MT BARBANI¹, P AGYEMAN², RA AMMANN², K LEIBUNDGUT², M GORGIEVSKI-HRISOHO<sup>1

1</sup>Institute for Infectious Diseases, University of Bern, Switzerland , ²Department of Paediatrics, University of Bern, Switzerland

Adenovirus (ADV) infections typically present with respiratory symptoms, gastroenteritis, or conjunctivitis and are usually mild and self-limiting in healthy children and adults. However, severe life-threatening infections with fatal outcome represent a challenge in immunocompromised patients and are more common in children than in adults. Patients who have undergone allogeneic haematopoietic stem cell transplantation (HSCT) represent the group with the highest risk of severe infections. We describe a case of fatal ADV infection in a child undergoing maintenance chemotherapy (CT) for acute lymphoblastic leukaemia (ALL). The 6½ year old boy presented with fever, leucopenia, rhinitis and cough on the day of admission. ADV serotype 4 was isolated in stool and different respiratory samples. Viral load in plasma peaked at 11.9 milliard copies/mL. He developed disseminated disease with hepatitis, pneumonia and multi-organ failure and died despite intensive care support and cidofovir therapy started on day 8 after admission. This was the second case of fatal ADV infection in a child undergoing maintenance CT for ALL in our Division of Paediatric Haematology/Oncology during a period of 10 years. The first case was published in 2008(1). To our knowledge only four other reports of disseminated ADV infections in children undergoing intensification or maintenance CT for ALL have been published. Only one child survived. He developed ADV diarrhoea and intermitted loose stools during 6 months before disseminated infection. The knowledge of previous ADV infection allowed prompt suspicion, diagnosis, and initiation of cidofovir therapy. Disseminated ADV infections in children receiving CT for ALL without HSCT are rare but often have a lethal outcome. Algorithms for diagnosis and treatment of ADV infections in this patient population are lacking. Moreover, whole genome analysis of ADV and studies on the host could help in future to better understand why certain children receiving CT for ALL have disseminated ADV infections while the majority have self-limiting infections.
1. Steiner I, Aebi C, Ridolfi Lüthy A, Wagner B, Leibundgut K. Pediatr Blood Cancer. 2008 Mar;50:647-9.