COMPLICATIONS - INFECTIONS

S.P. Watcharananan¹, K. Malathum¹, C. Srichanrusmi², S. Kantachuvessiri³, W. Chantratitaya^2
1Infectious Disease, Faculty of Medicine, Ramathibodi Hospital, Bangkok/THAILAND, ²Virology And Molecular Biology, Faculty of Medicine, Ramathibodi Hospital, Bangkok/THAILAND, ³Nephrology, Faculty of Medicine, Ramathibodi Hospital, Bangkok/THAILAND

Body: Introduction Adenoviruses are increasingly documented as contributors to infectious complication among transplant recipients. Currently, there is limited data to understand the pathogenesis and nature of the infection seen in human. At our medical centers in Bangkok, Thailand, confirmed cases of adenovirus (ADV) infection after kidney transplantation (KT) has increasingly been accumulated over the past three years. We demonstrate our recent experience on the seasonal distribution and nature of adenovirus infection within this population. Methods All adult recipients of KT diagnosed with ADV infection between April 2007 and March 2010 were included in this study. During the first period (April 2007 to August 2009), diagnosis of ADV was carried out following patients’ unexplained urinary symptoms or fever after KT. During the second period, (September 2009 to March 2010), in addition to the diagnosis of ADV based on symptoms, a prospective study was conducted to explore the incidence of ADV infection early after KT. Urine surveillance for ADV by polymerase chain reaction (PCR) was undertaken every 1-2 weeks, starting at week 2 post transplantation for a total 8 weeks. All participated recipients and donor were screened for ADV in urine and nasal swab by PCR prior to transplantation. Patients’ clinical information was prospectively followed and subsequently reviewed. Results Seventeen patients were diagnosed with adenovirus infection after KT at two major transplant centers; Faculty of Medicine, Ramathibodi hospital and Praram 9 hospital, Bangkok, Thailand. Of the 17 patients, 13 (76.5 %) acquired infection with a median of 4 (range 2-10) weeks post transplantation. Three patients had the infection beyond 6 months after transplantation. During the first period, number of infected cases each year was 2, 8 and 2. Following the second period, the number of infected cases during September to December 2009 and January to February 2010 was 2 and 3, respectively. An apparent seasonal distribution of the adenovirus infected cased was observed. Most of the infected cases occurred during October-November (8, 47.1%), followed by February-April (6, 35.3%) and July (3, 17.6%).Clusters of cases were noted in October 2008, October 2009 and February 2010. From a local investigation, there was no apparent social linkage between infected individual cases during the 3 clusters, except for 2 patients who were infected in October 2008. After sharing the same room post transplantation, the second patient had the infection within 2 weeks following the exposure to the first patient. Upper respiratory tract infection was with shredding of ADV from nasal swab PCR for longer than 4 weeks occurred. According to urine surveillance for ADV early post KT, only one patient had positive ADV PCR. Other four cases confirmed with ADV infection at the same period had clinical symptoms at presentation. Conclusion In Thailand, ADV infection is locally endemic with an apparent seasonal variation. Although our finding remains preliminary, the routine surveillance for ADV in urine early post transplantation is not cost-effective, as infected cases were most likely exogenously acquired. In resource-limited country, early diagnosis of ADV among patient with compatible symptoms and with an intense infection control to prevent nosocomial transmission from a confirmed case is justified.

Disclosure: All authors have declared no conflicts of interest.