Chapter 5 : Adenoviral Infections in Transplant Recipients

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Adenovirus (ADV) was first associated with severe morbidity and mortality in bone marrow transplant recipients in 1985. Numerous reports since then have confirmed the importance of ADV in recipients of hematopoietic stem cell transplants (HSCT). The immunosuppression involved with solid organ transplantation (SOT) also predisposes recipients to severe initial or reactivation ADV infections. This chapter describes the emerging importance of ADV in both HSCT and SOT recipients. A retrospective review of pediatric liver transplant recipients noted infection in 10%, with evidence of invasive disease occurring in 4.1%; most disease occurred in the immediate posttransplant period. Nuclear enlargement and intranuclear inclusions develop and contain adenovirions as seen by electron microscopy. Immunohistochemistry and in situ hybridization (technically challenging and not widely available) may further improve the sensitivity over that of histopathology and may be particularly helpful in differentiating rejection from ADV disease, particularly among small bowel transplant recipients. Treatment of ADV in HSCT and SOT recipients can be broken down into two major issues: whom to treat and how best to treat them. A wide variety of antiviral drugs have been used to treat ADV disease. Vidarabine has limited availability and significant toxicity but may have a role in the management of hemorrhagic cystitis. At present, only cidofovir appears to have significant antiviral efficacy. Future treatment strategies might include analogs of cidofovir and ex vivo generation of ADV-specific cytotoxic T cells with subsequent transplantation into patients suffering from or at high risk for ADV disease.

Citation: Anderson E, Ison M. 2008. Adenoviral Infections in Transplant Recipients, p 75-91. In Scheld W, Hammer S, Hughes J (ed), Emerging Infections 8. ASM Press, Washington, DC. doi: 10.1128/9781555815592.ch5
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Table 1.

Infections associated with ADV species and serotypes

Citation: Anderson E, Ison M. 2008. Adenoviral Infections in Transplant Recipients, p 75-91. In Scheld W, Hammer S, Hughes J (ed), Emerging Infections 8. ASM Press, Washington, DC. doi: 10.1128/9781555815592.ch5
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Table 2.

Available agents with activity against ADV

Citation: Anderson E, Ison M. 2008. Adenoviral Infections in Transplant Recipients, p 75-91. In Scheld W, Hammer S, Hughes J (ed), Emerging Infections 8. ASM Press, Washington, DC. doi: 10.1128/9781555815592.ch5

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