Adenovirus infections in patients undergoing bone-marrow transplantation
Abstract:
Viral infection is commonly observed after bone-marrow transplantation. We isolated adenovirus from 51 of 1051 patients undergoing marrow transplantation between 1976 and 1982. Of the 46 isolates available for typing, 13 (27.7 per cent) were of the closely related species 11, 34, or 35 (subgenus B). All 13 of the patients with these species had positive urine cultures. The species have previously been associated with the acquired immunodeficiency syndrome or with renal transplantation but are not commonly found in community surveys. Invasive infection was confirmed by biopsy or autopsy in 10 of 51 patients. Seven of the 10 had virus isolated from lung, and 4 died from pneumonia attributed to adenovirus. Two of the five patients with renal isolates had evidence of virally induced renal impairment, and both patients with liver isolates had adenovirus hepatitis. There was no common source that accounted for these adenovirus infections, and the most likely source of infection appeared to be endogenous viral reactivation. The only identifiable risk factor for the development of infection and for severe disease was the presence of moderate to severe graft versus host disease.
Insights
Adenovirus infections are common after bone-marrow transplants, particularly species 11, 34, and 35. Graft-versus-host disease significantly increases the risk of severe adenovirus infection and related complications.
Area of Science:
- Virology
- Immunology
- Transplantation Medicine
Background:
- Viral infections, including adenovirus, are a known complication following bone-marrow transplantation.
- Certain adenovirus species (subgenus B: types 11, 34, 35) are less common in general populations but have been linked to specific conditions.
Purpose of the Study:
- To investigate the incidence and characteristics of adenovirus infections in bone-marrow transplant recipients.
- To identify specific adenovirus species and risk factors associated with infection and severe outcomes.
Main Methods:
- Retrospective analysis of adenovirus isolates from 1051 bone-marrow transplant patients between 1976 and 1982.
- Serotyping of adenovirus isolates to determine species.
- Clinical data review for infection confirmation (biopsy, autopsy) and outcomes.
Main Results:
- Adenovirus was isolated from 51 patients; 13 isolates were identified as species 11, 34, or 35 (subgenus B), all from patients with positive urine cultures.
- Invasive infections occurred in 10 patients, with lung involvement (pneumonia) in 7 and fatal outcomes in 4.
- Renal and hepatic involvement were also observed, and endogenous reactivation was the likely source of infection.
- Moderate to severe graft-versus-host disease was the primary risk factor for infection and severe disease.
Conclusions:
- Adenovirus, particularly subgenus B species, can cause significant morbidity and mortality post-bone-marrow transplantation.
- Graft-versus-host disease is a critical determinant for developing adenovirus infection and its severity in transplant recipients.
- Endogenous reactivation is a probable mechanism for adenovirus acquisition in this immunocompromised population.
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