Fulminant adenovirus hepatitis after hematopoietic stem cell transplant: Retrospective real-time PCR analysis for adenovirus DNA in two cases
Fulminant adenovirus hepatitis after hematopoietic stem cell transplant: Retrospective real-time PCR analysis for adenovirus DNA in two cases
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DOI：
10.1016/j.jiac.2015.08.018
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发表时间：
2015-12-01
影响因子：
2.2
通讯作者：
Kojima, Seiji
中科院分区：
文献类型：
--
作者：
Kawashima, Nozomu;Muramatsu, Hideki;Kojima, Seiji
背景：病毒感染是造血干细胞移植（HSCT）患者死亡的主要原因之一。腺病毒（AdV）的系统性感染已成为一种常见的病毒感染，其发病率和死亡率与巨细胞病毒和EB病毒感染一样显著。对这些病毒的常规监测已成为临床实践，随后的预防性治疗可改善患者的预后;然而，预防性治疗AdV的有效性尚未在致命形式的AdV感染患者中得到充分研究。方法：回顾性分析HSCT后暴发性AdV肝炎儿童的序贯AdV负荷。早在HSCT后2周即可检测到AdV DNA（1 x 10（4）拷贝/mL）。这些水平在暴发性肝炎发作时达到>1 x 10（8）拷贝/mL。然而，我们确定，g-谷氨酰转移酶水平升高到>100 IU/L，至少2周前hepatitis.Conclusions：我们的观察提高了可能性，升高的g-谷氨酰转移酶可能是一个哨兵标志物AdV肝炎，这提示详细监测AdV负荷和有针对性的治疗。(c)2015年，日本化疗学会和日本传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Viral infection is one of the major causes of mortality in patients undergoing hematopoietic stem cell transplant (HSCT). Systemic infection of adenovirus (AdV) has emerged as a not uncommon viral infection with significant morbidity and mortality as with cytomegalovirus and EpsteineBarr virus infection. Routine surveillance for these viruses has become a clinical practice and subsequent pre-emptive therapy improves patients' outcomes; however, the effectiveness of preemptive therapy for AdV has not been fully investigated in patients with a lethal form of AdV infection.Methods: Sequential AdV loads were retrospectively analyzed in children with fulminant AdV hepatitis after HSCT.Results: The AdV DNA became detectable (1 x 10(4) copies/mL) as early as 2 weeks after HSCT. These levels reached >1 x 10(8) copies/mL at the onset of fulminant hepatitis. However, we determined that g-glutamyltransferase levels were elevated to >100 IU/L at least 2 weeks before the diagnosis of hepatitis.Conclusions: Our observation raises the possibility that elevated g-glutamyltransferase could be a sentinel marker for AdV hepatitis, which prompts elaborated monitoring of AdV load and targeted treatment. (c) 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.