tacrolimus and Adenoviridae-Infections

A 33-year-old man presented with a four-day history of redness and blurring of vision of the right eye. A clinical diagnosis of adenoviral keratitis was made with a differential of microsporidia epithelial keratitis. The patient subsequently developed nummular keratitis which was resistant to topical steroids. He continued to develop multiple recurrences of the condition. Treatment with tacrolimus ointment was started as the patient had an elevated intraocular pressure due to prolonged steroid use. Tacrolimus ointment showed a favourable outcome in the management of recurrent nummular keratitis.

Topics: Adenoviridae Infections; Adult; Humans; Immunosuppressive Agents; Keratitis; Male; Ointments; Steroids; Tacrolimus; Treatment Outcome

Adenovirus is commonly isolated from pediatric small bowel transplant recipients, but its clinical consequences remain poorly understood.. The medical records of pediatric small bowel transplant recipients transplanted between January 2003 and December 2007 were reviewed. Thymoglobulin and basiliximab induction and tacrolimus-based immunosuppression were the standard of care. Logistic regression analysis was performed to determine risk factors for infection, descriptive analysis to determine adenovirus incidence, and Kaplan-Meier curve analysis to determine the timing of events after transplantation.. Ninety-eight patients were included; 38 were positive for adenovirus (incidence 23.5%), 23 for viral shedding, 23 for infections. Nine infections developed in the first month after transplantation and 8 during the following 5 months. The small bowel was involved in 19 cases. Younger age at transplantation was a risk factor for adenovirus infection (odds ratio=0.81, 95% confidence interval, 0.663-0.994, P=0.04). Treatment of rejection did not increase the risk of adenovirus infection. Cytomegalovirus D+/R- sero-status was a protective factor (odds ratio=0.26, 95% confidence interval, 0.06-1.089, P=0.04).. Adenovirus infections affected 24% of recipients and developed mostly during the first 6 months after transplantation. Small bowel is the most frequently involved site. Younger age at transplantation is a risk factor for adenovirus infection; whereas cytomegalovirus D+/R- sero-status seems to be protective.

Topics: Adenoviridae Infections; Antibodies, Monoclonal; Antilymphocyte Serum; Antiviral Agents; Basiliximab; Child; Ganciclovir; Humans; Immunosuppressive Agents; Intestine, Small; Liver Transplantation; Postoperative Complications; Recombinant Fusion Proteins; Reoperation; Retrospective Studies; Risk Factors; Tacrolimus; Valganciclovir; Virus Shedding

Topics: Adenoviridae Infections; Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Bone Marrow Transplantation; Cyclophosphamide; Female; Graft vs Host Disease; Humans; Methotrexate; Myelodysplastic Syndromes; Tacrolimus; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome

We present a case of adenovirus (ADV) infection in a patient who had undergone nonmyeloablative stem cell transplantation (NST). A 50-year-old man with chronic myelogenous leukemia in the second chronic phase underwent NST from an HLA 2-loci-mismatched sibling. ADV hemorrhagic cystitis developed and progressed to lethal pneumonia. ADV was isolated from urine, bronchoalveolar lavage fluid, and postmortem specimens of kidney and liver. Because there are few reports of lethal pneumonia associated with ADV in Japan, we present the case and discuss the cause of and therapy for the infection.

Topics: Adenoviridae Infections; Adenoviruses, Human; Antilymphocyte Serum; Bronchoalveolar Lavage Fluid; Busulfan; Cystitis; Fatal Outcome; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukemia, Myeloid, Chronic-Phase; Lymphocyte Count; Lymphocyte Subsets; Male; Methylprednisolone; Middle Aged; Pneumonia, Viral; T-Lymphocytes; Tacrolimus; Transplantation Conditioning; Transplantation, Homologous; Vidarabine

We describe two children with intestinal failure due to short or absent small bowel who underwent isolated liver transplantation for liver disease related to parenteral nutrition. Both received reduced-size liver grafts whilst awaiting a suitable small bowel donor. Immunosuppressive therapy was based on oral tacrolimus and intravenous steroids. Therapeutic levels of tacrolimus were achieved at low dosage of 0.14-0.28 mg/kg per day. Median and mean blood tacrolimus levels were 9.9 and 13.7 ng/ml (range 4.9-42.3 ng/ml) in case 1 and 5.8 and 7.2 ng/ml (range 1-30 ng/ml) in case 2 before small bowel transplantation, respectively. Following small bowel transplantation, levels were 17.1 and 20.1 ng/ml (range 9.2-30 ng/ml), with oral doses of 0.54-1.35 mg/kg per day. Both children died of adenovirus pneumonia, with functioning grafts. Our experience demonstrates that effective levels of immunosuppression can be achieved by oral administration of tacrolimus in children with short or absent small bowel.

Topics: Adenoviridae Infections; Administration, Oral; Child, Preschool; Colon; Cyclosporine; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Infant; Intestinal Absorption; Intestinal Atresia; Intestine, Small; Liver Failure; Liver Transplantation; Male; Parenteral Nutrition; Pneumonia, Viral; Postoperative Complications; Short Bowel Syndrome; Tacrolimus