Adenovirus

Question 1

What different syndromes do adenovirus cause?

Answer 1

Respiratory
Gastrointestinal
Keratoconjunctivitis
Haemorrhagic cystitis

Question 2

How many species are there of adenovirus?

Answer 2

Seven (A-G)

Specific serotypes are numbered

Question 3

What is first line treatment in immunocompromised patient with adenovirus?

Answer 3

Reduction of immunosuppression, you should see a reduction in VL in 2 weeks

Question 4

What immune cells are required for recovery from adenovirus and what is a risk factor?

Answer 4

CD4 cells required

CD3+ T cells count of <300 ul is a risk factor

Question 5

When would you treat adenovirus?

What antivirals have been used?

Is the evidence good for efficacy?

Which is used most commonly in UK?

Answer 5

Only use in progressive or life threatening infection

Ribavirin (only for subtype C)

Ganciclovir

Cidofovir - used in UK

Question 6

What alternative to antivirals are available to treat adenovirus?

Answer 6

Donor lymphocyte infusion (low number of T cells available and high toxicity)

Dendritic cell vaccination with adenovirus to produce T cell response

Adenovirus specific T cells (CTLs)

Question 7

What screening is employed for adenovirus in immunocompromised patients?

Answer 7

No routine screening for SOT/chemo/auto-HSCT - Test if clinical suspicion

In allo-HSCT screen high risk patients weekly

Question 8

In HSCT where does adenovirus most commonly reactivate? And when?

Answer 8

In the GI tract

2-3 months post transplant

Question 9

In SOT where does adenovirus usually occur?

Answer 9

At the site of the transplanted organ

Question 10

What are the risk factors for adenovirus infection in HSCT?

Answer 10

T-cell depletion (alemtuzimab/ATG/ALG)
Cord blood allograft
Mismatched donor
Severe GVHD requiring steroids
Adenovirus positive pre transplant
Young age (due to risk of de novo infection)

Question 11

Symptoms of adenovirus in HSCT

Answer 11

Fever
Enteritis
Increased LFTs
Pancytopaenia

Can lead to myocarditis, encephalitis, organ failure

Question 12

When is the highest risk for adenovirus in HSCT? And what is the mortality rate?

Answer 12

First 100 days

8-20% mortality

Question 13

What are predictors of adenovirus disease in HSCT?

Answer 13

Increasing and high viral loads

Detection of adenovirus at two sites

Detection in stool is precursor to viraemia but low PPV

Question 14

Is there any prophylaxis for adenovirus?

Answer 14

No

Question 15

What is pre emptive treatment for adenovirus in HSCT and what are suggested treatment thresholds?

Answer 15

Cidofovir (IV 5mg/kg weekly or 1 mg/kg 3x a week) for 2-3 weeks then every other week

Log 4 in blood (10,000)
Log 6 in stool (1,000,000)

These can change depending on patient risk

Question 16

What is the treatment for adenovirus disease in HSCT?

Answer 16

1. Reduce Immunosuppression
2. Cidofovir (IV 5mg/kg weekly or 1 mg/kg 3x a week) for 2-3 weeks then every other week
3. CTLs

Question 17

Treatment of adenovirus disease in SOT?

Answer 17

Reduction of immunosuppression

Question 18

What are common symptoms of adenovirus in:

Kidney transplant patients?
Liver transplant patients?

Answer 18

Haemorrhagic cystitis

Hepatitis