Friday, April 08, 2011

More Information on Adenovirus

Yesterday Kylene blogged that adenovirus was found in Jacob's blood, and that cidofovir (sigh-DOFF-o-veer) and probenecid are being used to treat it.  I did a little research to see what I could find out about the potential effects of adenovirus, particularly in immunocompromised patients, and the effectiveness of cidofovir against it.

Adenovirus is very common in young children; healthy children with active T cells typically just get cold- or flu-like symptoms, and after the body suppresses the virus, the symptoms subside indefinitely.  It's very likely that Jacob had adenovirus in his body prior to hospitalization, but his T cells had been suppressing it, making it undetectable.  The Campath chemotherapy on Tuesday wiped out Jacob's T cells, which caused the virus to become active, hence the detection on Thursday.

Potential symptoms of acute adenovirus infection include fever, runny nose, cough, sore throat, rattling sounds when breathing, discoloration of urine and presence of blood in urine, and other symptoms similar to those of pink eye, flu, and pneumonia.  As of when I talked to Kylene this morning, she has not observed these symptoms in Jacob.  In extreme cases where immunocompromised patients are not treated or when treatment of adenoviral infection is ineffective, it can even result in death.

Based on what I've read, Jacob's cidofovir treatment will likely suppress adenovirus and make it undetectable again until his new immune system can suppress it sometime after transplantation.  However, as Kylene indicated in her previous post, cidofovir is not always effective against adenovirus.  In my research I discovered that in a 2002 retrospective study, cidofovir was effective in about 75% of patients with adenovirus infections (31 out of 41 patients) who did not die of unrelated complications, although it should be noted that the severity of the infection and the dosage and length of cidofovir treatment varied.  Of the 16 patients in the study with asymptomatic infections, 4 died of unrelated causes, and of the remaining 12 patients, 10 of them (83%) were treated successfully.  One of the two who was not treated successfully "relapsed with adenovirus after discontinuation of cidofovir. The patient was not retreated and died of disseminated adenovirus disease."  Forty percent of the 45 patients in the study developed toxicity, usually in the kidneys, so that's something we'll need to watch for.  Note that the sample in this study is small, but the overall success rate of suppressing adenovirus is promising.

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