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Section 2
Section 3
Section 4
Section 5
Appendices

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Section 3. Summaries of Infectious Diseases

Polyomaviruses (BK Virus and JC Virus)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

BK virus (BKV) and James Canyon virus (JCV) infections in immunocompetent children usually are asymptomatic. Because of tropism for genitourinary tract epithelium, BKV may cause asymptomatic hematuria or cystitis in healthy children but is more likely to cause disease in immunocompromised people, in whom both lower tract renal disease (hemorrhagic cystitis in hematopoietic stem cell transplant recipients) and upper tract renal disease (interstitial nephritis and ureteral stenosis in renal transplant recipients) is possible. BKV-associated nephropathy occurs in 3% to 8% of renal transplant recipients and should be suspected in any renal transplant patient with allograft dysfunction. More than 50% of patients with BKV-associated nephropathy experience renal allograft loss. The primary symptom of BKV-associated hemorrhagic cystitis is painful hematuria. Passage of blood clots in the urine and secondary obstructive nephropathy can occur in patients with BKV-associated hemorrhagic cystitis.

JCV is the cause of progressive multifocal leukoencephalopathy (PML) that occurs in severely immune-compromised patients. PML, the only known disease caused by JCV, occurs in approximately 5% of untreated adults with acquired immunodeficiency syndrome (AIDS) but is less frequent in children with AIDS. PML is a rare demyelinating disease of the central nervous system. Symptoms of PML include cognitive disturbance, hemiparesis, ataxia, cranial nerve dysfunction, and aphasia. Cytocidal infection of oligodendrocytes with JCV produces the pathognomonic lesions . . . [Go to Full Text]


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Summary of Major Changes in the 2009 Red Book

Red Book 2009: XXIX. [Extract] [Full Version]