Introduction: Adenovirus infections are associated with significant morbidity and mortality among immunocompromised hosts. Adenovirus pneumonia is a rare and often fatal disease in patients with AIDS. Case Report: We ...Introduction: Adenovirus infections are associated with significant morbidity and mortality among immunocompromised hosts. Adenovirus pneumonia is a rare and often fatal disease in patients with AIDS. Case Report: We report a case of a 28-year-old woman with advanced HIV/AIDS, who developed pneumonia four weeks after initiation of highly active antiretroviral therapy (HAART). Despite empiric antibiotics, the patient developed worsening hypoxemia and progressive pneumonia on chest x-ray. Culture data from a bronchoalveolar lavage (BAL) was negative for bacteria, fungi, pneumocystis jirovecii, but was positive for adenovirus detected by PCR. After transfer to a tertiary care hospital intensive care unit, a repeat BAL confirmed the presence of adenovirus by immunohistochemical staining. Tissue samples sent for histopathology revealed 'smudge cells'. Serum adenovirus viral load was 1.6 × 105 copies/mL. Intravenous cidofovir, 1 mg/kg/day, was initiated and scheduled three times a week. The patient exhibited remarkable improvement and was discharged to home in stable condition after four doses of cidofovir treatment. Discussion: Prior to our case, the few published accounts of HIV patients with adenovirus pneumonia treated with cidofovir have all resulted in death. Our case is distinct from these cases by the lack of concomitant pulmonary infection and the initiation of HAART prior to presentation. Conclusion: To our knowledge, we present the first case of adenovirus pneumonia in a patient with AIDS successfully treated with cidofovir. Our case suggests that limited and low dose cidofovir may be an efficacious approach to treat adenovirus pneumonia among HIV patients, especially those established on HAART.展开更多
Between 2021 and 2023,approximately 400 pediatric cases of acute hepatitis of unknown etiology(AHUE)were reported in European countries and the United States.In 2023,three pediatric studies revealed that adeno-associa...Between 2021 and 2023,approximately 400 pediatric cases of acute hepatitis of unknown etiology(AHUE)were reported in European countries and the United States.In 2023,three pediatric studies revealed that adeno-associated virus serotype 2(AAV-2)infection was associated with AHUE.This article presents a summary and comparison of the results of metagenomic sequencing,viral wholegenome sequencing,virus-specific real-time polymerase chain reaction(PCR)and histological analysis of the liver,all of which were among the common investigative methods used in the three pediatric studies.All three pediatric studies revealed 80%or greater rates of positivity for AAV-2 in cases of AHUE according to metagenomic sequencing.Moreover,on the basis of PCR results,two studies revealed high AAV-2 positivity rates(96.4%and 81.2%)among cases of AHUE.These findings suggest that AAV-2 is a pathogen in AHUE.Coinfection with AAV-2 and one or more helper viruses(human adenovirus,human herpesvirus 6B,Epstein–Barr virus,etc.),high viral loads of AAV-2 in blood,anti-AAV-2 IgM and human leukocyte antigen typing could be candidate diagnostic criteria for AHUE.AAV-2 infection should be incorporated into clinical guidelines for the management of acute liver failure.Cidofovir can be administered if coinfection with AAV-2 and HAdV is detected.展开更多
文摘Introduction: Adenovirus infections are associated with significant morbidity and mortality among immunocompromised hosts. Adenovirus pneumonia is a rare and often fatal disease in patients with AIDS. Case Report: We report a case of a 28-year-old woman with advanced HIV/AIDS, who developed pneumonia four weeks after initiation of highly active antiretroviral therapy (HAART). Despite empiric antibiotics, the patient developed worsening hypoxemia and progressive pneumonia on chest x-ray. Culture data from a bronchoalveolar lavage (BAL) was negative for bacteria, fungi, pneumocystis jirovecii, but was positive for adenovirus detected by PCR. After transfer to a tertiary care hospital intensive care unit, a repeat BAL confirmed the presence of adenovirus by immunohistochemical staining. Tissue samples sent for histopathology revealed 'smudge cells'. Serum adenovirus viral load was 1.6 × 105 copies/mL. Intravenous cidofovir, 1 mg/kg/day, was initiated and scheduled three times a week. The patient exhibited remarkable improvement and was discharged to home in stable condition after four doses of cidofovir treatment. Discussion: Prior to our case, the few published accounts of HIV patients with adenovirus pneumonia treated with cidofovir have all resulted in death. Our case is distinct from these cases by the lack of concomitant pulmonary infection and the initiation of HAART prior to presentation. Conclusion: To our knowledge, we present the first case of adenovirus pneumonia in a patient with AIDS successfully treated with cidofovir. Our case suggests that limited and low dose cidofovir may be an efficacious approach to treat adenovirus pneumonia among HIV patients, especially those established on HAART.
文摘Between 2021 and 2023,approximately 400 pediatric cases of acute hepatitis of unknown etiology(AHUE)were reported in European countries and the United States.In 2023,three pediatric studies revealed that adeno-associated virus serotype 2(AAV-2)infection was associated with AHUE.This article presents a summary and comparison of the results of metagenomic sequencing,viral wholegenome sequencing,virus-specific real-time polymerase chain reaction(PCR)and histological analysis of the liver,all of which were among the common investigative methods used in the three pediatric studies.All three pediatric studies revealed 80%or greater rates of positivity for AAV-2 in cases of AHUE according to metagenomic sequencing.Moreover,on the basis of PCR results,two studies revealed high AAV-2 positivity rates(96.4%and 81.2%)among cases of AHUE.These findings suggest that AAV-2 is a pathogen in AHUE.Coinfection with AAV-2 and one or more helper viruses(human adenovirus,human herpesvirus 6B,Epstein–Barr virus,etc.),high viral loads of AAV-2 in blood,anti-AAV-2 IgM and human leukocyte antigen typing could be candidate diagnostic criteria for AHUE.AAV-2 infection should be incorporated into clinical guidelines for the management of acute liver failure.Cidofovir can be administered if coinfection with AAV-2 and HAdV is detected.
