RESUMEN
The renal survival rate of pediatric renal transplant recipients (pRTR) has improved with the use of modern immunosuppressive agents; however, the incidence of post-transplantation viral infection has increased. This study investigated the incidence of BK viremia and BK viral-associated nephropathy (BKVAN) in pRTR. One-hundred-and-thirty-four pRTR were divided into two groups: group 1 (n = 20, 14.9%) comprised those who were prospectively followed with longitudinal analyses after renal transplantation in the time period from May 2007 to June 2008, while group 2 (n = 114, 85.1%) cross-sectional study of those who were transplanted from January 1994 to April 2007. The mean ages at transplantation in groups 1 and 2 were 10.6 ± 4.7 years and 7.8 ± 4.5 years, respectively. BK viremia was detected in four (20.0%) patients in group 1, and seven (6.1%) in group 2 (P = 0.04), with increased incidence associated with induction therapy. The median time to detection of BK viremia after transplantation was 44 days in group 1 and 142 days in group 2. BKVAN was diagnosed in three patients (two in group 1 and one in group 2). All three patients diagnosed with BKVAN were receiving tacrolimus, mycophenolate mofetil, and corticosteroids as maintenance immunosuppression. Reducing immunosuppression resulted in reduced BK viremia. Monitoring for BK viremia and BKVAN is important in pRTR being treated with the current immunosuppressive regimen. The first line of treatment for BK viremia remains careful reduction of immunosuppression and close monitoring of renal allograft function.
Asunto(s)
Virus BK , Enfermedades Renales/virología , Trasplante de Riñón , Infecciones por Polyomavirus/virología , Complicaciones Posoperatorias/virología , Infecciones Tumorales por Virus/virología , Viremia/virología , Niño , Femenino , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Enfermedades Renales/epidemiología , Estudios Longitudinales , Masculino , Infecciones por Polyomavirus/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Infecciones Tumorales por Virus/epidemiología , Viremia/epidemiologíaRESUMEN
Norovirus strains were detected in two patients and in environmental swabs from a pediatric primary immunodeficiency unit in London, United Kingdom, during an infection control incident in November and December 2007. Detailed analyses of the gene encoding the P2 domain demonstrated that the majority of the strains were not related to the patients and that the environmental contamination was most likely due to secondary transfer by the hands of staff or visitors.
Asunto(s)
Infecciones por Caliciviridae , Microbiología Ambiental , Norovirus/aislamiento & purificación , Infecciones por Caliciviridae/microbiología , Infecciones por Caliciviridae/transmisión , Análisis por Conglomerados , Heces/virología , Humanos , Huésped Inmunocomprometido , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino , Norovirus/genéticaRESUMEN
BACKGROUND: Cardiac allograft vasculopathy is the major limiting factor to the long-term success of pediatric heart transplantation. Cytomegalovirus (CMV) has been shown to be a significant risk factor for the development of cardiac allograft vasculopathy. Recent work has demonstrated CMV DNA in leukocytes in the absence of direct allograft infection, suggesting that vascular changes may not be limited to the allograft. METHOD AND RESULTS: Systemic arterial endothelial function was assessed with high-resolution ultrasound to determine brachial artery flow-mediated dilation in 50 pediatric heart transplant recipients (8 to 17 years of age; 27 male). Patients were separated into 2 groups according to CMV status: those without evidence of CMV replication after transplantation (n=38; 19 male) and patients with evidence of viremia after transplantation (n=12; 8 male). No patient had detectable viremia at the time of study. Flow-mediated dilation was significantly impaired in patients with evidence of CMV replication after transplantation (6.64+/-1.12%, mean+/-SE) compared with those without (9.48+/-0.56%; P=0.02). This difference remained after adjustment for age, time since transplantation, and medication. Pretransplantation recipient and donor CMV status and traditional CMV risk were not associated with flow-mediated dilation. CONCLUSIONS: CMV replication after cardiac transplantation is associated with chronic endothelial dysfunction in the systemic circulation in children. The implication for both systemic and coronary vascular health requires prospective evaluation.
Asunto(s)
Citomegalovirus/fisiología , Endotelio Vascular/fisiopatología , Trasplante de Corazón/efectos adversos , Enfermedades Vasculares/virología , Replicación Viral , Adolescente , Niño , Infecciones por Citomegalovirus/complicaciones , Endotelio Vascular/diagnóstico por imagen , Endotelio Vascular/virología , Femenino , Humanos , Masculino , Ultrasonografía , Enfermedades Vasculares/etiología , Vasodilatación , ViremiaRESUMEN
Enterovirus myocarditis is a potentially devastating diagnosis in the neonatal setting, with an associated high mortality and risk for chronically impaired cardiac function. Transplantation may be a possible therapeutic option, but, due to the comparative scarcity of the presentation, the limited donor pool, and fears of viral persistence and recurrence of myocarditis (especially in the immunocompromised, post-transplant setting), there are no reported cases in the literature. This case report illustrates an encouraging one-year outcome following heart transplantation for necrotic enterovirus myocarditis in a neonate.
Asunto(s)
Infecciones por Enterovirus/complicaciones , Enterovirus , Trasplante de Corazón , Miocarditis/cirugía , Disfunción Ventricular Izquierda/virología , Femenino , Humanos , Recién Nacido , Miocarditis/virologíaRESUMEN
Lymphoproliferative disease (LPD) is a recognized complication of primary immunodeficiency (PID) and immunodysregulatory syndromes. Historically, it has a very poor outcome. For patients surviving LPD, myeloablative hematopoietic stem cell transplantation (SCT) was the only cure for the underlying PID, with a high risk of developing posttransplantation complications, including recurrent lymphoproliferative disease. We describe 8 patients with a range of PID and immunodysregulatory syndromes complicated by LPD. After initial treatment of the LPD (including the use of anti-CD20 monoclonal antibody, rituximab, in 6 of the patients), all patients underwent reduced-intensity conditioning (RIC) SCT with prospective monitoring for Epstein-Barr virus (EBV) viremia. After transplantation, 3 patients received rituximab, and 3 patients received prophylactic EBV-specific cytotoxic T-lymphocytes. Only 1 patient developed recurrent LPD posttransplantation, which responded to rituximab. All patients who underwent transplantation survive free of LPD and are cured of their PID at a median follow-up of 4 years (range, 1-7 years). With careful monitoring and pre-emptive therapy, we advocate this RIC SCT approach to patients with PID who have pre-existing EBV-LPD.
Asunto(s)
Infecciones por Virus de Epstein-Barr/terapia , Trasplante de Células Madre Hematopoyéticas , Síndromes de Inmunodeficiencia/complicaciones , Trastornos Linfoproliferativos/terapia , Trasplante Homólogo , Adolescente , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales de Origen Murino , Antineoplásicos/farmacología , Niño , Preescolar , ADN Viral/sangre , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/virología , Femenino , Enfermedad Injerto contra Huésped , Herpesvirus Humano 4/patogenicidad , Humanos , Trastornos Linfoproliferativos/complicaciones , Trastornos Linfoproliferativos/virología , Masculino , Estudios Prospectivos , Rituximab , Linfocitos T Citotóxicos/metabolismo , Linfocitos T Citotóxicos/patología , Carga Viral , Viremia/etiología , Viremia/terapiaRESUMEN
The use of reduced intensity regimens has decreased early mortality following stem cell transplantation. However, the increased immunosuppression following these protocols results in profound and often prolonged lymphopenia, resulting in an increased incidence of viral reactivation. We and others have observed a high incidence of EBV viraemia and post-transplant lymphoproliferative disease (PTLD) following reduced-intensity conditioning regimens, reflecting the delayed recovery of EBV-specific immunity after such transplants. The clinical and histological features at presentation are similar to that seen after conventional intensity conditioning. Given the increasing use of reduced intensity conditioning (RIC) transplants, we review the risk factors for EBV related disease following transplantation with RIC, the potential for pre-emptive therapy of PTLD based on monitoring EBV viraemia and management options in such patients.
Asunto(s)
Infecciones por Virus de Epstein-Barr/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trastornos Linfoproliferativos/etiología , Acondicionamiento Pretrasplante/efectos adversos , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/virología , Herpesvirus Humano 4/fisiología , HumanosRESUMEN
Adenoviral infections represent a major cause of morbidity and mortality following haematopoietic stem cell transplantation. Current anti-viral agents are virostatic and it is evident that elimination of adenovirus (ADV) infection is only achieved by recovery of cellular immunity. Using an interferon-gamma (IFN-gamma) secretion and capture assay to isolate ADV-specific T cells, followed by a 2 week expansion and restimulation protocol, we generated ADV T cells that may be used for cellular immunotherapy. In contrast to virus-specific T cells for cytomegalovirus or Epstein-Barr virus, the ADV response was dominated by CD4(+) T cells and the majority of captured cells exhibited an effector/memory immunophenotype. Highly specific antigen responses were demonstrated by intracellular IFN-gamma expression and cytotoxicity assays when the expanded cells underwent restimulation with ADV-pulsed target cells. Although T cells were initially generated in response to ADV species C, the expanded populations also showed strong activity against ADV species B, suggesting cross-reactivity across ADV species; a finding that has important clinical consequences in the paediatric setting, where the majority of infections are caused by ADV type B and C. The protocols can be readily translated to generate ADV-specific T cells suitable for clinical use and offer an effective immunotherapeutic strategy to control ADV infection.
Asunto(s)
Infecciones por Adenovirus Humanos/inmunología , Adenovirus Humanos , Linfocitos T CD4-Positivos/inmunología , Inmunoterapia Adoptiva , Adulto , Antígenos Virales , Proliferación Celular , Separación Celular/métodos , Pruebas Inmunológicas de Citotoxicidad , Células Dendríticas/inmunología , Epítopos , Citometría de Flujo , Humanos , Inmunofenotipificación , Interferón gamma/inmunología , Antígenos Comunes de Leucocito/inmunología , Prueba de Cultivo Mixto de LinfocitosRESUMEN
Simple robust approaches are needed to monitor the prevalence and incidence of HIV in Africa. The aim of this study was to evaluate the use of dried blood spot (DBS) as an alternative to serum or plasma for sentinel surveillance. Paired DBS and blood samples were obtained from 200 patients attending a genito-urinary medicine clinic in West Africa. The gold standard of diagnosis was based on the combination of 3 enzyme-linked immunosorbent assays (ELISA) using serum. The presence of HIV antibodies in eluates of dried blood spots was detected by ELISA, Gelatin Particle Assay (GPA) and Pepti-Lav 1-2 in 5 different testing strategies. All 200 eluates were tested individually, and in addition pools of 5 eluates each were tested. The sensitivity of the testing strategies ranged from 95.0% (83.1 - 99.4%) to 100% and the specificity from 97.5% (93.7 - 99.3%) to 100%. Testing in pools of 5 did not affect sensitivity. Dried blood spots were easy to work with. Test kit and laboratory consumable costs varied between 492 pounds and 1037 pounds (unpooled strategies) and 163 pounds and 421 pounds (pooled). The monospecific ELISAs used in this study are no longer in production; currently available differentiating assays need to be tested. DBS are recommended for sentinel surveillance in Africa.
Asunto(s)
Serodiagnóstico del SIDA/métodos , Recolección de Muestras de Sangre/métodos , Anticuerpos Anti-VIH/aislamiento & purificación , Seropositividad para VIH/diagnóstico , VIH-1/inmunología , VIH-2/inmunología , Juego de Reactivos para Diagnóstico/virología , Ensayo de Inmunoadsorción Enzimática/métodos , Gambia , Anticuerpos Anti-VIH/sangre , Seropositividad para VIH/sangre , Seroprevalencia de VIH , Humanos , Sensibilidad y Especificidad , Vigilancia de GuardiaRESUMEN
A fecal archive containing 115 sapovirus (SaV) strains detected in samples collected from 15 outbreaks and 98 sporadic cases of gastroenteritis between 1989 and 2004 in the UK were characterized in order to determine the genomic diversity within SaV co-circulating in the human population. Strains were characterized by partial sequencing of the genes encoding the RNA-dependent RNA polymerase (RdRp) region and/or the polymerase/capsid (Pol/Cap) junction of the open reading frame (Orf) 1. Overall, SaV of genogroup I genotype 1 (GI 1) were the predominant strains circulating in the UK in each year between 1989 and 2004. During 2004, GII 1 was the predominant strain. These two SaV types accounted for 89.5% of the sporadic cases and outbreaks in the UK. The remaining cases were caused by six other SaV genotypes. On the basis of partial sequencing of the RdRp and capsid encoding genes of strains, which did not show sufficient homology to any of the currently recognized genotypes, we propose the inclusion of a presumptive fourth genotype within genogroup I (GI 4).
Asunto(s)
Infecciones por Caliciviridae/epidemiología , Brotes de Enfermedades , Gastroenteritis/epidemiología , Variación Genética , Epidemiología Molecular , Sapovirus/genética , Adulto , Infecciones por Caliciviridae/virología , Cápside/metabolismo , Niño , Preescolar , Heces/virología , Genes Virales/genética , Humanos , Lactante , Irak , Sistemas de Lectura Abierta/genética , ARN Polimerasa Dependiente del ARN/genética , ARN Polimerasa Dependiente del ARN/metabolismo , Sapovirus/clasificación , Especificidad de la Especie , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Elevation in Epstein-Barr virus (EBV) load measured in peripheral blood has been proposed as a marker for development of post-transplant lymphoproliferative disease (PTLD), but there are few published data examining this relationship. We report the longitudinal surveillance of EBV for all recipients of heart (HTx), heart-lung (HLTx) and lung (LTx) transplants at our institution. METHODS: The study population included all patients transplanted between January 2003 and July 2004. EBV load was serially measured in peripheral blood by real-time polymerase chain reaction (PCR). Results were correlated with recipient pre-transplant EBV status and development of PTLD. RESULTS: Forty-four transplant operations were performed, including 33 HTx, 6 HLTx and 5 LTx. Thirty-two (73%) of the patients were EBV seropositive pre-transplant. Nineteen (44%) pediatric recipients developed EB viremia, including 17 HTx, 1 HLTx and 1 LTx. Eleven (58%) of these patients were EBV seropositive pre-transplant. EBV was first detected at a median of 30.5 days (range 2 to 81) post-transplant. The median peak EBV load in that group was 10,099 copies/ml (range 5,935 to 255,466) whole blood. One patient with cystic fibrosis post-LTx developed PTLD localized in the colon. This patient was EBV seronegative pre-transplant; peak EBV load was 14,513 copies/ml. Acute infectious mononucleosis was seen in 1 case. Positive pre-transplant EBV status did not predict post-transplant EB viremia (positive predictive value 0.03). CONCLUSIONS: Contrary to earlier reports, our data demonstrate that a high EBV load does not lead to PTLD early post-transplant. These results do not support the practice of pre-emptively reducing immunosuppression in patients with raised EBV load.
Asunto(s)
Trasplante de Corazón-Pulmón , Trastornos Linfoproliferativos/virología , Complicaciones Posoperatorias/virología , Carga Viral , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Herpesvirus Humano 4 , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Factores de TiempoRESUMEN
Numerous outbreaks of adenovirus infection from different types of health care settings, except a hematology unit, have been reported. This is the first report describing an outbreak of adenovirus infection causing diarrhea among adult hematopoietic stem cell transplant recipients. Six of 21 patients from the outbreak cohort were affected with diarrhea. Electron microscopy, cell culture, and direct DNA sequencing of amplicons generated from stool and blood samples were used to investigate this outbreak. Electron microscopy and cell culture detected adenovirus in stools from symptomatic patients. DNA sequencing of amplicons generated from stool samples confirmed nosocomial transmission of infection from a single index case. The outbreak strain was also detected in plasma of four of these patients, suggesting systemic infection. The outbreak strain was identified as type 12. Standard infection control measures were effective to control this outbreak.
Asunto(s)
Infecciones por Adenovirus Humanos/epidemiología , Adenovirus Humanos/aislamiento & purificación , Infección Hospitalaria/epidemiología , Diarrea/epidemiología , Brotes de Enfermedades , Hematología , Unidades Hospitalarias , Infecciones por Adenovirus Humanos/transmisión , Infecciones por Adenovirus Humanos/virología , Adenovirus Humanos/clasificación , Adenovirus Humanos/genética , Adulto , Animales , Secuencia de Bases , Proteínas de la Cápside/química , Proteínas de la Cápside/genética , Línea Celular , Infección Hospitalaria/transmisión , Infección Hospitalaria/virología , Diarrea/virología , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa/métodos , Análisis de Secuencia de ADNRESUMEN
The incidence of Epstein-Barr virus (EBV) viraemia and lymphoproliferative disease (LPD) was studied in a consecutive cohort of 128 paediatric patients undergoing stem cell transplantation (SCT) with reduced-intensity conditioning (RIC; n = 65) or conventional-intensity conditioning (CIC; n = 68). Following CIC, six of 68 (8%) developed viraemia; all remained asymptomatic. EBV viraemia (23 of 65 patients = 35%, P < 0.001) and LPD (10 of 65 = 15%, P < 0.001) were significantly more frequent following RIC. Of the 23 RIC patients who developed viraemia, eight remained asymptomatic, five had symptomatic viraemia (fever +/- rash), and 10 patients developed LPD, two of whom died. An absolute lymphocyte count of <0.3 x 10(9)/l at the time of onset of viraemia was strongly predictive of development of LPD (P < 0.05) in this group. The incidence of viraemia was significantly higher in patients receiving serotherapy with antithymocyte globulin (ATG; 15 of 43, 35%) than Campath (12 of 73, 16.4%, P < 0.05). Primary immunodeficiency and acute graft-versus-host disease were associated with EBV viraemia in univariate analysis, but were not independent risk factors. In conclusion, EBV viraemia and LPD appear to be significantly more common in children following RIC SCT, particularly with selective depletion of recipient T cells relative to B cells following the use of ATG. This probably reflects the profound immunosuppression following RIC SCT, together with the incomplete ablation of recipient-derived B cells.
Asunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Herpesvirus Humano 4 , Trastornos Linfoproliferativos/cirugía , Trasplante de Células Madre , Acondicionamiento Pretrasplante/métodos , Adolescente , Alemtuzumab , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Anticuerpos Antineoplásicos/uso terapéutico , Suero Antilinfocítico/uso terapéutico , Linfocitos B/inmunología , Niño , Preescolar , Infecciones por Virus de Epstein-Barr/inmunología , Femenino , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/virología , Humanos , Inmunización Pasiva , Incidencia , Lactante , Recuento de Linfocitos , Trastornos Linfoproliferativos/inmunología , Trastornos Linfoproliferativos/virología , Masculino , Análisis Multivariante , Factores de Riesgo , Linfocitos T/inmunologíaRESUMEN
The genetic diversity of enteric viruses co-circulating in a cohort of patients with viral gastroenteritis in a large tertiary paediatric hospital in London, UK, was determined. Multiple strains of noroviruses (NV), sapoviruses (SV) and astroviruses (HAsV) were detected in these patients, indicating the likelihood of multiple introductions from different sources, possible sub-clinical infections and simultaneous infection with different viruses in immunocompromised and other patients. Routine screening of immunocompromised patients and infection control procedures are important to prevent nosocomial infection.
Asunto(s)
Infecciones por Astroviridae/virología , Infecciones por Caliciviridae/virología , Gastroenteritis/virología , Mamastrovirus/genética , Norovirus/genética , Sapovirus/genética , Adolescente , Infecciones por Astroviridae/epidemiología , Infecciones por Caliciviridae/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Infección Hospitalaria/epidemiología , Infección Hospitalaria/virología , Heces/virología , Hospitales Pediátricos , Humanos , Lactante , Londres , Mamastrovirus/aislamiento & purificación , Norovirus/aislamiento & purificación , Filogenia , ARN Viral/genética , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sapovirus/aislamiento & purificación , Análisis de Secuencia de ADN , Homología de SecuenciaRESUMEN
During an investigation of a hospital outbreak of norovirus gastroenteritis identified as being caused by a recombinant genogroup II (rGII-3a) strain, fecal specimens collected from asymptomatic staff and patients were tested by nested PCR. A GII-4 norovirus strain, the predominant strain associated with outbreaks in hospitals over the last few years, was detected in 26 and 33% of asymptomatic staff and patients, respectively. No rGII-3a (Harrow/Mexico) norovirus strains were detected in the samples of asymptomatic staff or patients.
Asunto(s)
Infecciones por Caliciviridae/epidemiología , Infecciones por Caliciviridae/virología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/virología , Brotes de Enfermedades , Gastroenteritis/epidemiología , Gastroenteritis/virología , Norovirus , Portador Sano/epidemiología , Portador Sano/virología , ADN Viral/genética , Genes Virales , Humanos , Londres/epidemiología , Norovirus/clasificación , Norovirus/genética , Norovirus/aislamiento & purificación , Personal de Hospital , Filogenia , Reacción en Cadena de la PolimerasaRESUMEN
OBJECTIVE: To monitor HIV-1 and HIV-2 trends in The Gambia, West Africa. METHODS: In 1993-1995 a nationwide survey among 29 670 pregnant women attending eight antenatal clinics estimated the seroprevalence of HIV-1 at 0.6%, and of HIV-2 at 1.1%. Five years later, sentinel surveillance in pregnant women was established, using unlinked anonymous testing in four clinics. A dried blood spot on filter paper was obtained and tested for HIV antibodies. RESULTS: Between May 2000 and August 2001, 8054 analysable samples were collected at four sites. The prevalence of HIV-1 rose sharply in one rural area from 0.6 to 3.0% (P < 0.0001), but the increase was small and non-significant in two other rural sites and in the urban site. The prevalence of HIV-2 did not change significantly at any of the sites. The overall prevalence of HIV-1 was 1.0% [95% confidence interval (CI) 0.8-1.3%], and of HIV-2 0.8% (CI 0.6-1.0%). Site, nationality and higher age were significantly associated with HIV-1 infection, and higher parity and site were significantly associated with HIV-2 infection. CONCLUSION: Fifteen years after the first case of HIV-1 was described in The Gambia, the epidemic is still at a low level. There is heterogeneity within the country, with one rural area experiencing a fivefold increase in 6 years. The prevalence of HIV-2 in The Gambia is stable.
Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH , VIH-1 , VIH-2 , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Edad , Femenino , Gambia/epidemiología , Humanos , Análisis Multivariante , Paridad , Embarazo , Vigilancia de GuardiaRESUMEN
All couples attending the premarital examination at four selected sites in Zhejiang and Yunnan provinces in China were included in this study. Blood from 9952 individuals was tested for HIV-1 using a gelatin particle agglutination technique. There were no HIV-positive individuals in Zhejiang. In Yunnan, 28 of 3742 individuals were positive, a prevalence of 0.75%. The premarital examination should be used for voluntary counselling and testing and anonymous surveillance for HIV in high prevalence areas.