La Rosa A M, Champlin R E, Mirza N, Gajewski J, Giralt S, Rolston K V, Raad I, Jacobson K, Kontoyiannis D, Elting L, Whimbey E
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Clin Infect Dis. 2001 Mar 15;32(6):871-6. doi: 10.1086/319352. Epub 2001 Mar 9.
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.
腺病毒是越来越被认可的可感染血液和骨髓移植（BMT）受者的病原体。回顾了2889例成年BMT受者的经历，以研究腺病毒感染的发生率、临床谱、播散的危险因素、治疗反应及结局。85例患者（3%）通过培养（n = 85）或培养与组织病理学检查（n = 6）确诊。9例患者有无症状病毒尿，76例有症状性感染，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%。肺炎患者（73%）和播散性疾病患者（61%）的死亡率更高。播散的危险因素包括接受同种异体移植、存在移植物抗宿主病（GVHD）以及接受联合免疫抑制治疗。在接受静脉用利巴韦林治疗的12例患者中，未观察到明显益处。总之，腺病毒感染是成年BMT受者发病和死亡的重要原因，尤其是患有GVHD且正在接受免疫抑制治疗的同种异体移植受者。显然需要一种有效、无毒的抗病毒治疗。
