Le Henaff G, Corradini N, Gras C, Méchinaud F
Service d'oncologie pédiatrique, hôpital Mère-Enfant, CHU de Nantes, France.
Arch Pediatr. 2007 Jul;14(7):900-2. doi: 10.1016/j.arcped.2007.03.014. Epub 2007 Apr 24.
Adenovirus (Adv) infections are frequent in pediatric patients, sometimes serious, above all in immunocompromised children. We report the cases of 2 children who presented an Adv infection after allogeneic stem cell transplantation (SCT).
Case n(o) 1 concerns a boy who received SCT at the age of 6 years. He had a hemorragic cystitis, which resolved after antiviral treatment and successful engraftment. Case n(o) 2 concerns a boy who received SCT at the age of 2. He shortly presented a disseminated infection, and died in spite of antiviral treatment and re-infusion of an autologous transplant.
T-cell depletion (mainly carried out in vivo at present) is the major risk factor of Adv infection after allogeneic SCT. It is important to be recognized, in order to proceed to a routine screening among transplanted patients. Moreover, the detection of viral genoma by molecular biology is a predictive factor of disseminated disease development, with mortality rates higher than 50%. Early treatment is thus crucial. Immunotherapy is to be developed, by tapering of immunosuppression, or by manipulating grafts and donor lymphocyte infusions, in order to improve Adv specific responses. The possibility of a prophylaxis is still to be investigated.
腺病毒（Adv）感染在儿科患者中很常见，有时很严重，尤其是在免疫功能低下的儿童中。我们报告了2例异基因干细胞移植（SCT）后出现腺病毒感染的儿童病例。
病例1涉及一名6岁接受SCT的男孩。他患有出血性膀胱炎，经抗病毒治疗和成功植入后痊愈。病例2涉及一名2岁接受SCT的男孩。他很快出现播散性感染，尽管接受了抗病毒治疗和自体移植回输仍死亡。
T细胞清除（目前主要在体内进行）是异基因SCT后腺病毒感染的主要危险因素。认识到这一点很重要，以便对移植患者进行常规筛查。此外，通过分子生物学检测病毒基因组是播散性疾病发展的预测因素，死亡率高于50%。因此早期治疗至关重要。应通过逐渐减少免疫抑制，或通过操纵移植物和供体淋巴细胞输注来开发免疫疗法，以改善针对腺病毒的特异性反应。预防的可能性仍有待研究。
