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BK polyomavirus
Epidemiology:
- isolated from the urine of a renal transplant patients
- infection is common; antibodies to BK virus are present in 73% of children
Pathology:
- causes BK virus-associated tubulointerstial nephropathy in renal transplant patients on immunosuppressants: [3]
- sirolimus (Rapamune)
- cyclosporine (Sandimmune, Neoral)
- mycophenolate mofetil (Cellcept, Myfortic)
- tacrolimus (Prograf)
Clinical manifestations:
- infection occurs > 12 months after renal transplantation &/or intensive immunosuppression
Laboratory:
- BK polyomavirus serology
- BK polyomavirus DNA
- see ARUP consult [5]
Management:
- decrease immunosuppression if BK virus-associated nephropathy
- most antiviral agents, including acyclovir & ganciclovir are ineffective
- cidofovir, fluoroquinolones, leflunomide seem to have some activity against BK virus
Comparative biology:
- BK virus causes tumors in hamsters
General
polyomavirus
Properties
KINGDOM: virus
GENOME-TYPE: deoxyribonucleic acid (DNA)
DOUBLE-STRANDED
GENOME-SIZE: 5-9 kB
ENVELOPE: NONE
CAPSID-SYMMETRY: ICOSAHEDRAL
References
- Greenfield's Neuropathology, 5th ed., 1992 p. 367
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1066-67
- FDA Medwatch
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm171828.htm
- Mylonakis E et al
BK virus in solid organ transplant recipients:
an emerging syndrome.
Transplantation. 2001 Nov 27;72(10):1587-92. Review.
PMID: 11726814
- ARUP Consult: BK Virus
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/bk-virus
- Medical Knowledge Self Assessment Program (MKSAP) 16,17,18.
American College of Physicians, Philadelphia 2012,2015,2018.
- Barraclough KA, Isbel NM, Staatz CE, Johnson DW.
BK Virus in Kidney Transplant Recipients: The Influence of
Immunosuppression.
J Transplant. 2011;2011:750836
PMID: 21766009