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Research of adenovirus, polyomavirus, cytomegalovirus and human herpesvirus 6 and 7 in pediatric patients with glomerular disease

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Author(s):
Silvia Mendonça Ferreira Menoni
Total Authors: 1
Document type: Doctoral Thesis
Press: Campinas, SP.
Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
Defense date:
Examining board members:
Sandra Helena Alves Bonon; Gabriel Hessel; Maria Cristina de Andrade; Antônia Teresinha Tresoldi; Inalda Fancicani
Advisor: Sandra Helena Alves Bonon; Vera Maria Santoro Belangero
Abstract

Few studies with viral infections use pediatric patients with glomerular diseases. Objectives: To verify the frequency of active infection caused by herpesvirus Epstein-Barr (EBV), human cytomegalovirus (HCMV), human herpesvirus 6 (HHV-6 types A / B) and human herpesvirus 7 (HHV-7), adenovirus (HAdV) and human polyomavirus (BKV) in children and adolescents with glomerular diseases and to analyze a possible association between active viral infection and other clinical data. Patients and methods: Two studies were performed, a a cross-sectional one containing 83 transplant patients and other longitudinal, with a prospective cohort of 35 patients, monitored weekly and monthly. Plasma and/or urine were collected for DNA extraction and, through the use of nested-PCR technique, it was possible to detect viral DNA in these samples. In the cross-sectional study, mean age was 10 years (1.4-19 ± 4.4 years), of which 46 were male (55.4%). Fifty patients were in remission at the time of collection (60.2%). In this series, 31/83 (37%) had presented viremia or viruria. The distribution of the DNA results of the virus found was: 11 cases of HHV-7, 9 of HHV-6, 5 of HCMV, 4 cases of adenovirus, EBV and BKV was 2 cases, were two patients had shown two viruses in the same sample. The frequency of virus in patients with relapse of their disease was higher than in patients in remission (47% vs 32%), although this difference was not statistically significant (p=0.131). The occurrence of the viruses in the secondary disease was higher than in the patients with primary glomerulopathy (60% vs 34%), (p = 0.164). The distribution of each virus showed a higher frequency of HCMV in primary glomerulopathy (p = 0.07). Regarding the age group, 21 of the 31 patients with positive virus results were older than 10 years, while only 10 were less than 10 years old (p = 0.014). There was no association between the dose of prednisone or the dose of cyclosporine and the presence of viremia or viruria (p =0.583 and p=0.62, respectively). In the longitudinal study, thirty-seven biological samples presented DNA positive for one or more virus analyzed from the total samples collected (8%). Viral active infections were detected in 11/35 patients (31.4%). Viral co-infection occurred in 6/11 patients (54.5%), viral recurrence in 4/11 (36.4%) and consecutive viral infection in 7/11 (63.6%). Ten patients with active viral infection were relapsed (91%) and 1 were in remission (9%). Eight patients with active viral infection were hospitalized compared to those who did not have active viral infection (72.7% vs. 16.7%) and this difference was statistically significant (p= 0.0022). Active HCMV infection was the most frequent in 6/11 patients (54.5%). Of these, 3/6 (50%) had probable HCMV disease in the gastrointestinal tract and one of them had coinfection with the HHV-7 virus. The frequencies of the other viral active infections were: 45.5% for BKV, 27.3% for HHV-7, 18.2% for EBV, 18.2% for AdVH and for HHV-6 was 9%. The monitoring of active infections caused by viruses in pediatric patients with GD presented in this study is very important and thus it was possible to identify active viral infections that can cause relapse, hospitalization and other complications in these patients (AU)

FAPESP's process: 16/07892-2 - "RESEARCH OF ADENOVIRUS, POLYOMAVIRUS (BK) AND BETAHERPESViRUS IN PEDIATRIC PATIENTS WITH CHRONIC GLOMERULOPATHIES AND KIDNEY TRANSPLANTATION"
Grantee:Silvia Mendonça Ferreira Menoni
Support type: Scholarships in Brazil - Doctorate