Symeonidis N, Jakubowski A, Pierre-Louis S, Jaffe D, Pamer E, Sepkowitz K, O'Reilly R J, Papanicolaou G A
Department of Medicine, Memorial Sloan-Ketterring Cancer Center, New York, New York 10021, USA.
Transpl Infect Dis. 2007 Jun;9(2):108-13. doi: 10.1111/j.1399-3062.2006.00184.x.
Adenovirus (ADV) infection occurs in 5-21% of allogeneic hematopoietic stem cell transplants (HSCT). Symptomatic enteritis and hemorrhagic cystitis may be encountered but are seldom fatal. In contrast, mortality rates of up to 75% are reported for adenoviral pneumonia or hepatitis. Cidofovir is currently being increasingly used for treatment of adenoviral infections after HSCT. The efficacy of cidofovir in patients with invasive adenoviral infection is not established.
We reviewed 687 adult and pediatric patients who received allogeneic HSCT at our institution from 1998 through June 2005. ADV was isolated from 64 (9.3%) patients. Eleven patients received cidofovir for invasive disease occurring at median 39 days (range 3-145) post HSCT. The median age was 40 (range 6-61) years. Seventy-three percent received a T-cell-depleted graft and 18% had grade 3-4 graft-versus-host disease (GVHD) of the gut. Three out of 3 (100%) patients with adenoviral pneumonia died. One patient with hepatitis, cholecysitis, and viremia cleared the infection after 3 months. Two out of 7 (28.6%) patients with hemorrhagic colitis or cystitis died of ADV (1 with extensive GVHD).
Mortality rates of ADV pneumonitis after allogeneic HSCT remain high in the era of cidofovir. Clinical trials are needed to evaluate management strategies for this life-threatening infection.
腺病毒（ADV）感染发生于5% - 21%的异基因造血干细胞移植（HSCT）中。可能会出现症状性肠炎和出血性膀胱炎，但很少致命。相比之下，腺病毒性肺炎或肝炎的死亡率报告高达75%。西多福韦目前越来越多地用于HSCT后腺病毒感染的治疗。西多福韦在侵袭性腺病毒感染患者中的疗效尚未确立。
我们回顾了1998年至2005年6月在我们机构接受异基因HSCT的687例成人和儿童患者。从64例（9.3%）患者中分离出ADV。11例患者因HSCT后中位39天（范围3 - 145天）出现的侵袭性疾病接受了西多福韦治疗。中位年龄为40岁（范围6 - 61岁）。73%的患者接受了T细胞清除的移植物，18%的患者有3 - 4级肠道移植物抗宿主病（GVHD）。3例腺病毒性肺炎患者中有3例（100%）死亡。1例患有肝炎、胆囊炎和病毒血症的患者在3个月后感染清除。7例出血性结肠炎或膀胱炎患者中有2例（28.6%）死于ADV（1例伴有广泛GVHD）。
在西多福韦时代，异基因HSCT后ADV肺炎的死亡率仍然很高。需要进行临床试验来评估这种危及生命的感染的管理策略。
