Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: Incidence, clinical management, and outcome.

BACKGROUND: Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with poor outcome. Available data on risk factors and optimal management of ADVi in adult allo-HSCT recipients are limited, and recommendations on monitoring and pre-emptive therapy are mainly based on pediatric data. METHODS: In this single-center, retrospective study, we reported all cases of positive ADV-DNA from adult patients undergoing allo-HSCT in the period 2014-2019. The study aimed to describe the incidence of ADVi at day +180 post-transplant. Secondly to describe timing, clinical presentation, risk factors, and outcome of ADVi and to analyze the application of a screening strategy in our cohort. RESULTS: In 445 allo-HSCT recipients, the day +180 incidence was: 9% (39/445) for ADVi, 5% (24/445) for ADV viremia (ADVv), and 3% (15/445) for localized ADVi. The median time to ADVi was 65 (IQR 19; 94) days after HSCT. ADVv-related mortality was 13% (3/24), all cases occurring with blood max-ADV-DNA > 10^3 cp/mL. Independent risk factors for ADVi were diagnosis of lymphoproliferative disease (p = .011) and acute graft-versus-host-disease (p = .021). CONCLUSIONS: In our cohort, ADVi and ADVv were more frequent than previously reported. ADVv with max-ADV-DNA > 10^3 cp/mL was associated with ADV-related mortality, thus careful monitoring and early initiation of treatment are advisable.

Molecular typing and pathogenicity assessment of fowl adenovirus associated with inclusion body hepatitis in chicken from India.

Recently, inclusion body hepatitis (IBH) outbreaks have been increasingly reported in different regions of India, particularly in broiler flocks. The present study was undertaken to characterize fowl adenovirus associated with IBH in chicken and assessment of its pathogenicity. Liver samples were collected from fowl adenovirus (FAdV) suspected 100 commercial broiler and six broiler breeder flocks from eleven different States of India from 2016 to 2019. All the samples were subjected to 897-bp FAdV hexon gene-specific PCR for confirmation and primary chicken liver cells were used to isolate the field FAdVs. Sequencing and phylogenetic analysis of 897-bp FAdV hexon gene revealed that all the isolates have showed close evolutionary relationship with fowl adenovirus serotype 11 of species D. For pathogenicity assessment, 0.5 ml of 106.5 TCID50/ml of field FAdV serotype 11 isolate was orally inoculated in 1-day-old SPF chicks and observed for 21 days. This experimental study revealed that there was no mortality in infected chicks and showed clinical signs of dullness, depression and diarrhoea between third and fifth day of oral inoculation. The FAdV was reisolated and confirmed by PCR from experimentally infected chicken. Based on this study, among all serotypes, FAdV serotype 11 is involved in pathogenesis of inclusion body hepatitis in broiler-type chickens in India.

Mating strategy is determinant of adenovirus prevalence in European bats.

Adenoviruses are double-strained DNA viruses found in a great number of vertebrates, including humans. In order to understand their transmission dynamics, it is crucial, even from a human health perspective, to investigate how host traits influence their prevalence. Bats are important reservoirs for adenoviruses, and here we use the results of recent screenings in Western Europe to evaluate the association between characteristic traits of bat species and their probability of hosting adenoviruses, taking into account their phylogenetic relationships. Across species, we found an important phylogenetic component in the presence of adenoviruses and mating strategy as the most determinant factor conditioning the prevalence of adenoviruses across bat species. Contrary to other more stable mating strategies (e.g. harems), swarming could hinder transmission of adenoviruses since this strategy implies that contacts between individuals are too short. Alternatively, bat species with more promiscuous behavior may develop a stronger immune system. Outstandingly high prevalence of adenoviruses was reported for the Iberian species Pipistrellus pygmaeus, P. kuhlii and Nyctalus lasiopterus and we found that in the latter, males were more likely to be infected by adenoviruses than females, due to the immunosuppressing consequence of testosterone during the mating season. As a general trend across species, we found that the number of adenoviruses positive individuals was different across localities and that the difference in prevalence between populations was correlated with their geographic distances for two of the three studied bat species (P. pygmaeus and P.kuhlii). These results increase our knowledge about the transmission mechanisms of adenoviruses.

Variant Serotypes of Fowl Adenovirus Isolated from Commercial Poultry Between 2007 and 2017 in Some Regions of China.

The present study was performed to detect and characterize the serotypes of fowl adenovirus associated with inclusion body hepatitis (IBH) or hepatitis-hydropericardium syndrome (HHS) in commercial poultry in some regions of China between 2007 and 2017. Approximately 81 fowl adenovirus strains were isolated from liver or kidney samples from diseased poultry. A sequencing analysis of the hexon loop 1 gene revealed fowl adenovirus serotypes 8a, 8b, and 11 in samples of broilers with IBH, serotype 11 in layers with IBH, and serotype 4 in poultry with HHS. Of the fowl adenovirus serotype 4 strains, 62.07% were isolated from layers. Additionally, 74.07% of the isolated strains were fowl adenovirus serotype 11 prior to June 2014; 53.70% were serotype 4 after that time point; and strains isolated in the first half of 2017 were all serotype 8b, which was related to the widespread application of inactivated serotype 4 adenovirus vaccines. These results demonstrate that fowl adenovirus serotypes 11, 4, and 8b were the predominant serotypes in some regions of China between 2007 and June 2014, between June 2014 and 2016, and in the first half of 2017, respectively. Layers were the predominant host infected with fowl adenovirus serotype 4 and could also be infected by serotype 11.

Prospective Assessment of Adenovirus Infection in Pediatric Kidney Transplant Recipients.

BACKGROUND: Adenovirus infection is associated with graft dysfunction and graft loss in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. METHODS: We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. RESULTS: Adenovirus viremia was detected in 11 (14.7%) patients at a median onset of 173 days (interquartile range, 109-310 days) posttransplant, 6 (8%) had asymptomatic viremia, and 5 (6.7%) had symptomatic disease (2 with hematuria and 3 with an acute febrile respiratory illness). Viremic patients did not differ from nonviremic patients in age, immunosuppression management, or cytomegalovirus or Epstein-Barr virus serostatus, but were more likely to develop cytomegalovirus viremia during the first 2 years posttransplant. No patient had an increase in creatinine from baseline during the time of adenovirus viremia. In a Cox proportional hazards regression, subclinical adenovirus viremia was not associated with a faster time to a 30% decline in estimated glomerular filtration rate. CONCLUSIONS: Adenovirus infection is common among pediatric kidney transplant recipients and frequently causes symptomatic disease; however, symptoms are often mild and are not associated with a decline in graft function. Routine monitoring for adenovirus viremia in pediatric kidney transplant recipients may not be warranted.

Assessment of serum antibody titers against canine distemper virus, canine adenovirus type II, and canine parvovirus in Alaskan sled dogs before and after a long-distance race.

OBJECTIVE: To determine serum antibody titers against canine distemper virus (CDV), canine adenovirus type II (CAV-2), and canine parvovirus (CPV) in trained sled dogs prior to and after completion of a long-distance race. DESIGN: Prospective cohort study. ANIMALS: 195 Alaskan sled dogs (from 18 kennels) that participated in the 2006 Iditarod Trail Race. PROCEDURES: All 1,323 dogs participating in the race had been vaccinated against the 3 viruses at 19 to 286 days prior to initial blood sample collection (obtained within the month preceding the race). Within 12 hours of race completion, blood samples were collected from 195 dogs (convenience sample) and matched with each dog's prerace sample. Serum antibody titers (90% confidence intervals [CIs]) were determined via serum neutralization assays. RESULTS: After racing, geometric mean titers against CDV and CPV were significantly higher (2,495 [90% CI, 321 to 16,384] and 6,323 [90% CI, 512 to 32,768], respectively) than prerace values (82 [90% CI, 11 to 362] and 166 [90% CI, 32 to 1,024], respectively). Sixty-one of 194 (31.4%) dogs had > or = 4-fold increases in anti-CPV antibody titers after racing. Prerace serum antibody titers against CDV, CPV, and CAV-2 varied significantly by sled team but were not associated with time since vaccination. CONCLUSIONS AND CLINICAL RELEVANCE: Postrace increases in serum anti-CDV and anti-CPV antibody titer might reflect exposure of dogs to these agents immediately before or during racing. Dogs had no clinical signs of CDV-, CAV-2-, or CPV-associated disease; therefore, the clinical importance of these titer changes is uncertain.

A serologic assessment of exposure to viral pathogens and Leptospira in an urban raccoon (Procyon lotor) population inhabiting a large zoological park.

In urban environments, raccoons (Procyon lotor) may act as reservoirs for an array of pathogenic organisms, presenting spillover risks for human, domestic animal, and captive (zoo) animal populations. Over 5 yr, 159 raccoons from a high-density raccoon population in St. Louis, Missouri (USA), were surveyed for exposure to canine distemper virus (CDV), canine adenovirus 1 (CAV-1); feline parvovirus (FPV; =feline panleukopenia), and several serovars of Leptospira interrogans. Exposure to each of the viruses and two Leptospira serovars (grippotyphosa and icterohemorrhagiae) was detected (prevalence of CDV = 54.1%; FPV = 49.7%; CAV-1 = 6.9%; L. interrogans icterohemorrhagiae = 8.9%; L. interrogans grippotyphosa = 6.3%). Eighty percent of raccoons showed evidence of exposure to at least one of the five primary pathogens, and 39% were positive for multiple species. Among the viruses, there was a significant co-occurrence of CDV and CAV-1. Longitudinal data on a subset of animals revealed that among individuals who were diagnosed as seropositive on first capture, 33-100% became seronegative for the pathogen of interest when reexamined at a later date. Thus, free-ranging urban raccoons have been exposed to multiple infectious agents, some of which may pose risks to humans and to nonvaccinated domestic and captive animal populations.

Assessment of adenovirus infection in adult lung transplant recipients using molecular surveillance.

BACKGROUND: Little is known about adenovirus infections in adult lung transplant recipients. Because the virus can establish latency, re-activation may be relatively common after transplantation. METHODS: We assessed adenovirus infection in 80 adult lung transplant recipients. Adenovirus polymerase chain reaction (real-time PCR assay; limit of detection approximately 25 copies/ml plasma) was done on plasma samples collected at regular intervals until 1 year post-transplant. RESULTS: Adenovirus DNA was detected in 18 of 80 patients (22.5%) and in 19 of 595 (3.4%) plasma samples up to 12 months post-transplant. Median time to detection of viremia was 134 days post-transplant (range 1 to 370 days). Median viral load was 180 copies/ml plasma (range 50 to 360 copies/ml). Symptoms were evaluated at the time of adenovirus detection: 14 of 18 (78%) patients were asymptomatic; 4 of 18 (22%) patients had otherwise unexplained febrile/flu-like illness that resolved spontaneously. Adenovirus was not found to be a trigger for acute rejection. No detrimental effect on pulmonary function was seen immediately after adenovirus infection. CONCLUSIONS: Adenovirus viremia is common in adult lung transplant recipients. In contrast to findings on adenoviral pneumonitis in lung transplant recipients, isolated episodes of low-level viremia are self-limited and do not trigger acute rejection or a decline in pulmonary function.

Medicaid outpatient utilization for waterborne pathogenic illness following Hurricane Floyd.

OBJECTIVES: Flooding provides an opportunity for epidemics of waterborne viral, protozoan, or bacterial diseases to develop in affected areas. Epidemic levels of disease may translate into higher than average levels of health services use, depending in part on help-seeking behaviors. The authors investigated whether the flooding that occurred as a result of Hurricane Floyd in September 1999 was associated with an increase in outpatient visits for waterborne diseases among Medicaid enrollees in eastern North Carolina. METHODS: Using a difference-in-differences estimation technique, the authors examined the change in outpatient visits by North Carolina Medicaid enrollees for selected waterborne diseases following the hurricane. The study focused on counties with high concentrations of hog farming that were mildly/moderately or severely affected by the hurricane, using unaffected counties and the year before the hurricane as controls. RESULTS: Small increases in Medicaid-covered outpatient visits were found in severely affected counties for two of the six pathogens selected for analysis, relative to unaffected counties. Larger increases in visits were found for nonspecific intestinal infections in both severely and moderately affected counties following the hurricane, relative to unaffected counties. CONCLUSIONS: The large increase in visits for ill-defined intestinal infection is noteworthy. The relative lack of increase in visits with specific pathogenic diagnoses may be attributable, at least in part, to a number of factors, including incomplete diagnostic information provided by treating clinicians, low treatment-seeking behavior, and use of non-Medicaid-funded emergency services.