Adenovirus infections in adult recipients of blood and marrow transplants
Adenovirus infections in adult recipients of blood and marrow transplants
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DOI：
10.1086/319352
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发表时间：
2001-03-15
影响因子：
11.8
通讯作者：
Whimbey, E
中科院分区：
文献类型：
--
作者：
La Rosa, AM;Champlin, RE;Whimbey, E
腺病毒是越来越多地被认识到的影响血液和骨髓移植（BMT）受者的病原体。回顾了2889例成人骨髓移植受者的经验，以研究腺病毒感染的发病率、临床谱、传播危险因素、治疗反应和结局。85例患者（3%）通过培养（n = 85）或培养和组织病理学检查（n = 6）诊断。9例无症状病毒尿，76例有症状感染，包括上呼吸道感染（n = 20）、肠炎（n = 18）、出血性膀胱炎（n = 10）、肺炎（n = 15）和播散性疾病（n = 13）。总死亡率为26%。肺炎（73%）和播散性疾病（61%）患者的死亡率较高。传播的风险因素包括接受同种异体移植、存在移植物抗宿主病（GVHD）和接受同时免疫抑制治疗。静脉注射利巴韦林与12例接受这种治疗的患者的明显获益无关。总之，腺病毒感染是成年骨髓移植受者发病率和死亡率的重要原因，特别是接受免疫抑制治疗的同种异体移植受者的GVHD。显然需要一种有效的、无毒的抗病毒治疗。
Adenoviruses are increasingly recognized pathogens that affect blood and marrow transplant (BMT) recipients. Experiences with 2889 adult BMT recipients were reviewed to study the incidence, clinical spectrum, risk factors for dissemination, response to therapy, and outcome of adenovirus infections. Eight-five patients (3%) were diagnosed by means of culture (n = 85) or culture and histopathological examination (n = 6). Nine patients had asymptomatic viruria, and 76 had symptomatic infections, which included upper respiratory tract infection (n = 20), enteritis (n = 18), hemorrhagic cystitis (n = 10), pneumonia (n = 15), and disseminated disease (n = 13). The overall mortality rate was 26%. A higher mortality rate was observed among patients with pneumonia (73%) and disseminated disease (61%). Risk factors for dissemination included receipt of an allogeneic transplant, presence of graft-versus-host disease (GVHD), and receipt of concurrent immunosuppressive therapy. Intravenous ribavirin was not associated with an appreciable benefit among 12 patients who received this treatment. In conclusion, adenovirus infections are an important cause of morbidity and mortality in adult BMT recipients, particularly allogeneic transplant recipients with GVHD who are receiving immunosuppressive therapy. The need for an effective, nontoxic antiviral therapy is apparent.