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Detection of adenovirus in stool may aid in pre-emptive therapy decisions
The use of quantitative PCR detection of adenovirus in stool could support pre-emptive therapy in children who undergo allogeneic hematopoietic stem cell transplant, according to study results.
Ashok Srinivasan, MD, of the department of bone marrow transplantation and cellular therapy at St. Jude Children’s Research Hospital, and colleagues, set out to identify the cutoff load of adenovirus in the stool of 117 children as a predictor for adenoviremia. All children underwent allogeneic hematopoietic stem cell transplant between January 2009 and May 2012.
Overall, 71 children had diarrhea, of which 55% had adenovirus detected in stool. Results of univariate analysis indicated that age 10 years or younger (OR = 2.57; 95% CI, 0.98-6.75) and male gender (OR = 2.67; 95% CI, 1.02-6.99) were associated with an increased risk for adenovirus in stool. Moreover, parenteral nutrition was more likely to be required among children with adenovirus detected in stool (OR = 2.94; 95% CI, 1.06-8.14).
Patients with a viral load greater than 106 copies/g stool predicted adenoviremia with an 82% sensitivity and specificity. Three patients had sapovirus detected in their stool, four had norovirus and one patient had astrovirus.
The researchers identified coinfections with C. difficile in 17 children, rotavirus in one child and vancomycin-resistant Enterococcus in 13 children.
“These data support the use of quantitative rather than qualitative PCR for adenoviral stool testing in [hematopoietic stem cell transplantation] patients, which would allow earlier initiation of antiviral therapy in patients with high stool viral loads with cidofovir, a potentially nephrotoxic drug,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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