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>2log(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.
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>2log(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.
Authors: Benjamin L Laskin; Kathleen E Sullivan; Jeff Hester; Jens Goebel; Stella M Davies; Sonata Jodele Journal: Pediatr Blood Cancer Date: 2015-04-01 Impact factor: 3.167
Authors: Amy E Caruso Brown; Mindy N Cohen; Suhong Tong; Rebecca S Braverman; James F Rooney; Roger Giller; Myron J Levin Journal: Antimicrob Agents Chemother Date: 2015-03-02 Impact factor: 5.191
Authors: L E Lunde; S Dasaraju; Q Cao; C S Cohn; M Reding; N Bejanyan; B Trottier; J Rogosheske; C Brunstein; E Warlick; J A H Young; D J Weisdorf; C Ustun Journal: Bone Marrow Transplant Date: 2015-07-13 Impact factor: 5.483
Authors: Gowri Satyanarayana; Sarah P Hammond; Thomas A Broge; Matthew R Mackenzie; Raphael Viscidi; Ioannis Politikos; Igor J Koralnik; Corey S Cutler; Karen Ballen; Vassiliki Boussiotis; Francisco M Marty; Chen Sabrina Tan Journal: Transpl Immunol Date: 2014-12-20 Impact factor: 1.708