Questions
Adenovirus — Questions
Study questions about Adenovirus — exam-style, clinical-scenario and FAQ.
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Exam-styleDiscuss disseminated adenovirus infection after haematopoietic stem-cell transplantation: who is at risk, how it is monitored, and how it is managed. [8]
Model answer
A complete answer identifies the high-risk groups, explains viral-load surveillance, and gives the management ladder.
Who is at risk
Adenovirus is most dangerous after allogeneic stem-cell transplantation, particularly in children and above all with T-cell depletion (in vivo antithymocyte globulin or ex vivo graft manipulation), which removes the cellular immunity needed to control it. Graft-versus-host disease and cord-blood or mismatched donors add risk. It usually appears within the first three months.
Clinical disease
Infection ranges from asymptomatic shedding to disseminated, frequently fatal disease: gastroenteritis and hepatitis, pneumonia, haemorrhagic cystitis and nephritis, and multi-organ failure. Detectable and rising adenovirus in the blood is the key predictor of dissemination.
Monitoring
High-risk patients are monitored with quantitative real-time PCR on blood and, because shedding there precedes viraemia, on stool and urine. Pre-emptive treatment is triggered by viraemia, not by stool positivity alone, since most stool-positive patients never develop disease.
Management
Reduce immunosuppression to let adenovirus-specific T cells recover. Cidofovir, or its oral lipid-ester brincidofovir (less nephrotoxic), is given pre-emptively on confirmed viraemia, with close attention to renal toxicity and hydration. Adoptive transfer of donor-derived adenovirus-specific T cells is an effective option for refractory disease where it is available.