Adenovirus in marrow transplant recipients

Adenovirus disease is a major cause of morbidity and mortality among recipients of marrow transplants. Recent advances have contributed to our understanding of the mechanisms which contribute to viral persistance in the normal host and to the development of disseminated disease in the immunocompromised patient. With the advent of more immunosuppressive transplant protocols, including T-cell depletion, the incidence of adenoviral disease appears to have increased. This review summarizes the clinical manifestations of adenovirus in the bone marrow transplant population. Clinical syndromes that have been associated with adenoviral infection in the transplant setting include hemorrhagic cystitis, nephritis, gastroenteritis, pneumonia, hepatitis, pancreatitis, encephalitis, disseminated disease, and rarely viral-associated hemophagocytic syndrome. There are currently no proven antiviral therapies available for treating adenoviral disease. Several case reports, however, have described resolution of symptoms and clearing of positive cultures in patients with more limited disease such as cystitis, nephritis, or gastroenteritis in response to ribavirin, IVIG, and/or donor T-cell infusions. Since the mortality from disseminated adenovirus infection remains high, there is growing interest in the early detection of viral replication and the design effective intervention protocols.