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Toomey D, Phan TL, Phan T, Hill JA, Zerr DM. Viral Encephalitis after Hematopoietic Cell Transplantation: A Systematic Review. Transplant Cell Ther 2023; 29:636.e1-636.e9. [PMID: 37422195 DOI: 10.1016/j.jtct.2023.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Viral encephalitis is a rare but serious complication after hematopoietic cell transplantation (HCT). The nonspecific early signs and symptoms and rapid progression can make it difficult to diagnose and treat in a timely fashion. To better inform clinical decision making in post-HCT viral encephalitis, a systematic review of prior studies of viral encephalitis was performed, with the goal of characterizing the frequency of various infectious etiologies and their clinical course, including treatments and outcomes. A systematic review of studies of viral encephalitis was performed. Studies were included if they described a cohort of HCT recipients who were tested for at least 1 pathogen. Of 1613 unique articles initially identified, 68 met the inclusion criteria, with a total of 72,423 patients studied. A total of 778 cases of encephalitis were reported (1.1%). Human herpesvirus 6 (HHV-6) (n = 596), Epstein-Barr virus (n = 76), and cytomegalovirus (n = 33) were the most commonly reported causes of encephalitis, and HHV-6 encephalitis tended to occur the earliest, accounting for most cases prior to day +100 post-transplantation. Of 29,671 patients with available transplantation data, encephalitis was diagnosed in 282 of 4707 (6.0%) cord blood transplantation (CBT) recipients, in 372 of 24,664 (1.5%) non-CBT allogeneic HCT recipients, and in 5 of 300 (1.7%) autologous HCT recipients. Of the 282 CBT encephalitis cases, 270 (95.7%) were caused by HHV-6. Overall, 288 (37.0%) of the 778 patients with encephalitis died, and 75 deaths were attributable to encephalitis, with the time between diagnosis and death ranging from 3 to 192 days. Viral encephalitis occurs in approximately 1% of HCT recipients, and HHV-6 is the most common cause. Mortality following encephalitis in HCT recipients is high, indicating an urgent need for advancement in preventive and therapeutic strategies.
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Affiliation(s)
- Danny Toomey
- 1Day Sooner Research Team, Delaware; HHV-6 Foundation, Santa Barbara, California.
| | - Tuan L Phan
- HHV-6 Foundation, Santa Barbara, California; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Thommas Phan
- Department of Statistics, University of California, Davis, California
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center Seattle, Washington
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
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Holterhus M, Hennies M, Hillmann H, Thorer H, Rossig C, Burkhardt B, Groll AH. Parvovirus B19 infection in pediatric allogeneic hematopoietic cell transplantation - Single-center experience and review. Transpl Infect Dis 2023; 25:e14028. [PMID: 36748962 DOI: 10.1111/tid.14028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Parvovirus B19 (B19V) infection following pediatric hematopoietic cell transplantation (HCT) is a rare complication and available data is scarce. Therefore, we present the experience with B19V Infection in allogeneic pediatric HCT recipients at our transplant center together with a systematic review of the literature. METHODS Pediatric HCT patients with Parvovirus B19 infection treated at the University Children's Hospital Münster between 1999 and 2021 were retrospectively identified and clinical data were analyzed. Additionally, a systematic MEDLINE search to identify relevant articles was performed. RESULTS We identified three out of 445 patients (0.6%) with B19V infection post-transplantation. B19V infection occurred in combination with other complications like Graft-versus-Host disease, additional infections, or autoimmune-mediated hemolysis potentially triggered by B19V. In one patient these complications lead to a fatal outcome. The review of the literature showed considerable morbidity of B19V infection with the potential for life-threatening complications. Most patients were treated by red blood cell transfusion and intravenous immunoglobulins (IVIG) with a high succession rate. CONCLUSION Symptomatic B19V infection following HCT remains a rare but potentially challenging complication. A causal antiviral therapy does not exist as well as general recommendations on dosage and duration of IVIG therapy. Despite this, most patients are treated successfully with these measures. Additionally, transmission via blood or stem cell products is also rare and no general recommendations on B19V screenings exist.
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Affiliation(s)
- Malcolm Holterhus
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Marc Hennies
- Department for Clinical Virology, Institute of Virology, University Hospital Munster, Munster, Germany
| | - Hartmut Hillmann
- Department of Transfusion Medicine and Cellular Therapy, University Hospital Munster, Munster, Germany
| | - Heike Thorer
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, University Children's Hospital Munster, Munster, Germany.,Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Munster, Germany
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Badierah RA, Uversky VN, Redwan EM. Dancing with Trojan horses: an interplay between the extracellular vesicles and viruses. J Biomol Struct Dyn 2020; 39:3034-3060. [DOI: 10.1080/07391102.2020.1756409] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Raied A. Badierah
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Molecular Diagnostic Laboratory, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vladimir N. Uversky
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Laboratory of New Methods in Biology, Institute for Biological Instrumentation, Russian Academy of Sciences, Federal Research Center ‘Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences’, Pushchino, Moscow Region, Russia
| | - Elrashdy M. Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Adoptive T Cell Therapy Strategies for Viral Infections in Patients Receiving Haematopoietic Stem Cell Transplantation. Cells 2019; 8:cells8010047. [PMID: 30646564 PMCID: PMC6356262 DOI: 10.3390/cells8010047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 01/18/2023] Open
Abstract
Adverse outcomes following virus-associated disease in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT) have encouraged strategies to control viral reactivation in immunosuppressed patients. However, despite timely treatment with antiviral medication, some viral infections remain refractory to treatment, which hampers outcomes after HSCT, and are responsible for a high proportion of transplant-related morbidity and mortality. Adoptive transfer of donor-derived lymphocytes aims to improve cellular immunity and to prevent or treat viral diseases after HSCT. Early reports described the feasibility of transferring nonspecific lymphocytes from donors, which led to the development of cell therapy approaches based on virus-specific T cells, allowing a targeted treatment of infections, while limiting adverse events such as graft versus host disease (GvHD). Both expansion and direct selection techniques have yielded comparable results in terms of efficacy (around 70–80%), but efficacy is difficult to predict for individual cases. Generating bespoke products for each donor–recipient pair can be expensive, and there remains the major obstacle of generating products from seronegative or poorly responsive donors. More recent studies have focused on the feasibility of collecting and infusing partially matched third-party virus-specific T cells, reporting response rates of 60–70%. Future development of this approach will involve the broadening of applicability to multiple viruses, the optimization and cost-control of manufacturing, larger multicentred efficacy trials, and finally the creation of cell banks that can provide prompt access to virus-specific cellular product. The aim of this review is to summarise present knowledge on adoptive T cell manufacturing, efficacy and potential future developments.
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Shah RM, Waugh S, Ng KF, Gennery AR, Slatter M, Cant AJ. Enterovirus-Related Immune Reconstitution Inflammatory Syndrome (IRIS) Following Haploidentical Stem Cell Transplantation in an MHC Class II-Deficient Child. J Clin Immunol 2017; 37:419-421. [DOI: 10.1007/s10875-017-0402-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
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Dhingra N, Yadav SP, de Villartay JP, Picard C, Sabharwal RK, Dinand V, Ghuman SS, Sachdeva A. Severe combined immunodeficiency caused by a new homozygous RAG1 mutation with progressive encephalopathy. Hematol Oncol Stem Cell Ther 2013; 7:44-9. [PMID: 24333136 DOI: 10.1016/j.hemonc.2013.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/31/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022] Open
Abstract
We describe an unusual case of severe combined immunodeficiency (SCID) with neutropenia and central nervous system (CNS) manifestations in which a novel RAG1 mutation was identified. A 15-month-old boy presented with failure to thrive, neutropenia and recurrent infections. He was diagnosed with T-B-NK+ SCID. He subsequently developed right partial seizures with ipsilateral hemiparesis and became comatose. Magnetic resonance imaging (MRI) of the brain revealed an inflammatory lesion in the left thalamus which later progressed to diffuse meningo-encephalitis on serial imaging. No CNS infection was documented. Genetic work-up in the child revealed a novel homozygous deleterious mutation in the RAG1 gene (c:2881T>C; p:I794T), for which both parents were heterozygous. He underwent a haploidentical bone marrow transplant without conditioning and died on day +35 with no improvement in his neurological status. The features of neutropenia and progressive encephalopathy could be linked to the novel genetic defect but more data is required to establish this conclusively.
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Affiliation(s)
- Nivedita Dhingra
- Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Satya Prakash Yadav
- Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Sir Ganga Ram Hospital, New Delhi, India.
| | | | - Capucine Picard
- Centre d'Étude des Déficits Immunitaires, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - R K Sabharwal
- Pediatric Neurology Unit, Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Veronique Dinand
- Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Anupam Sachdeva
- Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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Comparison of in-house real-time quantitative PCR to the Adenovirus R-Gene kit for determination of adenovirus load in clinical samples. J Clin Microbiol 2010; 48:3132-7. [PMID: 20631100 DOI: 10.1128/jcm.00976-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the context of hematopoietic stem cell transplantation, adenovirus infections are associated with relevant mortality and morbidity. Detection of adenovirus DNA by quantitative PCR is the "gold standard" for these patients. A total of 150 samples, namely, 78 whole-blood, 22 cerebrospinal fluid, 24 digestive biopsy, and 26 stool samples, from 29 patients, including 24 hematopoietic stem cell transplant recipients, were tested for the detection of adenovirus using an in-house real-time quantitative PCR assay (A. Heim, C. Ebnet, G. Harste, and P. Pring-Akerblom, J. Med. Virol. 70:228-239, 2003) and the commercially available Adenovirus R-Gene kit. Adenovirus DNA was automatically isolated from whole-blood samples (Magna Pure LC system; Roche) or was manually extracted from other specimens (QIAamp; Qiagen) using the appropriate kit. The intra- and interassay reproducibilities and sensitivities were evaluated with cell culture supernatant dilutions. Of the 150 samples tested, 86 were found to be positive and 55 were found to be negative using both techniques. Nine (6%) discordant results were obtained. In most cases, discrepant results concerned samples with low viral loads. Quantitative results for all concordant positive samples were analyzed using the Spearman correlation test. A good correlation between the results of the in-house assay and those of the kit assay was obtained (r = 0.95; P < 0.001). Regarding the threshold cycle value for internal control spiked samples, none of the 150 samples tested contained a PCR inhibitor. In conclusion, a relevant correlation of results between the in-house assay and the kit assay, as well as the high-quality reproducibility and sensitivity of the kit assay, warranted its use for follow-up of hematopoietic stem cell transplantation recipients.
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Schmutzhard E, Pfausler B. [Infections of the central nervous system in the immuno-compromised]. DER NERVENARZT 2009; 79 Suppl 2:93-108; quiz 109. [PMID: 18679642 DOI: 10.1007/s00115-008-2462-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Infections of the central nervous system (CNS) can be caused by a variety of pathogens, depending on whether the number and function of T-cells or monocytes are impaired (as in HIV patients) or whether the number and function of polymorphonuclear granulocytes are reduced or impaired, as typically seen in patients on immunosuppressive therapy, post transplantation, etc.. The first part of the chapter deals with CNS infections associated with reduced or abnormal T-cell (or monocytic) function and number, mainly seen in HIV patients, such as cerebral toxoplasmosis, CNS cryptococcosis, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy. The clinical presentation, diagnostic procedures, as well as therapeutic and prophylactic management of these diseases are described in detail. The second part of the chapter deals with diseases usually seen in patients with impaired or reduced number and function of polymorphonuclear granulocytes. Such CNS infections are frequently caused by viral, bacterial, or fungal pathogens and are described in their clinical presentation, their diagnostic procedures and the best possible therapeutic and prophylactic management.
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Affiliation(s)
- E Schmutzhard
- Neurologische Intensivstation, Universitätsklinik für Neurologie, Anichstrasse 35, 6020, Innsbruck, Austria.
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Mazzolari E, Forino C, Guerci S, Imberti L, Lanfranchi A, Porta F, Notarangelo LD. Long-term immune reconstitution and clinical outcome after stem cell transplantation for severe T-cell immunodeficiency. J Allergy Clin Immunol 2007; 120:892-9. [PMID: 17825895 DOI: 10.1016/j.jaci.2007.08.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Revised: 08/02/2007] [Accepted: 08/06/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Currently, hematopoietic stem cell transplantation allows long-term survival in a high proportion of infants with congenital severe T-cell immunodeficiency. However, relatively little is known of their long-term quality of life. OBJECTIVE We sought to assess the long-term immune reconstitution and clinical status in children treated with stem cell transplantation for severe T-cell immunodeficiency. METHODS Immune function and clinical status have been analyzed in a cohort of 40 patients with severe T-cell immunodeficiency who are alive at a follow-up of at least 5 years after transplantation. RESULTS Most patients have attained normal T- and B-cell function. Weight and height were normal at last follow-up in most patients. Endocrine and severe neurologic abnormalities have been observed in 17.5% and 10% of the patients, respectively. CONCLUSIONS These data indicate that with current management strategies, stem cell transplantation can lead to long-term survival and good quality of life in the majority of patients with severe T-cell immunodeficiency. CLINICAL IMPLICATIONS Prompt recognition of congenital severe T-cell immunodeficiency, followed by stem cell transplantation, allows excellent perspectives of long-term survival and good quality of life for these otherwise fatal disorders.
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Affiliation(s)
- Evelina Mazzolari
- Divisione di Oncoematologia Pediatrica, Ospedale dei Bambini, Spedali Civili
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