Adenovirus and Marrow Transplantation in Children

Abstract

Adenovirus disease is a major cause of morbidity and mortality among recipients of marrow transplants. Recent advances have contributed to a finer understanding of the biological basis for viral persistence in the normal host as well as disseminated disease in the immunocompromised patient. However, these insights have not yielded new, effective therapeutic interventions. Currently, there are no proven antiviral therapies available for treating adenoviral disease. Anecdotal reports have indicated that combinations of ribavirin, intravenous immunoglobulin, and donor T cells are efficacious in cases with limited infection. We anticipate that the incidence of adenoviral infections in marrow transplant recipients will continue to increase because the pool of transplant recipients continues to enlarge and more immunosuppressive preparative regimens, including T-cell depletion, are more commonly used. This review summarizes the clinical manifestations of adenovirus in the bone marrow transplant population including such common complications as hemorrhagic cystitis and rarer manifestations of disseminated infection, such as nephritis, gastroenteritis, pneumonia, hepatitis, pancreatitis, and encephalitis.

Key Words:

• immunocompromised host
• serotype
• supportive care
• viral infection