A Case of Adenovirus Viremia in a Pediatric Liver Transplant Recipient With Neutropenia and Lymphopenia: Who and When Should We Treat?
| Autor: | Adriana E. Kajon, Elizabeth B. Rand, R. R. Patel, Sarah B. Klieger, Z. Oikonomopoulou, Hans Petersen, Richard L. Hodinka, Brian T. Fisher, Edward F. Attiyeh |
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| Rok vydání: | 2013 |
| Předmět: |
Hepatoblastoma
Male medicine.medical_specialty Neutropenia medicine.medical_treatment Viremia Disease Liver transplantation Electronic Articles Adenovirus Infections Human Immunocompromised Host chemistry.chemical_compound Lymphopenia Internal medicine medicine Humans Hepatitis business.industry Adenoviruses Human Liver Neoplasms virus diseases General Medicine Viral Load medicine.disease eye diseases Liver Transplantation Infectious Diseases chemistry Child Preschool Pediatrics Perinatology and Child Health Immunology business Viral load Immunosuppressive Agents Cidofovir |
| Zdroj: | Journal of the Pediatric Infectious Diseases Society. 4:e1-e5 |
| ISSN: | 2048-7207 2048-7193 |
| DOI: | 10.1093/jpids/pit081 |
| Popis: | Human adenovirus (HAdV) is one of the most feared infections among immunocompromised patients. In particular, in liver transplant patients, HAdV has been implicated in acute liver failure with resultant mortality. The development of current molecular techniques and surveillance testing protocols have provided tools for early detection of HAdV infection, prior to or at the early onset of HAdV disease. Although reduction in immune suppression is the mainstay of therapy, many researchers have also advocated for early administration of antiviral therapy. In multiple reports, cidofovir treatment has been associated with declines in HAdV viral loads or clinical improvement in solid organ and bone marrow transplant recipients. However, there have also been case reports that raise questions about the effectiveness of antiviral therapy in controlling systemic HAdV disease. We report a case of a 26-month-old male recipient of a liver transplantation for hepatoblastoma who developed adenoviremia with an associated hepatitis and gastroenteritis. He recovered with reduced immune suppression but without antiviral therapy, thus avoiding potential toxicities associated with cidofovir therapy. This case a contrast to previous reports, and it highlights the ambiguity regarding which patients should receive HAdV-specific antiviral therapy. Additional knowledge regarding specific pediatric host factors and HAdV factors that predict poor outcomes are needed. Such information would allow clinicians to better stratify patients by risk at the time of adenoviremia detection so that low-risk patients are not unnecessarily exposed to medications with potential toxicities. |
| Databáze: | OpenAIRE |
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