Early diagnosis of adenovirus infection and treatment with cidofovir afterbone marrow transplantation in children

Adenovirus infection remains an important cause of mortality after bone mar row transplantation (BMT), Currently no efficient antiviral treatment is kn own. Thus, testing new modalities of early diagnosis and treatment is a cru cial objective, Adenovirus infection is defined by the combination of sympt oms and the isolation of virus from the source of clinical symptoms. The in volvement of two or more organs and the presence of virus in blood cultures define disseminated disease. Seven children with a median age of 7 years r eceived bone marrow transplantation for leukemia. All received an unrelated graft without T cell depletion. Adenovirus was sought in blood, urine and biopsy specimens using PCR and culture. Analysis of biopsy specimens includ ed systematic immunohistochemistry. Cidofovir treatment was initiated as so on as biopsy revealed the histopathological signs of adenovirus, Cidofovir was given at 5 mg/kg once weekly for 3 weeks then every 2 weeks. Six patien ts had diarrhoea and one patient had cystitis, Adenovirus infection and dis seminated disease were diagnosed in four cases and three cases, respectivel y, In six cases, serotype A31 was isolated from gastrointestinal biopsy and in two cases serotypes B2 and C6 were detected in blood and urine. Cidofov ir treatment was associated with clinical improvement of diarrhoea, cystiti s and fever in five patients, in whom the virus became undetectable in cult ures and PCR analyses despite the persistence of immunodeficiency, The medi an follow-up was 360 days after BMT (240-570), One child died of invasive a spergillosis and another of disseminated adenovirus after interruption of c idofovir therapy. Further studies in immunocompromised patients will be nee ded to extend these promising results concerning the role of cidofovir in a denovirus infection.