Abstract
Lower urinary tract infections (UTIs) are common among the general population and are most often caused by bacterial pathogens. Viruses are an uncommon cause of UTIs in an immunocompetent host; however, viruses are increasingly recognized as the cause of lower UTI, especially hemorrhagic cystitis, among immunocompromised patients. BK virus, adenovirus, and cytomegalovirus are predominant pathogens involved in hemorrhagic cystitis after stem cell and solid organ transplantation, and their early diagnosis and treatment may prevent significant morbidity of hemorrhagic cystitis. The diagnosis of viral lower UTI is based on molecular techniques, and real-time polymerase chain reaction is often the method of choice because it allows for quantification of viral load. Cidofovir is becoming a drug of choice in viral UTIs because it is active against the most common viral pathogens. This review discusses the epidemiology, pitfalls in diagnosis, and current treatment of viral UTIs.
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References and Recommended Reading
Yusuf U, Hale GA, Carr J, et al.: Cidofovir for the treatment of adenoviral infection in pediatric hematopoietic stem cell transplant patients. Transplantation 2006, 81:1398–1404.
Singh D, Kiberd B, Gupta R, et al.: Polyoma virus-induced hemorrhagic cystitis in renal transplantation patient with polyoma virus nephropathy. Urology 2006, 67:423.e11–423.e12.
Giraud G, Bogdanovic G, Priftakis P, et al.: The incidence of hemorrhagic cystitis and BK-viruria in allogeneic hematopoietic stem cell recipients according to intensity of the conditioning regimen. Haematologica 2006, 91:401–404.
Hale GA, Rochester RJ, Heslop HE, et al.: Hemorrhagic cystitis after allogeneic bone marrow transplantation in children: clinical characteristics and outcome. Biol Blood Marrow Transplant 2003, 9:698–705.
Gorczynska E, Turkiewicz D, Rybka K, et al.: Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2005, 11:797–804.
Boubenider S, Hiesse C, Marchand S, et al.: Post-transplantation polyomavirus infections. J Nephrol 1999, 12:24–29.
Mylonakis E, Goes N, Rubin RH, et al.: BK virus in solid organ transplant recipients: an emerging syndrome. Transplantation 2001, 72:1587–1592.
Hofland CA, Eron LJ, Washecka RM: Hemorrhagic adenovirus cystitis after renal transplantation. Transplant Proc 2004, 36:3025–3027.
Koga S, Shindo K, Matsuya F, et al.: Acute hemorrhagic cystitis caused by adenovirus following renal transplantation: review of the literature. J Urol 1993, 149:838–839.
Maraha B, Bonten H, van Hooff H, et al.: Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect 2001, 7:619–625.
Boldorini R, Brustia M, Veggiani C, et al.: Periodic assessment of urine and serum by cytology and molecular biology as a diagnostic tool for BK virus nephropathy in renal transplant patients. Acta Cytol 2005, 49:235–243.
Hogan TF, Padgett BL, Walker DL, et al.: Rapid detection and identification of JC virus and BK virus in human urine by using immunofluorescence microscopy. J Clin Microbiol 1980, 11:178–183.
Duran N, Yarkin F, Evruke C, Koksal F: Asymptomatic herpes simplex virus type 2 (HSV-2) infection among pregnant women in Turkey. Indian J Med Res 2004, 120:106–110.
Fung JC, Shanley J, Tilton RC: Comparison of the detection of herpes simplex virus in direct clinical specimens with herpes simplex virus-specific DNA probes and monoclonal antibodies. J Clin Microbiol 1985, 22:748–753.
Xu F, Sternberg MR, Kottiri BJ, et al.: Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006, 296:964–973.
Stolt A, Sasnauskas K, Koskela P, et al.: Seroepidemiology of the human polyomaviruses. J Gen Virol 2003, 84:1499–1504.
Schmutzhard J, Merete Riedel H, Zweygberg Wirgart B, Grillner L: Detection of herpes simplex virus type 1, herpes simplex virus type 2 and varicella-zoster virus in skin lesions: comparison of real-time PCR, nested PCR and virus isolation. J Clin Virol 2004, 29:120–126.
Vera-Sempere FJ, Rubio L, Moreno-Baylach MJ, et al.: Polymerase chain reaction detection of BK virus and monitoring of BK nephropathy in renal transplant recipients at the University Hospital La Fe. Transplant Proc 2005, 37:3770–3773.
Lundstig A, Dillner J: Serological diagnosis of human polyomavirus infection. Adv Exp Med Biol 2006, 577:96–101.
Minassian H, Schinella R, Reilly JC: Polyomavirus in the urine: follow-up study. Diagn Cytopathol 1994, 10:209–211.
Boon ME, van Keep JP, Kok LP: Polyomavirus infection versus high-grade bladder carcinoma: the importance of cytologic and comparative morphometric studies of plastic-embedded voided urine sediments. Acta Cytol 1989, 33:887–893.
Coleman DV, Wolfendale MR, Daniel RA, et al.: A prospective study of human polyomavirus infection in pregnancy. J Infect Dis 1980, 142:1–8.
Hirsch HH, Suthanthiran M: The natural history, risk factors and outcomes of polyomavirus BK-associated nephropathy after renal transplantation. Nat Clin Pract Nephrol 2006, 2:240–241.
Fusaro F, Murer L, Busolo F, et al.: CMV and BKV ureteritis: which prognosis for the renal graft? J Nephrol 2003, 16:591–594.
Elfaitouri A, Hammarin AL, Blomberg J: Quantitative real-time PCR assay for detection of human polyomavirus infection. J Virol Methods 2006, 135:207–213.
Singh HK, Bubendorf L, Mihatsch MJ, et al.: Urine cytology findings of polyomavirus infections. Adv Exp Med Biol 2006, 577:201–212.
Hatakeyama N, Suzuki N, Yamamoto M, et al.: Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. Pediatr Infect Dis J 2006, 25:84–85.
Chang CY, Gangji A, Chorneyko K, Kapoor A: Urological manifestations of BK polyomavirus in renal transplant recipients. Can J Urol 2005, 12:2829–2836.
Andrei G, Snoeck R, Vandeputte M, De Clercq E: Activities of various compounds against murine and primate polyomaviruses. Antimicrob Agents Chemother 1997, 41:587–593.
Bridges B, Donegan S, Badros A: Cidofovir bladder instillation for the treatment of BK hemorrhagic cystitis after allogeneic stem cell transplantation. Am J Hematol 2006, 81:535–537.
Gonzalez-Fraile MI, Canizo C, Caballero D, et al.: Cidofovir treatment of human polyomavirus-associated acute haemorrhagic cystitis. Transpl Infect Dis 2001, 3:44–46.
Ison MG: Adenovirus infections in transplant recipients. Clin Infect Dis 2006, 43:331–339.
Fanourgiakis P, Georgala A, Vekemans M, et al.: Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient. Clin Infect Dis 2005, 40:199–201.
Hatakeyama N, Suzuki N, Kudoh T, et al.: Successful cidofovir treatment of adenovirus-associated hemorrhagic cystitis and renal dysfunction after allogenic bone marrow transplant. Pediatr Infect Dis J 2003, 22:928–929.
Leung AY, Chan MT, Yuen KY, et al.: Ciprofloxacin decreased polyoma BK virus load in patients who underwent allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2005, 40:528–537.
Geetha D, Tong BC, Racusen L, et al.: Bladder carcinoma in a transplant recipient: evidence to implicate the BK human polyomavirus as a causal transforming agent. Transplantation 2002, 73:1933–1936.
Runde V, Ross S, Trenschel R, et al.: Adenoviral infection after allogeneic stem cell transplantation (SCT): report on 130 patients from a single SCT unit involved in a prospective multi center surveillance study. Bone Marrow Transplant 2001, 28:51–57.
Allen CW, Alexander SI: Adenovirus associated haematuria. Arch Dis Child 2005, 90:305–306.
Miyamura K, Takeyama K, Kojima S, et al.: Hemorrhagic cystitis associated with urinary excretion of adenovirus type 11 following allogeneic bone marrow transplantation. Bone Marrow Transplant 1989, 4:533–535.
Chakrabarti S, Mautner V, Osman H, et al.: Adenovirus infections following allogeneic stem cell transplantation: incidence and outcome in relation to graft manipulation, immunosuppression, and immune recovery. Blood 2002, 100:1619–1627.
Moriyama Y, Koike T, Shibata A: Hemorrhagic cystitis after conditioning for bone marrow transplantation and its prophylaxis. Jpn J Clin Oncol 1984, 14(Suppl 1):531–536.
Nagafuji K, Aoki K, Henzan H, et al.: Cidofovir for treating adenoviral hemorrhagic cystitis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2004, 34:909–914.
Legrand F, Berrebi D, Houhou N, et al.: Early diagnosis of adenovirus infection and treatment with cidofovir after bone marrow transplantation in children. Bone Marrow Transplant 2001, 27:621–626.
Gavin PJ, Katz BZ: Intravenous ribavirin treatment for severe adenovirus disease in immunocompromised children. Pediatrics 2002, 110:e9.
Miyamura K, Hamaguchi M, Taji H, et al.: Successful ribavirin therapy for severe adenovirus hemorrhagic cystitis after allogeneic marrow transplant from close HLA donors rather than distant donors. Bone Marrow Transplant 2000, 25:545–548.
Jurado M, Navarro JM, Hernandez J, et al.: Adenovirus-associated haemorrhagic cystitis after bone marrow transplantation successfully treated with intravenous ribavirin. Bone Marrow Transplant 1995, 15:651–652.
Chen FE, Liang RH, Lo JY, et al.: Treatment of adenovirus-associated haemorrhagic cystitis with ganciclovir. Bone Marrow Transplant 1997, 20:997–999.
Kurosaki K, Miwa N, Yoshida Y, et al.: Therapeutic basis of vidarabine on adenovirus-induced haemorrhagic cystitis. Antivir Chem Chemother 2004, 15:281–285.
Kawakami M, Ueda S, Maeda T, et al.: Vidarabine therapy for virus-associated cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant 1997, 20:485–490.
Kitabayashi A, Hirokawa M, Kuroki J, et al.: Successful vidarabine therapy for adenovirus type 11-associated acute hemorrhagic cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant 1994, 14:853–854.
Spach DH, Bauwens JE, Myerson D, et al.: Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. Clin Infect Dis 1993, 16:142–144.
Basquiera AL, Calafat P, Parodi JM, et al.: Cytomegalovirus-induced haemorrhagic cystitis in a patient with neurogenic bladder. Scand J Infect Dis 2003, 35:902–904.
Childs R, Sanchez C, Engler H, et al.: High incidence of adeno-and polyomavirus-induced hemorrhagic cystitis in bone marrow allotransplantation for hematological malignancy following T cell depletion and cyclosporine. Bone Marrow Transplant 1998, 22:889–893.
Tutuncuoglu SO, Yanovich S, Ozdemirli M: CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report. Bone Marrow Transplant 2005, 36:265–266.
Mueller BU, MacKay K, Cheshire LB, et al.: Cytomegalovirus ureteritis as a cause of renal failure in a child infected with the human immunodeficiency virus. Clin Infect Dis 1995, 20:1040–1043.
Kalil AC, Levitsky J, Lyden E, et al.: Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med 2005, 143:870–880.
Mengoli C, Cusinato R, Biasolo MA, et al.: Assessment of CMV load in solid organ transplant recipients by pp65 antigenemia and real-time quantitative DNA PCR assay: correlation with pp67 RNA detection. J Med Virol 2004, 74:78–84.
Bielorai B, Shulman LM, Rechavi G, Toren A: CMV reactivation induced BK virus-associated late onset hemorrhagic cystitis after peripheral blood stem cell transplantation. Bone Marrow Transplant 2001, 28:613–614.
Held TK, Biel SS, Nitsche A, et al.: Treatment of BK virus-associated hemorrhagic cystitis and simultaneous CMV reactivation with cidofovir. Bone Marrow Transplant 2000, 26:347–350.
McClanahan C, Grimes MM, Callaghan E, Stewart J: Hemorrhagic cystitis associated with herpes simplex virus. J Urol 1994, 151:152–153.
Nguyen ML, Borochovitz D, Thomas G, et al.: Hemorrhagic cystitis with herpes simplex virus type 2 in the bladder mucosa. Clin Infect Dis 1992, 14:767–768.
DeHertogh DA, Brettman LR: Hemorrhagic cystitis due to herpes simplex virus as a marker of disseminated herpes infection. Am J Med 1988, 84:632–635.
Sacks SL, Griffiths PD, Corey L, et al.: HSV shedding. Antiviral Res 2004, 63(Suppl 1):S19–S26.
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Paduch, D.A. Viral lower urinary tract infections. Curr Urol Rep 8, 324–335 (2007). https://doi.org/10.1007/s11934-007-0080-y
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DOI: https://doi.org/10.1007/s11934-007-0080-y