Adenovirus infections in adult recipients of blood and marrow transplants

Adenoviruses are increasingly recognized pathogens that affect blood and ma rrow transplant (BMT) recipients. Experiences with 2889 adult BMT recipient s were reviewed to study the incidence, clinical spectrum, risk factors for dissemination, response to therapy, and outcome of adenovirus infections. Eight-five patients (3%) were diagnosed by means of culture (n = 85) or cul ture and histopathological examination (n = 6). Nine patients had asymptoma tic viruria, and 76 had symptomatic infections, which included upper respir atory tract infection (n = 20), enteritis (n = 18), hemorrhagic cystitis (n = 10), pneumonia (n = 15), and disseminated disease (n = 13). The overall mortality rate was 26%. A higher mortality rate was observed among patients with pneumonia (73%) and disseminated disease (61%). Risk factors for diss emination included receipt of an allogeneic transplant, presence of graft-v ersus-host disease (GVHD), and receipt of concurrent immunosuppressive ther apy. Intravenous ribavirin was not associated with an appreciable benefit a mong 12 patients who received this treatment. In conclusion, adenovirus inf ections are an important cause of morbidity and mortality in adult BMT reci pients, particularly allogeneic transplant recipients with GVHD who are rec eiving immunosuppressive therapy. The need for an effective, nontoxic antiv iral therapy is apparent.