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.com
Volume 5, Issue 7 (Suppl)
J Infect Dis Ther, an open access journal
ISSN: 2332-0877
Infection Prevention 2017
December 14-15, 2017
December 14-15, 2017 | Rome, Italy
13
th
World Congress on
INFECTION PREVENTION AND CONTROL
Adenovirus-rough n tough: Successful treatment of disseminated adenovirus infection in two solid
organ transplant recipients
Ram Prakash Thirugnanasambandam, Shuchi Pandya, Sally Alrabaa and Cynthia Manor
University of South Florida, USA
A
denovirus is a DNA virus that causes infections of the respiratory tract, gastrointestinal tract, conjunctiva and rarely urinary
or neurological systems. Disease caused by adenovirus is usually self-limiting, but it can cause disseminated infection with
high morbidity and mortality. We present two cases of transplant recipients who developed disseminated adenovirus infection
and were successfully treated on a compassionate basis with the investigational drug Brincidofovir. The first patient was a
47-year-old female with kidney/pancreas transplant done 6 months prior to presentation who was admitted with hematuria
for 9 days, fever and acute kidney injury. A cystoscopy was done which revealed erythema in the bladder and transplant ureter.
Biopsy of transplanted kidney was PCR positive for adenovirus and had changes consistent with adenovirus tubulo-interstitial
nephritis. Due to pancytopenia, she underwent a bone marrow biopsy which was PCR positive for adenovirus. She was started
on cidofovir, but quickly developed worsening renal failure, hence she was switched to brincidofovir. Within 3 weeks of starting
treatment, her symptoms resolved, and adenovirus PCR was negative in urine. Unfortunately, her renal function did not
improve, and she remains on hemodialysis. The second patient is a 46-year-old African American female who underwent
Deceased Donor Kidney Transplant (DDKT) 4 months prior to presentation. She presented with fever for 2 days, abdominal
pain and non-bloody watery diarrhea. Temperature was 103 F and she had pancytopenia. On labs, pertinent negatives included
urine culture, blood culture, serum PCR for CMV and EBV and stool studies. Adenovirus was detectable by PCR in urine
and was positive in blood with 11,571 copies detected. Due to pancytopenia, she had a bone marrow biopsy which was PCR
positive for adenovirus. She was diagnosed with disseminated adenovirus infection and was initiated on brincidofovir with
improvement in fever and diarrhea. Due to our experience with the first patient we were hesitant to initiate cidofovir. At one
month follow up, blood cell counts had improved and adenovirus PCR in blood and urine were both undetectable. Brincidofovir
is an investigational drug that is an oral lipid formulation of cidofovir and is less nephrotoxic. Our center has had positive
experiences with the compassionate use of this agent. Polymerase Chain Reaction testing (PCR) is useful for diagnosis as it is
highly sensitive and specific. Due to significant morbidity and mortality as well as limited data on prevention and treatment,
it is important to consider adenovirus as a causative infectious agent in solid organ transplant patients who present with fever
of unknown origin, pancytopenia and hemorrhagic cystitis. It is critical to rule out disseminated adenovirus disease, reduce
immunosuppression where possible, and consider starting anti-viral therapy early. Brincidofovir is currently in phase three
clinical trial for adenovirus infections.
ramcancer12@gmail.comJ Infect Dis Ther 2017, 5:7(Suppl)
DOI: 10.4172/2332-0877-C1-036