Les infections à adénovirus en transplantation

Abstract

Human adenoviruses are non-enveloped DNA viruses.There are currently 90 types of HAdV divided into seven species (A to G).These viruses are responsible of many diseases that are often benign in immunocompetent individuals. In hematopoietic stem cell allogeneic transplant patients (HSCT), especially in children, adenoviruses are associated with a high morbidity and mortality. In case of a disseminated infection, the mortality raises to more than 50 %. Disseminated infections usually occur after reactivations from the digestive tract and the risk of dissemination is correlated with HAdV levels in stool. In HSCT patients systematic molecular monitoring of HAdV in the peripheral blood and/or in the stool is now recommended in first weeks after transplant. The control of the HAdV infection will depend on the time to start an antiviral treatment l. To date, no targeted antiviral has been validated yet. However, some drugs are used out of FDA or EMA approval, including cidofovir or brincidofovir. Specific adaptive immunotherapy is also used despite its cost and time of production. The prevention of adenovirus infections requires strict hygiene measures and the isolation of infected patients in transplantation medical units.