Outcome and clinical course of 100 patients with adenovirus infection following bone marrow transplantation
Outcome and clinical course of 100 patients with adenovirus infection following bone marrow transplantation
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DOI：
10.1038/sj.bmt.1702716
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发表时间：
2000-12-01
影响因子：
4.8
通讯作者：
Marks, DI
中科院分区：
文献类型：
--
作者：
Baldwin, A;Kingman, H;Marks, DI
我们进行了回顾性审查；在一个中心连续移植572例患者的临床特征和10年期间腺病毒感染的结果中，100例患者（17%）在移植后18天（范围2-150天）共诊断出105次腺病毒感染。儿童的发病率高于成人（21%对9%，p < 0.001），非亲属供体移植高于匹配的兄弟姐妹供体移植（26%对9%，p < 0.001），腹泻和发烧是最常见的表现特征。反映这些症状，最常见的隔离部位是粪便。血清型1、2和7是最常见的（总共41/68或60%的可评估病例）。在6例（6%）患者中，腺病毒感染是移植后72天（18-365天）死亡的直接原因。6例患者中有5例肺部受累，4例有相关的移植物抗宿主病（GVHD），另外3例患者被认为患有严重的腺病毒疾病(总发病率为9%，从多个部位分离病毒与预后差相关（P < 0.001），合并症病毒感染在该组中很常见，50%的患者分离了其他病毒（主要是多瘤病毒和巨细胞病毒）。我们得出的结论是，腺病毒通常在骨髓移植后被分离出来，是一个显著发病率的原因，但在我们的患者组中是一个罕见的死亡率原因（6/572 = 1%），严重感染的相对罕见将使移植医生难以决定哪些患者应该接受实验性抗病毒药物，如利巴韦林和西多福韦，或通过供体白细胞输注进行免疫调节治疗。
We conducted a retrospective review; of the clinical features and outcome of adenovirus infection in 572 consecutive patients transplanted in a single centre over a 10 year period, One hundred patients (17%) had a total of 105 episodes of adenovirus infection diagnosed at a median of 18 days post transplant (range 2-150 days). The incidence was higher in children than adults (21% vs 9%, p < 0,001) and in unrelated donor vs matched sibling donor transplants (26% vs 9%, P < 0,001), Diarrhoea and fever were the most common presenting features. Reflecting these symptoms, the most common site of isolation was the stool. Serotypes 1, 2 and 7 were the most frequently seen (total of 41/68 or 60% of evaluable cases). In six patients (6%) adenovirus infection was the direct cause of death occurring at a median of 72 days post transplant (range 18-365 days). Five of these six patients had pulmonary involvement and four had associated graft-versus-host disease (GVHD), Three further patients were considered to have severe adenoviral disease (total incidence 9%, Isolation of virus from multiple sites correlated with a poor outcome (P < 0,001), Comorbid viral infection was common in this group with 50% of all patients having other viruses isolated (predominantly polyoma virus and cytomegalovirus), We conclude that adenovirus is commonly isolated after bone marrow transplant and is a cause of significant morbidity but was a rare cause of mortality (6/572 = 1%) in our patient group as a whole, The relative infrequency of severe infection will make it difficult for the transplant physician to decide which patients should receive experimental antiviral drugs such as ribavirin and cidofovir or immunomodulatory therapy with donor white cell infusions.