Department of Transplantation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
Department of Pediatrics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
BMC Infect Dis. 2023 Sep 11;23(1):592. doi: 10.1186/s12879-023-08577-2.
In immunocompromised populations, such as patients with AIDS and recipients of solid organ and hematopoietic stem cell transplants, BK polyomavirus (BKPyV) can reactivate and cause several diseases, which can lead to death in their severe forms. Unlike hemorrhagic cystitis and BKPyV-associated nephropathy, BKPyV-associated pneumonia is rare, with only seven known cases worldwide. However, the disease can rapidly progress with extremely high mortality.
Herein, we report two cases of BKPyV-associated pneumonia following hematopoietic stem cell transplantation. Both patients had consistent infectious pneumonia and graft-versus-host disease after stem cell transplantation. The diagnosis of BKPyV-associated pneumonia was confirmed by metagenomic next-generation sequencing and polymerase chain reaction after the sudden worsening of the pulmonary infection signs and symptoms concomitant with renal dysfunction and systemic immune weakening. Both patients eventually died of systemic multi-organ failure caused by severe pneumonia.
Currently, BKPyV reactivation cannot be effectively prevented. Immunocompromised patients must actively manage their primary lung infections, pay close attention to pulmonary signs and imaging changes. Especially during and after steroid pulse therapy or immunosuppressive therapy for graft versus host diseases, BKPyV load in blood/urine needs to be regularly measured, and the immunosuppressive intensity should be adjusted properly after the BKPyV reactivation diagnosis. Clinical trials of new antiviral drugs and therapies for BKPyV are urgently needed.
在免疫功能低下的人群中，如艾滋病患者和实体器官及造血干细胞移植受者，BK 多瘤病毒（BKPyV）可重新激活并导致多种疾病，在严重形式下可导致死亡。与出血性膀胱炎和 BKPyV 相关肾病不同，BKPyV 相关肺炎罕见，全球仅有 7 例已知病例。然而，该疾病可迅速进展，死亡率极高。
本文报告了两例造血干细胞移植后 BKPyV 相关肺炎病例。两例患者在干细胞移植后均出现一致的感染性肺炎和移植物抗宿主病。在肺部感染症状和体征突然恶化并伴有肾功能障碍和全身免疫功能减弱的情况下，通过宏基因组下一代测序和聚合酶链反应确诊 BKPyV 相关肺炎。两名患者最终均因严重肺炎引起的全身多器官衰竭而死亡。
目前，BKPyV 再激活无法有效预防。免疫功能低下的患者必须积极治疗原发性肺部感染，密切关注肺部体征和影像学变化。特别是在类固醇脉冲治疗或移植物抗宿主病免疫抑制治疗期间及之后，需要定期测量血液/尿液中的 BKPyV 载量，并在诊断 BKPyV 再激活后适当调整免疫抑制强度。迫切需要针对 BKPyV 的新型抗病毒药物和治疗方法的临床试验。
