Journal
JOURNAL OF CLINICAL VIROLOGY
Volume 56, Issue 1, Pages 77-81Publisher
ELSEVIER
DOI: 10.1016/j.jcv.2012.09.003
Keywords
BK virus; Cluster; Stem cell transplantation; Infection; Pediatric
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Funding
- Helsinki University Hospital Funds
- University of Basel
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Background: BK polyomavirus-associated hemorrhagic cystitis (BK-PyVHC) is a significant complication of allogenic hematopoietic stem cell transplantation (HSCT), but risk factors and treatment are currently unresolved. BK-PyVHC typically presents with clinical cystitis, macrohematuria, and increasing urine and blood BKV loads. Objectives: Characterization of children undergoing allogeneic HSCT with BK-PyVHC and their clinical and antibody response to cidofovir treatment. Study design: By prospective screening of urine and plasma in 50 pediatric allogenic HSCT performed between 2008 and 2010, we identified 6 (12%) children with BK-PyVHC. Cidofovir was administered intravenously to 5 patients and intravesically to 4 patients (3 double treatments). Results: Decreasing BKV viremia of >2 log(10) copies/mL and clinical resolution was seen in 4 patients over 5-12 weeks. Responses occurred only in patients mounting BKV-specific IgM and IgG responses. Epidemic curve plots, BKV genotyping and contact tracing provided evidence of transmission between 2 BKV-seronegative patients, but ruled out transmission among the remaining four patients Conclusions: The data suggest that BK-PyVHC may be the result of nosocomial transmission in children with low/undetectable BKV antibodies and raises urgent questions about appropriate infection control measures and the role of cidofovir. (C) 2012 Elsevier B.V. All rights reserved.
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