396. The Clinical Spectrum of BK Virus Infection after Hematopoietic Stem Cell Transplant (HSCT)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Hemorrhagic cystitis manifesting as gross hematuria (GH) is a well described BK virus associated syndrome after HSCT. Other BK virus associated syndromes, such as polyoma virus associated nephropathy (PVAN), are reported as cases in the HSCT literature. Data regarding the spectrum, incidence, treatment, and treatment response of BK virus associated syndromes in a large patient cohort are few. The primary aim of this study was to describe these features in a large cohort of allogeneic HSCT recipients.
Methods: Charts of 115 allogeneic HSCT recipients were reviewed. Continuous variables were compared using the t-test.
Results: 11 patients had gross hematuria (GH). In 6/11 cases, GH resolved without intervention. 2/11 cases required urologic procedures and the remaining 3 were treated with cidofovir. Mean urinary BK viral load (VL) was 17,349,496 copies/mL (c/mL) in GH cases and 5,615,542 c/mL in those without GH (p = 0.001). Mean blood BK VL was 9689 c/mL in GH cases and 78,208 c/mL in patients without GH (p = 0.18).
9 patients had cystitis symptoms other than GH (uncomplicated cystitis, UC). None required directed therapy. Mean urinary BK VL was 19,817,151 c/mL in UC cases and 5,055,767c/mL in those without UC (p < 0.0001). Mean blood BK VL was 11,380 c/mL in UC cases and 77,119 c/mL in patients those without UC (p = 0.20). 2 patients developed PVAN. Both were treated with leflunomide, required dialysis, and had urinary BK VLs greater than 25,000,000 c/mL and blood BK VLs greater than 100,000 c/mL persistently for over 6 months.
Discussion: Our understanding of clinical syndromes associated with BK virus continues to evolve. Urinary BK VL was associated with all BK associated syndromes reported. In patients with UC, symptoms resolved without anti-viral treatment. PVAN was seen in 2.7% of the present cohort and may represent an emerging BK virus associated syndrome.
C Bertozzi-Villa, Undergraduate1, Pursell K, MD2, P O'Donnell, MD2, C Ramaprasad, MD, MPH3, K Swanson, BS2, K Van Besien, MD3 and  C. Ramaprasad, None..
C. Bertozzi-Villa, None..
P. O'Donnell, None..
K. Swanson, None..
K. Van Besien, None..
P. K, None., (1)The University of Chicago Medical Center, Chiago, IL, (2)The University of Chicago, Chicago, IL, (3)The University of Chicago Medical Center, Chicago, IL