Mendoza Maria Alejandra, Imlay Hannah
Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA.
Viruses. 2025 Mar 12;17(3):403. doi: 10.3390/v17030403.
Polyomaviruses (PyVs) are non-enveloped double-stranded DNA viruses that can cause significant morbidity in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients, particularly BK polyomavirus (BKPyV) and JC polyomavirus (JCPyV). BKPyV is primarily associated with hemorrhagic cystitis (HC), while JCPyV causes progressive multifocal leukoencephalopathy (PML). The pathogenesis of these diseases involves viral reactivation under immunosuppressive conditions, leading to replication in tissues such as the kidney, bladder, and central nervous system. BKPyV-HC presents as hematuria and urinary symptoms, graded by severity. PML, though rare after allo-HSCT, manifests as neurological deficits due to JCPyV replication in glial cells. Diagnosis relies on nucleic acid amplification testing for DNAuria or DNAemia as well as clinical criteria. Management primarily involves supportive care, as no antiviral treatments have proven consistently effective for either virus and need further research. This review highlights the virology, clinical presentations, and management challenges of PyV-associated diseases post-allo-HSCT, emphasizing the need for improved diagnostic tools and therapeutic approaches to mitigate morbidity and mortality in this vulnerable population.
多瘤病毒（PyVs）是无包膜的双链DNA病毒，可在异基因造血干细胞移植（allo-HSCT）受者中引起严重发病，尤其是BK多瘤病毒（BKPyV）和JC多瘤病毒（JCPyV）。BKPyV主要与出血性膀胱炎（HC）相关，而JCPyV可导致进行性多灶性白质脑病（PML）。这些疾病的发病机制涉及免疫抑制条件下的病毒再激活，导致在肾脏、膀胱和中枢神经系统等组织中复制。BKPyV-HC表现为血尿和泌尿系统症状，并根据严重程度分级。PML在allo-HSCT后虽罕见，但由于JCPyV在神经胶质细胞中复制而表现为神经功能缺损。诊断依赖于对尿或血中DNA的核酸扩增检测以及临床标准。治疗主要包括支持性护理，因为尚无抗病毒治疗对这两种病毒均被证明持续有效，且需要进一步研究。本综述重点介绍allo-HSCT后PyV相关疾病的病毒学、临床表现和管理挑战，强调需要改进诊断工具和治疗方法以降低这一脆弱人群的发病率和死亡率。
