Life-threatening adenovirus infections in the setting of the immunocompromised allogeneic stem cell transplant patients.
Life-threatening adenovirus infections in the setting of the immunocompromised allogeneic stem cell transplant patients.
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DOI：
10.1155/2010/601548
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发表时间：
2010
影响因子：
--
通讯作者：
Maziarz RT
中科院分区：
文献类型：
--
作者：
Fowler CJ;Dunlap J;Troyer D;Stenzel P;Epner E;Maziarz RT
一个单一的机构的病例系列的腺病毒感染后异基因造血干细胞移植，强调考虑腺病毒感染的病因，在明显的GVHD稳定的情况下，快速肝脏或其他突然器官恶化的患者。该系列还强调，这些感染的生存率是有限的，部分原因是伴随的机会性感染。此外，病理生理学事件，如GVHD和肝功能障碍，可能使临床表现复杂化，并延迟机会性感染的治疗。这对于腺病毒感染尤其如此，因为与免疫功能正常的患者相比，它们在免疫功能低下的患者中也具有不同的临床表现。腺病毒感染也有额外的挑战，其治疗，西多福韦，有相关的毒性，可以延迟其管理。最近的发展已经产生了一种测定法，可用于早期检测和连续测定晚期GVHD患者中的腺病毒，以及目前正在进行临床试验的新治疗剂。
A single institution case series of adenovirus infections after allogeneic hematopoietic stem cell transplantation is presented to highlight the consideration for adenovirus infections as an etiology in patients with rapid hepatic or other sudden organ deterioration in the setting of apparent GVHD stabilization. The series also highlights that survival is limited with these infections often due in part to concomitant opportunistic infections. In addition, the pathophysiological events, such as GVHD and hepatic dysfunction, may complicate the clinical picture and delay therapy of an opportunistic infection. This is particularly true for adenoviral infections as they also have a distinct clinical picture in immunocompromised patients when compared to immune competent patients. Adenovirus infections also have the additional challenge that its treatment, cidofovir, has associated toxicities that can delay its administration. Recent developments has yielded an assay that can be used in the early detection and for serial determinations of adenovirus in patients with advanced GVHD, as well as a new therapeutic agent currently undergoing clinical trials.