scholarly journals Cytomegalovirus Infections in Children with Primary and Secondary Immune Deficiencies

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2001
Author(s):  
Caroline M. Bateman ◽  
Alison Kesson ◽  
Madeleine Powys ◽  
Melanie Wong ◽  
Emily Blyth
Keyword(s):  
Infection Prevention ◽  
Morbidity And Mortality ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Healthy Children ◽  
Significant Morbidity ◽  
Cmv Infection ◽  
Mild Disease ◽  
Immune Deficiencies ◽  
Cytomegalovirus Infections

Cytomegalovirus (CMV) is a human herpes virus that causes significant morbidity and mortality in immunosuppressed children. CMV primary infection causes a clinically mild disease in healthy children, usually in early childhood; the virus then utilises several mechanisms to establish host latency, which allows for periodic reactivation, particularly when the host is immunocompromised. It is this reactivation that is responsible for the significant morbidity and mortality in immunocompromised children. We review CMV infection in the primary immunodeficient host, including early identification of these infants by newborn screening to allow for CMV infection prevention strategies. Furthermore, clinical CMV is discussed in the context of children treated with secondary immunodeficiency, particularly paediatric cancer patients and children undergoing haematopoietic stem cell transplant (HSCT). Treatments for CMV are highlighted and include CMV immunotherapy.

Valganciclovir Is Safe and Effective as Pre-Emptive Treatment for CMV Infection in Allogeneic Hematopoietic Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5300-5300
Author(s):  
Rocco Pastano ◽  
Federica Gigli ◽  
Giovanna Andreola ◽  
Liliana Calabrese ◽  
Fedro Peccatori ◽  
...  
Keyword(s):  
Stem Cell ◽  
Oral Administration ◽  
Intravenous Administration ◽  
Oral Treatment ◽  
Drug Formulation ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Cmv Infection ◽  
Intravenous Ganciclovir ◽  
Hematopoietic Stem

Abstract RATIONALE OF STUDY: Despite significant advances in prevention and therapy, cytomegalovirus (CMV) infection still represents an important cause of morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplant (HSCT). The standard pre-emptive treatment is based on intravenous administration of Ganciclovir (GCV). Valganciclovir (VGC), the pro-drug formulation of GCV is characterised by an excellent bio availability, making this drug suitable for oral administration. PATIENTS: Since March 2003 all patients treated with reduced (27 patients) or fully ablative (3 patients) conditioning regimens followed by sibling HSCT, were monitored with bi-weekly CMV/PCR and pp65/assays. Overall 15 episodes of CMV positivity were detected in seven patients. Patients resulted positive (3 cells pp65+ or 1000/100000 PCR +) started oral treatment with VGC 900 mg bid, for the first fourteen days, followed by 900 mg q.d. up to at least seven days after assays normalization. The median duration of therapy was 21 days (range 10–21 days). No significant toxicity was observed. All patients had a normalization of CMV/PCR and pp65/assays within fourteen days, with a response rate (RR) of 100%. In two patients the oral VGC therapy was changed to the intravenous administration of Foscavir, because of concomitant neutropenia and acute GvHD. CONCLUSION: Pre-emptive treatment of CMV infection with VGC is safe, feasible and effective. Furthermore, the oral administration of this drug in an outpatient setting, reduces significantly the costs compared with a therapy that needs hospitalization as intravenous Ganciclovir.

Haematopoietic Stem Cell Transplantation - An Experience from Developing World.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5036-5036
Author(s):  
Khalil Ullah ◽  
Parvez Ahmed ◽  
Shahid Raza ◽  
Tariq Mahmood ◽  
Badshah Khan
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Stem Cell ◽  
Fungal Infections ◽  
Chronic Gvhd ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Cmv Infection ◽  
Post Transplant ◽  
Transplant Complications

Abstract One hundred and fifty four patients received allogeneic stem cell transplant from HLA matched siblings for various haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from July 2001 to Sep 2006. Indications for transplant included aplastic anaemia (n=66), b-thalassaemia major (n=40), CML (n=33), acute leukaemia (n=8) and misc disorders (n=7). One hundred and twenty patients were male and thirty four were female. Median age of patient cohort was 14 yrs (range 1 ¼ −54 yrs). Pre-transplant infection surveillance was carried out and strict prophylaxis against infection was observed. The mean mononuclear cell dose was 4.2 x 109/kg of recipient. Post transplant complications encountered in our patients were: acute GvHD (grade II-IV) 28.5%, chronic GvHD 15.5%, haemorrhagic cystitis 9.7%, VOD liver 5.1%, acute renal failure 3.2%, bacterial infections 51.2%, fungal infections 15.0%, CMV infection 4%, herpes zoster 4%, tuberculosis 2.6%, pneumocytitis jirovici infection 0.6%, malaria 0.6% patient, graft rejection 5.2% patients and relapse in 4%patients. Certain unexpected rare post transplant complications were also observed in our patients. These included hickman catheter embolization, GB syndrome, deep vein thrombosis, haemorrhagic pericarditis with clots leading to cardiac temponade, idiopathic polycythemia, dengue fever and status epilepticus. Mortality was observed in 27.2% patients. Major causes of mortality were GvHD, VOD, relapse, intracranial haemorrhage, acute renal failure, pseudomonas septicemia, tuberculosis, disseminated aspergillosis and CMV infection. At five years, the overall survival (OS) and disease free survival (DFS) was 72.5% & 70.7% respectively.

Risk of respiratory viral infections after hematopoietic stem cell transplantation in Indian patients

2021 ◽  
Vol 16 (10) ◽  
pp. 87-91
Author(s):  
Jyoti Jethani ◽  
Sameer Samad ◽  
Prashant Kumar ◽  
Lalit Dar
Keyword(s):  
Stem Cell ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Respiratory Viruses ◽  
Morbidity And Mortality ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Allogeneic Hsct ◽  
Respiratory Viral Infections ◽  
Autologous Hsct

Haematopoietic stem cell transplant (HSCT) recipients are at higher risk of morbidity and mortality due to respiratory infections and their frequency is not well studied in Indian HSCT recipients. A cohort of 55 HSCT recipients were enrolled prospectively for respiratory episodes. Real-time polymerase chain reaction was performed for respiratory viral aetiology. A total of 153 episodes of acute respiratory infections occurred, [107 episodes (mean; 2.8/patient) in autologous HSCT (n=38); 46 episodes (mean; 2.7/patients) in allogeneic HSCT (n=17)]. From these episodes, 70 samples could be tested for respiratory viruses, of which 33 (47.1%) samples tested positive. A higher infection rate (52%; 26/50) was seen in autologous HSCT compared with allogeneic HSCT (35%; 7/20). Rhinoviruses were detected most often (18/33; 54.5%), followed by parainfluenza viruses, (PIV, 6/33; 18.1%). Human metapneumoviruses, (hMPV) and influenza A/H3N2 were detected in 4 samples each (4/33; 12.1%) followed by respiratory syncytial virus (RSV, 2/33; 6.1%). Of the 13 patients with an unfavourable outcome, 4 had respiratory viral infections. Significantly higher fatality was observed in allogeneic than in autologous recipients. Respiratory viruses cause multiple episodes of infection contributing to morbidity and mortality in HSCT recipients.

scholarly journals Management of Adenovirus in Children after Allogeneic Hematopoietic Stem Cell Transplantation

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Winnie WY Ip ◽  
Waseem Qasim
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Haematopoietic Stem Cell Transplantation ◽  
Morbidity And Mortality ◽  
Haematopoietic Stem Cell ◽  
Effective Strategy ◽  
Significant Morbidity ◽  
Hematopoietic Stem ◽  
Prevention And Treatment

Adenovirus (ADV) can cause significant morbidity and mortality in children following haematopoietic stem cell transplantation (HSCT), with an incidence of up to 27% and notable associated morbidity and mortality. T-cell depleted grafts and severe lymphopenia are major risk factors for the development of adenovirus disease after HSCT. Current antiviral treatments are at best virostatic and may have significant side effects. Adoptive transfer of donor-derived virus-specific T cells has been shown to be an effective strategy for the prevention and treatment of ADV infection after HSCT. Here we review progress in the field and present a pathway for the management of adenovirus in the posttransplant setting.

scholarly journals Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients

2021 ◽  
Vol 8 ◽  
pp. 204993612199137
Author(s):  
Aditya Jandial ◽  
Kundan Mishra ◽  
Rajeev Sandal ◽  
Kamal Kant Sahu
Keyword(s):  
Stem Cell ◽  
Platelet Rich Plasma ◽  
Severe Disease ◽  
Unmet Need ◽  
Bk Virus ◽  
Haematopoietic Stem Cell ◽  
Cellular Immunotherapy ◽  
Cell Transplant ◽  
Clotting Factors ◽  
Haemorrhagic Cystitis

BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC.

scholarly journals 1075. Absolute Lymphocyte Count as a Predictor of Cytomegalovirus (CMV) Infection and Recurrence in Hematopoietic Stem Cell Transplant (HSCT) Recipients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S565-S565
Author(s):  
Joanne Reekie ◽  
Marie Helleberg ◽  
Christina Ekenberg ◽  
Mark P Khurana ◽  
Isabelle P Lodding ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Lymphocyte Count ◽  
Absolute Lymphocyte Count ◽  
Cell Transplant ◽  
Cmv Infection ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Increased Risk ◽  
Acute Graft

Abstract Background Cytomegalovirus (CMV) is a serious complication following Hematopoietic Stem Cell Transplant (HSCT) and can lead to serious organ disease and mortality. This study aimed to investigate the association between absolute lymphocyte count (ALC) and CMV to determine whether ALC could help to identify those at an increased risk of CMV infection and recurrence Methods Adults undergoing HSCT between 2011 and 2016 at Rigshospitalet, Denmark were included. Cox proportional hazards models investigated risk factors, including ALC, for CMV infection in the first year post-transplant and recurrent CMV infection 6 months after clearance and stopping CMV treatment for the first infection. For the primary outcome ALC was investigated as a time-updated risk factor lagged by 7 days, and for recurrent CMV, ALC measured at the time at the time of stopping treatment for the first CMV infection was investigated (+/- 7 days). Results Of the 352 HSCT recipients included, 57% were male, 40% received myeloablative conditioning, 42% had high risk (D-R+) CMV IgG serostatus at transplant and the median age was 56 (IQR 43-63). 143 (40.6%) patients had an episode of CMV DNAemia a median of 47 days after transplant (IQR 35-62). A lower current ALC (≤ 0.3 x109/L) was associated with a higher risk of CMV infection in univariate analysis compared to a high current ALC (> 1 x109/L). However, this association was attenuated after adjustment, particularly for acute graft versus host disease (Figure). 102 HSCT recipients were investigated for risk of recurrent CMV of which 41 (40.2%) had a recurrent CMV episode a median of 27 days (IQR 16-50) after stopping CMV treatment for the first infection. A lower ALC (≤ 0.3 x109/L) at the time of stopping CMV treatment was associated with a significantly higher risk of recurrent CMV after adjustment (Figure). A higher peak viral load (> 1500 IU/ml) during the first episode of CMV infection was also associated with an increased risk of recurrent CMV (aHR 2.47, 95%CI 1.00-6.10 compared to < 750 IU/ml). Association between absolute lymphocyte count (ALC) and risk of CMV infection and recurrent CMV within 6 months. **First CMV infection multivariable model also adjusted for sex, CMV serostatus, age, year of transplant, Charlson Comorbidity Index, Anti-thymocyte globulin (ATG) given, HLA donor-recipient matching, and acute graft versus host disease (time-updated) *Recurrent CMV infection multivariable model also adjusted for conditioning regimen, sex, CMV serostatus, age, year of transplant Anti-thymocyte globulin (ATG) given, HLA donor-recipient matching, and acute graft versus host disease and peak CMV viral load during the first CMV infection Conclusion A lower ALC at the time of stopping treatment for the first CMV infection was associated with an increased risk of recurrent CMV and could be used to help guide decisions for augmented CMV surveillance and clinical awareness of CMV disease symptoms in these patients. Disclosures All Authors: No reported disclosures

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