Seidemann Kathrin, Heim Albert, Pfister Eva D, Köditz Harald, Beilken Andreas, Sander Annette, Melter Michael, Sykora Karl-Walter, Sasse Michael, Wessel Armin
Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Germany.
Am J Transplant. 2004 Dec;4(12):2102-8. doi: 10.1111/j.1600-6143.2004.00631.x.
Adenoviral (AdV) infections after transplantation remain a challenge in pediatric patients. Qualitative and quantitative PCR offer new approaches to early diagnosis and monitoring. However, their role in the management of AdV infections in pediatric transplant recipients remains to be determined. We report six children with positive qualitative serum-PCR for AdV on routine follow-up after transplantation (liver n = 4, hematopoetic stem cells (HSCT) n = 1, combined liver and HSCT n = 1). None of these children were symptomatic at the time of first detection of AdV. Two patients remained asymptomatic, one developed hemorrhagic cystitis and enteritis. Three children with positive PCR developed high viral load on quantitative PCR, all developed clinical AdV sepsis with further rising virus load. Despite antiviral therapy with cidofovir, these three patients died of septic multiorgan failure. Positive qualitative AdV-PCR from blood after pediatric transplantation is not necessarily followed by clinical disease. In case of positive AdV-PCR, monitoring by serial quantitative PCR is useful regarding treatment decision and prevention of fatal disease.
移植后腺病毒（AdV）感染仍是儿科患者面临的一项挑战。定性和定量聚合酶链反应（PCR）为早期诊断和监测提供了新方法。然而，它们在儿科移植受者腺病毒感染管理中的作用仍有待确定。我们报告了6例在移植后常规随访中血清AdV定性PCR呈阳性的儿童（肝移植4例，造血干细胞移植（HSCT）1例，肝移植联合HSCT 1例）。这些儿童在首次检测到AdV时均无症状。2例患者仍无症状，1例出现出血性膀胱炎和肠炎。3例PCR阳性儿童在定量PCR时病毒载量升高，均发展为临床腺病毒败血症，病毒载量进一步上升。尽管使用西多福韦进行了抗病毒治疗，这3例患者仍死于感染性多器官功能衰竭。儿科移植后血液中AdV定性PCR呈阳性不一定会继发临床疾病。在AdV-PCR呈阳性的情况下，通过连续定量PCR进行监测对于治疗决策和预防致命疾病很有用。
