trimethoprim--sulfamethoxazole-drug-combination and Adenovirus-Infections--Human

We report a fatal case of disseminated adenovirus infection in a non-transplant haematology adult patient with chronic lymphocytic leukaemia who had completed combination chemoimmunotherapy a few months before developing respiratory symptoms. In such non-transplant patients, monitoring for adenovirus in the blood is not routine. However, with adenoviruses, when there is a more peripheral (i.e. non-blood) site of infection such as the chest, serial adenovirus monitoring in blood for the duration of that illness may be warranted.. This case started with an initial bacterial chest infection that responded to treatment, followed by an adenovirus pneumonitis that disseminated to his blood a week later with levels of up to 92 million adenovirus DNA copies/ml. Despite prompt treatment with cidofovir, his respiratory function continued to deteriorate over the next two weeks and he was moved to intensive care. Intravenous immunoglobulin and ribavirin were subsequently added to his treatment. However, he died soon after this with a final adenovirus load of 20 million copies/ml in his blood.. We recommend that even in non-transplant haematology patients, where such patients present with an acute respiratory adenovirus infection, teams should consider checking the blood for adenovirus to check for signs of disseminated infection. The earlier this can be tested, the earlier treatment can be initiated (if adenovirus positive), which may produce more successful clinical outcomes.

Topics: Adenoviridae; Adenovirus Infections, Human; Antineoplastic Agents; Bronchoalveolar Lavage Fluid; Cidofovir; Cytosine; DNA, Viral; Drug Therapy, Combination; Fatal Outcome; Haemophilus influenzae; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Organophosphonates; Polymerase Chain Reaction; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a fatal case of haemolytic uraemic syndrome in a young woman with AIDS, and disseminated adenovirus (ADV) and cytomegalovirus (CMV) co-infection. We hypothesize that ADV/CMV co-infection may have a causative role in this clinical picture.

Topics: Acquired Immunodeficiency Syndrome; Acute Kidney Injury; Adenovirus Infections, Human; Colitis; Cytomegalovirus Infections; Enteritis; Fatal Outcome; Female; Foscarnet; Ganciclovir; Hemolytic-Uremic Syndrome; Humans; Respiratory Distress Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination