BK polyomavirus-associated hemorrhagic cystitis among pediatric allogeneic bone marrow transplant recipients: Treatment response and evidence for nosocomial transmission |
| |
| Authors: | Minna Koskenvuo Alexis Dumoulin Irmeli Lautenschlager Eeva Auvinen Laura Mannonen Veli-Jukka Anttila Kirsi Jahnukainen Ulla M. Saarinen-Pihkala Hans H. Hirsch |
| |
| Affiliation: | 1. Division of Hematology-Oncology and Stem Cell Transplantation, Childrens’ Hospital and Helsinki University Central Hospital, Helsinki, Finland;2. Transplantation and Clinical Virology, Institute for Medical Microbiology, Department of Biomedicine, University of Basel, Basel, Switzerland;3. Department of Virology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland;4. Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland;5. Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland;1. Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary;2. Department of Paediatrics, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary;1. Department Medical Microbiology, University Medical Centre, Maastricht, The Netherlands;2. Research School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht, The Netherlands;1. Université Lille 2, Faculté de Médecine, CHRU de Lille, Laboratoire de virologie, EA3610, Lille, France;2. Service de Neuropédiatrie, Pôle de Médecine et Spécialités Médicales, CHRU de Lille, France;1. SC Ostetricia e Ginecologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;2. Fondazione Carlo Denegri, Torino, Italy;3. SC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;4. Laboratori Sperimentali di Ricerca, Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy |
| |
| Abstract: | BackgroundBK polyomavirus-associated hemorrhagic cystitis (BK-PyVHC) is a significant complication of allogenic hematopoietic stem cell transplantation (HSCT), but risk factors and treatment are currently unresolved. BK-PyVHC typically presents with clinical cystitis, macrohematuria, and increasing urine and blood BKV loads.ObjectivesCharacterization of children undergoing allogeneic HSCT with BK-PyVHC and their clinical and antibody response to cidofovir treatment.Study designBy prospective screening of urine and plasma in 50 pediatric allogenic HSCT performed between 2008 and 2010, we identified 6 (12%) children with BK-PyVHC. Cidofovir was administered intravenously to 5 patients and intravesically to 4 patients (3 double treatments).ResultsDecreasing BKV viremia of > 2 log10 copies/mL and clinical resolution was seen in 4 patients over 5–12 weeks. Responses occurred only in patients mounting BKV-specific IgM and IgG responses. Epidemic curve plots, BKV genotyping and contact tracing provided evidence of transmission between 2 BKV-seronegative patients, but ruled out transmission among the remaining four patientsConclusionsThe data suggest that BK-PyVHC may be the result of nosocomial transmission in children with low/undetectable BKV antibodies and raises urgent questions about appropriate infection control measures and the role of cidofovir. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
