Occurrence of adenovirus infection and clinical impact in paediatric stem cell transplant recipients

In this study, the occurrence and clinical impact of adenovirus (AdV) infection was investigated in paediatric hematopoietic stem cell transplantation (HSCT) recipients. A number of 603 specimens (including whole blood, respiratory and other samples) from 181 patients were tested by real-time polymerase chain reaction; clinical outcome was investigated. Overall, 118/603 (19.6%) specimens from 21/181 (11.6%) patients resulted positive to AdV (including 17.3, 29.9, 17.6, and 15.8% of total number of whole blood, respiratory, urine and other specimens, respectively). On whole blood specimens, viral loads ranged from <600 (limit of detection) to >5×10⁶ copies/mL, with a median value 2×104. Multiple specimens were positive in patients in which viral load on whole blood was high. Adenoviral positivity on whole blood was associated to poor prognosis, as death occurred in three of ten (30%) patients with persistent positivity on whole blood specimens, also despite the administration of an antiviral agent (cidofovir). Adenovirus infection can account for systemic and/or organ-specific signs/symptoms in approximately 10% of paediatric HSCT recipients. At moment, there is no indication for routine monitor of AdV in these patients, although AdV aetiology of infectious transplant complications should be taken in account.