Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA.
Transplantation. 2022 May 1;106(5):920-927. doi: 10.1097/TP.0000000000003988. Epub 2021 Nov 24.
Adenoviruses result in a wide array of clinical presentations, including primarily respiratory, gastrointestinal, genitourinary, or systemic infections. Although adenovirus causes mild disease limited to a single organ system in immunocompetent individuals, severe and life-threatening infections do rarely occur. Disseminated disease and severe localized disease resulting in significant morbidity and mortality have been well described in the immunocompromised populations. Although asymptomatic viremia, respiratory tract, and gastrointestinal infections are the most common disease in most transplant patients, renal transplant patients more commonly experience urinary tract infections, including hemorrhagic cystitis or nephritis. Diagnosis requires astute clinical awareness of the patient's clinical presentation that would be compatible with adenovirus combined with cultures, molecular testing, polymerase chain reaction, and tissue sampling. There is no Food and Drug Administration-approved treatment for adenovirus; however, several studies have evaluated therapeutic options including cidofovir, brincidofovir, and immunotherapy. This article will summarize our current understanding of adenovirus in the transplant population.
腺病毒可引起多种临床表现，主要包括呼吸道、胃肠道、泌尿生殖道或全身感染。虽然腺病毒在免疫功能正常的个体中引起局限于单一器官系统的轻度疾病，但严重和危及生命的感染确实很少发生。在免疫功能低下的人群中，已充分描述了播散性疾病和严重局部疾病，导致发病率和死亡率显著增加。尽管无症状病毒血症、呼吸道和胃肠道感染是大多数移植患者最常见的疾病，但肾移植患者更常发生尿路感染，包括出血性膀胱炎或肾炎。诊断需要敏锐的临床意识，认识到与腺病毒一致的患者临床表现，并结合培养、分子检测、聚合酶链反应和组织取样。目前尚无获得美国食品和药物管理局批准的腺病毒治疗方法；然而，已有多项研究评估了治疗选择，包括西多福韦、溴昔福韦和免疫疗法。本文将总结我们目前对移植人群中腺病毒的认识。
