Nancy L. Stitt, RN, BSN

Disclosures

April 03, 2003

Polyomavirus

The polyomaviruses are DNA viruses that are ubiquitous in nature. Three species are known to infect man: BK virus, JC virus, and a simian virus, SV40. Serologic studies have shown that up to 90% of humans have been exposed to polyomavirus by adulthood. Initial infection is usually asymptomatic and probably occurs via the respiratory route or as a blood-borne infection.

Known risk factors in the transplant recipient include multiple rejection episodes and a seropositive donor and/or recipient. As the use of potent immunosuppressive agents such as tacrolimus, mycophenolate mofetil, and sirolimus has increased, so have reports of polyomavirus nephropathy (PVAN).[43] PVAN is characterized by mononuclear cell interstitial infiltrates and tubulitis, which can be confused with acute cellular rejection. Recognition is critical since the correct therapy is reduction, rather than intensification, of immunosuppression.

The clinical presentation of PVAN encompasses a wide spectrum. Viral shedding in the urine and serologic activation are not usually associated with symptoms. On the other hand, the development of PVAN heralds a distressing complication that is difficult to treat. Urine cytology is technically the simplest method for monitoring polyomavirus infection after transplantation.

Therapeutic strategies for polyomavirus continue to evolve. No prospective studies have been done to determine whether patients with asymptomatic viremia or viruria benefit from specific therapeutic intervention, but there is a general consensus that optimal therapy of patients with PVAN is reduction in immunosuppression. The reader is referred to a previously published article on Medscape for a detailed discussion of polyomavirus infection.[43]

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