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Pikkel-Geva HZ, Grisariu S, Rivkin M, Stepensky P, Strahilevitz J, Averbuch D, Orit C, Even-Or E, Zaidman I, Zimran E, Wolf DG, Avni B. High rate of adenovirus detection in gastrointestinal biopsies of symptomatic stem cell transplant recipients. Clin Transplant 2023; 37:e15098. [PMID: 37563430 DOI: 10.1111/ctr.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The gastrointestinal (GI) tract is a major human adenovirus (HAdV) replication site in patients undergoing hematopoietic stem cell transplantation (HSCT), yet the prevalence and correlates of HAdV GI infection in this setting have remained poorly recognized, especially among adult HSCT recipients. DESIGN OR METHODS We retrospectively studied the prevalence and risk factors of HAdV GI-tissue infection in HSCT recipients (73 adults and 15 children) with GI symptoms who underwent GI-tissue biopsy between January-2012 and December-2017. The presence of HAdV in the GI tissues was determined by real-time PCR. RESULTS HAdV GI-tissue infection was detected in 21 (23.9%) patients, with similar infection rates identified in adults and children. GI-tissue detection was more common at late (>100 days) compared to early times post-transplantation (50% vs. 12.9%, p < .001). The presence of bloody diarrhea, Arab ethnicity (p = .014) and concurrent cytomegalovirus GI-tissue detection (p = .025) were significantly correlated with HAdV GI-tissue infection, while chronic graft versus host disease was of borderline association (p = .055). CONCLUSIONS Our findings reveal a high rate and new clinical-demographic correlates of HAdV GI-tissue infection in adult and pediatric HSCT recipients with GI symptoms. The findings highlight the need for future prospective studies to assess the relatedness of HAdV infection to the GI symptoms, and the prevalence, impact, and treatment of HAdV GI infection in HSCT recipients.
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Affiliation(s)
| | - Sigal Grisariu
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Polina Stepensky
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel
| | - Dina Averbuch
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Faculty of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Caplan Orit
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ehud Even-Or
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
| | - Irina Zaidman
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
| | - Eran Zimran
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
| | - Dana G Wolf
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel
| | - Batia Avni
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center, Jerusalem, Israel
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Chan J, Ganosi V, Basude D, Mirci-Danicar OC, Wiskin AE. Complications and Utility of Gastrointestinal Endoscopy Post Hematopoietic Stem Cell Transplantation: An 11 Year Experience. J Pediatr Gastroenterol Nutr 2023; 76:494-497. [PMID: 36689930 DOI: 10.1097/mpg.0000000000003711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Diagnostic gastrointestinal (GI) endoscopy is used to differentiate GI graft versus host disease (GI-GvHD), which requires escalation of immunosuppressive treatment (IST), from other conditions such as viral infection, which may require reduction of IST. The aim of this study was to establish the clinical utility of GI endoscopy post hematopoietic stem cell transplant (HSCT) and the complication rate of these procedures. METHODS This was a single-center observational retrospective cohort study. Hospital pediatric endoscopy and HSCT databases identified patients between January 2010 and December 2020. GI-GvHD was diagnosed if there were positive histological findings and clinical context. Data collected included demographics, timing of endoscopy post-HSCT, clinical utility, and complications of endoscopy. The endoscopy was deemed to be "clinically useful" if it resulted in a change of clinical management or helped to narrow down the differential diagnosis for the clinical team. RESULTS Three hundred thirty-nine HSCT occurred in 320 children during the study period. Sixty-six of 339 (19%) HSCT needed an "endoscopy episode." One hundred nineteen endoscopies were performed (53 concurrent upper and lower GI endoscopies, 11 upper GI endoscopies, and 2 lower GI endoscopies). Four of 119 (3%) endoscopies had complications: septic shock (1), duodenal hematoma (1), GI bleeding (1), and colonic perforation (1). Four patients had incomplete records to assess utility of endoscopy. Fifty-seven of 62 (92%) endoscopy episodes were "clinically useful," and 41 of 62 (66%) had a change in IST. CONCLUSIONS The clinical utility of endoscopy is high and in the majority of cases is associated with a change in patient management. Children post-HSCT are at high risk of complications from endoscopy; this should be made clear in the process of obtaining consent for procedures.
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Affiliation(s)
- Joseph Chan
- From Paediatric Gastroenterology, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Vasiliki Ganosi
- Paediatric Oncology, University Hospital Southampton, Southampton, UK
| | - Dharamveer Basude
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | - Oana C Mirci-Danicar
- Paediatric Stem Cell Transplantation, Bristol Royal Hospital for Children, Bristol, UK
| | - Anthony E Wiskin
- Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
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