Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment
Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment
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DOI：
10.1016/j.cmi.2015.03.011
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发表时间：
2015-07-01
影响因子：
14.2
通讯作者：
LeGoff, J.
中科院分区：
文献类型：
--
作者：
Feghoul, L.;Chevret, S.;LeGoff, J.
人类腺病毒（HAdV）感染是儿童造血干细胞移植（HSCT）患者发病的主要原因。新的抗病毒治疗提供了有希望的前景。然而，识别有播散性感染风险的患者以及谁应该接受早期抗病毒干预仍然具有挑战性。我们对同种异体 HSCT 受者进行了一项纵向研究，包括每周 HAdV 监测，以确定与 HAdV 感染和传播相关的风险因素，并评估粪便中的 HAdV 载量是否可用作 HAdV 传播的替代标志物。 2010年9月至2011年12月，72例患者中，HAdV消化道感染、全身感染及相关疾病第100天的累积发病率分别为35.9%、24.0%和18.3%。在多变量分析中，HAdV 消化道和全身感染的危险因素是脐带血和体外 T 细胞耗竭。移植物抗宿主病（GVHD）>2 级也与全身感染相关。在HAdV消化道脱落的患者中，GVHD>2级和粪便中HAdV载量是全身感染的唯一危险因素。在HAdV全身感染和未全身感染的患者中，粪便中HAdV的中位峰值水平分别为7.9和4.0 log(10)拷贝/mL。对接受脐带血或体外 T 细胞耗尽移植的儿科 HSCT 受者的粪便进行 HAdV 监测有助于预测患者发生 HAdV 全身感染的风险。我们的结果为随机对照试验提供了依据，以评估基于粪便中 HAdV DNA 水平的抗 HAdV 预防性治疗的益处。临床微生物学和感染 (C) 2015 年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Human adenovirus (HAdV) infections constitute a major cause of morbidity in paediatric haematopoietic stem cell transplant (HSCT) patients. New antiviral treatments offer promising perspectives. However, it remains challenging to identify patients at risk for disseminated infection, and who should receive early antiviral intervention. We conducted a longitudinal study of allogeneic HSCT recipients, including weekly HAdV monitoring, to determine the risks factors associated with HAdV infection and dissemination, and to assess whether HAdV loads in stools may be used as surrogate markers for HAdV dissemination. Between September 2010 and December 2011, out of 72 patients, the cumulative incidence rates at day 100 of HAdV digestive infection, systemic infection and related disease were 35.9%, 24.0%, and 18.3%, respectively. In multivariate analysis, the risk factors for HAdV digestive and systemic infection were cord blood and in vitro T-cell depletion. Graft-versus-host disease (GVHD) grade >2 was also associated with systemic infection. In patients with HAdV digestive shedding, GVHD grade >2 and HAdV load in stools were the only risk factors for systemic infection. The median peak levels of HAdV in stool were 7.9 and 4.0 log(10) copies/mL, respectively, in patients with HAdV systemic infection and in those without. HAdV monitoring in stools of paediatric HSCT recipients receiving cord blood or in vitro T-cell depleted transplants helps to predict patients at risk for HAdV systemic infection. Our results provide a rationale for randomized controlled trials to evaluate the benefit of anti-HAdV pre-emptive treatments based on HAdV DNA levels in stools. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.