rologie i - European Congress of Virology

5 th European Congress of VirologySaturday 14 th September 2013, 8h30 – 10h30WORKSHOP 26: “VIRAL INFECTIONS IN TRANSPLANTAND IMMUNOCOMPROMISED PATIENTS”Chairpersons: Paulo PAIXAO (Lisbon, PORTUGAL)& Thomas SCHULZ (Hannover, GERMANY)AmphitheaterKEYNOTE: AWARD of the Italian Society of Virology: “Excellence inVirology”Virologic and immunologic monitoring of human cytomegalovirusinfections in the immunocompetent and immunocompromised host:perspectives for the development of a subunit glycoprotein pentamericvaccineGiuseppe GERNALaboratori Sperimentali di Ricerca, Area Trapiantologica, FondazioneIRCCS Policlinico San Matteo, 27100 Pavia, ITALYPCR analysis of hundreds of immunocompetent healthy subjects with andwithout reactivated HCMV infections never revealed presence in wholeblood of HCMV DNA at a measurable level (>100 copies/ml blood). Asimilar approach in the immunocompromised host allowed to define onsetof clinical symptoms at 1,000,000 DNA copies/ml in SOTR, while inHSCTR caution suggested that severe clinical syndromes, such as pneumonia,could start at a viral load of ≤ 100,000 copies/ml. This level ofVL allowed to fix blood levels for preemptive therapy at 300,000 HCMVDNA copies for SOTR, and 30,000 HCMV DNA copies for HSCTR.Levels of HCMV-specific CD4+ and CD8+ T-cell responses showing protectionagainst HCMV reactivation were 0.4 T-cells/l blood for boththe immunocompetent and SOTR patients, and 1.0 CD4+ and 3.0 CD8+T-cells/l for HSCTR. In pregnant women with primary HCMV infectionlevels of VL never overcame 1,000 DNA copies/ml blood, due tothe prompt T-cell response. Neutralizing antibody titers, as determinedin ARPE-19 epithelial cells, appeared very early during primary infection,reaching extraordinarily high titers in the immunocompromised host(both primary and reactivated infections). B-T-cells interactions must beinvestigated.On the vaccine side, the gH/gL/pUL128L pentamer complex elicits a verystrong antibody response to its components and to the whole complex,both in natural infection of humans and experimentally inoculated mice.The T-cell response to the pentamer is now under study.ORAL COMMUNICATIONSREF O147Hepatitis E virus: an underestimated opportunistic pathogen in recipientsof allogeneic hematopoietic stem cell transplantationSuzan PAS 1 , Jurjen VERSLUIS 2 , Erik AGTERESCH 2 , Robert DEMAN 3 , Jolanda MAASKANT 1 , Marguerite SCHIPPER 4 , AlbertOSTERHAUS 1 , Jan CORNELISSEN 3 , Annemiek VAN DER EIJK 11 Department of Viroscience, ErasmusMC, Rotterdam, THE NETHER-LANDS; 2 Department of Hematology, ErasmusMC, Rotterdam, THENETHERLANDS; 3 Department of Hepatogastroenterology, ErasmusMC,Rotterdam, THE NETHERLANDS; 4 Department of Pathology, ErasmusMC,Rotterdam, THE NETHERLANDSHepatitis E virus (HEV) is an emerging health issue in industrializedcountries, particularly in the immunocompromised. Since littleis known of HEV infections in allogeneic hematopoietic stem celltransplantation recipients (alloHSCT), we studied HEV infection inalloHSCT.Patients receiving alloHSCT between January 2006 July 2011 were included.Anti HEV serostatus (Wantai assay) before alloHSCT and presence ofHEV RNA after alloHSCT and during episodes of liver function abnormalitieswere assessed. The course of HEV infection and clinical implicationswere studied from confirmed cases.328 Patients were included in the study. In total, eight HEV genotype3 infected cases (2.4%) were identified, of which five developed chronicHEV. These were misdiagnosed before as hepatic graft versus host disease(n=5) or drug toxicity (n=3). Seroprevalence prior to alloHSCT was 12.9%,2 patients (0.6%) were anti HEV IgM positive, though HEV RNA was notdetected.Four of eight cases died with HEV viremia, signs of ongoing hepatitis(n=4)and neurologic disease(n=1). The four living patients cleared HEV supportedby ribavirin treatment (n=1) and reduction of immune suppression(n=3). Two of four living patients were diagnosed with chronic hepatitisand fibrosis by liver biopsy. One HEV patient presented with viralreactivation.We conclude that a differential diagnosis including HEV is mandatorygiven the clinical impact. Future alloHSCT recipients should be screenedfor HEV RNA prior to transplantation and should be monitored afteralloHSCT, especially if liver abnormalities occur.REF O148Prolonged rhinovirus infection in hematological immunocompromisedpatients with impaired T cell immunityAntonio PIRALLA 1 , Marco ZECCA 2 , Anna Amelia COLOMBO 3 ,Alessia GIRELLO 1 , Patrizia COMOLI 2 , Rita MACCARIO 2 , FaustoBALDANTI 11 Molecular Virology Unit, Virology and Microbiology Department,Fondazione IRCCS Policlinico San Matteo, Pavia, ITALY; 2 PediatricHematology Oncology and Research Laboratories Fondazione IRCCSPoliclinico San Matteo, Pavia, ITALY; 3 Institute of Hematology, FondazionePoliclinico San Matteo IRCCS, University of Pavia, Pavia, ITALYRespiratory samples from patients hospitalized with acute respiratory syndromein the period 2006 2012 were tested with a panel of respiratoryviruses. In 12 hematopoietic stem cell transplant recipients (HSCTR) and3 patients with hematologic diseases a prolonged rhinovirus (HRV) shedding(>30 days) was observed. In these 15 patients, HRV was quantifiedby real time RT PCR and molecular typing was performed by sequencingthe 5 ′ NCR VP4 region in sequential respiratory samples. In detail:11/15 (73.3%) patients were pediatric (10 HSCTR, and 1 acute myeloidleukemia) and 4/15 (26.7%) were adults (2 HSCTR and 2 acute lymphocyticleukemia). The median duration of HRV positivity was 64 days(range 30 174 days). Phylogenetic analysis showed the persistence ofa single HRV type in all patients except one. In 9/12 (75.0%) HSCTRpatients, HRV infection occurred across the transplant aplastic period(either during induction or prior to engraftment). Low level (