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1 May 2005

Volume 40, Number 9
Clinical Infectious Diseases 2005;40:1244–1249
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4009-0006$15.00
DOI: 10.1086/429235
MAJOR ARTICLE

Adenovirus Infection after Pediatric Bone Marrow Transplantation: Is Treatment Always Necessary?

Tony Walls,1

Khidir Hawrami,3

Innes Ushiro‐Lumb,3

Delane Shingadia,1

V. Saha,2,4 and

A. G. Shankar2

1Academic Department of Child Health and 2Department of Pediatric Hematology/Oncology, Royal London Hospital, 3Department of Virology, St. Bartholemew’s Hospital, and 4Cancer Research UK Children's Cancer Group, London, United Kingdom

Background.Adenovirus infections are associated with significant rates of morbidity and mortality among children after bone marrow transplantation (BMT). Many transplantation units use molecular virological methods, such as polymerase chain reaction (PCR), for surveillance for adenovirus infection and give preemptive antiviral therapy to children with evidence of disseminated adenovirus infection. This treatment strategy has never been evaluated in clinical trials.

Methods.We retrospectively tested blood samples obtained from a cohort of children who had undergone BMT before the introduction of regular weekly surveillance for adenovirus infection. A total of 273 samples collected from 26 patients between May 1998 and June 2002 were tested for adenovirus infection by quantitative PCR. Virus load was quantified for each sample yielding positive test results, and the clinical notes and virological records of each child were reviewed.

Results.Evidence of adenovirus infection was found in 11 children (42%), 7 of whom had not previously had positive test results. Receipt of T cell–depleted transplants was associated with a significantly higher incidence of adenovirus infection during the posttransplantation period. The 2 children who died from adenovirus disease developed infection within 2 weeks after transplantation, and both had very low absolute lymphocyte counts at the time of diagnosis. Seven of 11 children with blood samples that were found to be positive for adenovirus by PCR cleared the virus without antiviral therapy.

Conclusions.Surveillance for adenovirus by PCR is better than symptomatic testing for detecting adenovirus infection. Antiviral therapy may not be necessary for all children who develop adenovirus viremia after BMT.

Received 19 July 2004; accepted 10 December 2004; electronically published 31 March 2005.

Reprints or correspondence: Dr. Tony Walls, Academic Dept. of Child Health, Royal London Hospital, 1st Floor Luckes House, Stepney Way, Whitechapel, London E1 1BB, United Kingdom ().

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