis, meningoencephalitis, retinitis and even PML ( Antoniolli et al., 2017 ; Silva, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

O’Kelly

Keane

Devitt

et al. 2021

Brain, Behavior, & Immunity - Health

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“…This retinal disease was probably caused by varicella zoster virus. Neurological syndromes associated with BKV infection were analyzed in two reviews[ 268 , 274 ].…”

Section: Clinical Manifestations Of Bkv Infection Other Than Nephropamentioning

confidence: 99%

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

Vigil

Konstantinov

Barry

et al. 2016

WJT

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Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.

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“…Only a few cases of BKV-associated neurological disease in kidney transplant recipients have been reported so far. [ 2 ] We are reporting this case to spread awareness among all physicians, so as to intervene early in a patient with BKV encephalitis. Early intervention can reduce the mortality significantly.…”

Section: Introductionmentioning

confidence: 99%

A Rare Cause of Encephalopathy Post Renal Transplant: BK Polyoma Virus Encephalitis

Jeemon,

Ganesh,

Madavana

et al. 2023

Indian Journal of Nephrology

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BK polyoma virus (BKV) belongs to Polyomaviridae family. It is a double-stranded DNA virus. Only a few cases of BKV–associated neurological disease in renal transplant recipients have been reported. BKV related central nervous system (CNS) infection may often remain unrecognized in immunocompromised patients. Here, we are reporting a case of BKV encephalitis post renal transplantation for the awareness of all physicians regarding this entity.

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Polyoma BK virus: an emerging opportunistic infectious agent of the human central nervous system

Cited by 9 publications

References 51 publications

BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

BK polyomavirus associated progressive multifocal leukoencephalopathy in a person living with HIV

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

A Rare Cause of Encephalopathy Post Renal Transplant: BK Polyoma Virus Encephalitis

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