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Description

BK virus infection, also known as Human polyomavirus 1[1], is a member of the polyomavirus family. Past infection with the BK virus is widespread, but significant consequences of infection are uncommon, with the exception of the immunocompromised and the immunosuppressed. BK virus is an abbreviation of the name of the first patient, from whom the virus was isolated in 1971 .[2][3][4]Treatment for Bk virus infection includes reduction of immunosuppression, while fluoroquinolones may be beneficial as well.[5]

Presentation

The BK virus rarely causes disease but is typically associated with patients who have had a kidney transplant; many people who are infected with this virus are asymptomatic. If symptoms do appear, they tend to be mild: respiratory infection or fever. [6]

Cause

Similarly to JC virus and SV40, BK virus has a small, non-enveloped, icosahedral capsid with a diameter of 45 to 50 nanometers.[7] The capsid is made up of viral proteins VP1, VP2, and VP3. The capsid proteins have T=7 arrangement. The icosahedral structure contains 72 pentamers of the major capsid protein VP1, 360 molecules in total. [8]

Risk factors

In some renal transplant patients, the necessary use of immunosuppressive drugs has the side-effect of allowing the virus to replicate within the graft, a disease called BK nephropathy.[9]From 1 to 10 percent of renal transplant patients progress to BK virus associated nephropathy (BKVAN) and up to 80 percent of these patients lose their grafts. The onset of nephritis can occur as early as several days post-transplant to as late as 5 years.[10]

Transmission

It is not known how this virus is transmitted, except that it spreads from person to person, and not from an animal source. It has been suggested that this virus may be transmitted through respiratory fluids or urine, since infected individuals periodically excrete virus in the urine. A survey of 400 healthy blood donors was reported as showing that 82 percent were positive for IgG against BK virus.[11]

Diagnosis

This virus can be diagnosed by a BKV blood test or a urine test for decoy cells, in addition to carrying out a biopsy in the kidneys. PCR techniques are often carried out to identify the virus.[12]

Differential diagnosis

As to the differential diagnosis we find the following should be considered: JCPyV, Human adenovirus, CMV and Herpes simplex virus.[13][14]

Treatment

The cornerstone of therapy is reduction in immunosuppression. A recent surge in BKVAN correlates with use of potent immunosuppressant drugs, such as tacrolimus and mycophenolate mofetil (MMF). [15][16]Cidofovir has been successfully used in very low doses. [17]

History

The BK virus was first isolated in 1971 from the urine of a renal transplant patient, initials B.K. The BK virus is similar to another virus called the JC virus (JCV), since their genomes share 75 percent sequence similarity. Both of these viruses can be identified and differentiated from each other by carrying out serological tests using specific antibodies or by using a PCR-based genotyping approach.[18][19]

References

  1. ↑ "Taxonomy browser (Betapolyomavirus hominis)". www.ncbi.nlm.nih.gov. Archived from the original on 4 February 2025. Retrieved 18 February 2025.
  2. ↑ Chong, Stephanie; Antoni, Michelle; Macdonald, Andrew; Reeves, Matthew; Harber, Mark; Magee, Ciara N. (July 2019). "BK virus: Current understanding of pathogenicity and clinical disease in transplantation". Reviews in Medical Virology. 29 (4): e2044. doi:10.1002/rmv.2044. ISSN 1099-1654. PMID 30958614.
  3. ↑ Reploeg, Mark D.; Storch, Gregory A.; Clifford, David B. (15 July 2001). "BK Virus: A Clinical Review". Clinical Infectious Diseases. 33 (2): 191–202. doi:10.1086/321813. ISSN 1058-4838. PMID 11418879.
  4. ↑ Kuppachi, Sarat; Thomas, Beje; Kokko, Kenneth E. (1 June 2013). "BK Virus in the Kidney Transplant Patient". The American Journal of the Medical Sciences. 345 (6): 482–488. doi:10.1097/MAJ.0b013e31826c64ef. ISSN 0002-9629. PMID 23698093. Retrieved 16 February 2025.
  5. ↑ Gorriceta, June Hayrelle; Lopez Otbo, Amy; Uehara, Genta; Posadas Salas, Maria Aurora (18 December 2023). "BK viral infection: A review of management and treatment". World Journal of Transplantation. 13 (6): 309–320. doi:10.5500/wjt.v13.i6.309. PMC 10758681. PMID 38174153.
  6. ↑ Tagliapietra A, Rotondo JC, Bononi I, Mazzoni E, Magagnoli F, Maritati M (2019). "Footprints of BK and JC polyomaviruses in specimens from females affected by spontaneous abortion". Hum Reprod. 34 (3): 433–440. doi:10.1093/humrep/dey375. hdl:11392/2397214. PMID 30590693. S2CID 58621197. Archived from the original on 30 September 2020. Retrieved 8 December 2023.
  7. ↑ Hurdiss, Daniel L.; Morgan, Ethan L.; Thompson, Rebecca F.; Prescott, Emma L.; Panou, Margarita M.; Macdonald, Andrew; Ranson, Neil A. (April 2016). "New Structural Insights into the Genome and Minor Capsid Proteins of BK Polyomavirus using Cryo-Electron Microscopy". Structure. 24 (4): 528–536. doi:10.1016/j.str.2016.02.008. PMC 4826271. PMID 26996963.
  8. ↑ Ambalathingal, George R.; Francis, Ross S.; Smyth, Mark J.; Smith, Corey; Khanna, Rajiv (April 2017). "BK Polyomavirus: Clinical Aspects, Immune Regulation, and Emerging Therapies". Clinical Microbiology Reviews. 30 (2): 503–528. doi:10.1128/CMR.00074-16. ISSN 0893-8512. PMC 5355639. PMID 28298471.
  9. ↑ Fishman, J. A. (2002). "BK Virus Nephropathy — Polyomavirus Adding Insult to Injury". New England Journal of Medicine. 347 (7): 527–530. doi:10.1056/NEJMe020076. PMID 12181409.
  10. ↑ Favi, Evaldo; Puliatti, Carmelo; Sivaprakasam, Rajesh; Ferraresso, Mariano; Ambrogi, Federico; Delbue, Serena; Gervasi, Federico; Salzillo, Ilaria; Raison, Nicholas; Cacciola, Roberto (6 February 2019). "Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation". World Journal of Clinical Cases. 7 (3): 270–290. doi:10.12998/wjcc.v7.i3.270. Retrieved 9 March 2025.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ↑ Egli A; Infanti L; Dumoulin A; et al. (2009). "Prevalence of polyomavirus BK and JC infection and replication in 400 healthy blood donors". J Infect Dis. 199 (6): 837–46. doi:10.1086/597126. PMID 19434930.
  12. ↑ Bista, BR; Ishwad, C; Wadowsky, RM; Manna, P; Randhawa, PS; Gupta, G; Adhikari, M; Tyagi, R; Gasper, G (2007). "Development of a Loop-Mediated Isothermal Amplification Assay for Rapid Detection of BK Virus". Journal of Clinical Microbiology. 45 (5): 1581–7. doi:10.1128/JCM.01024-06. PMC 1865893. PMID 17314224.
  13. ↑ Siguier, M.; Sellier, P.; Bergmann, J. -F. (1 May 2012). "BK-virus infections: A literature review". Médecine et Maladies Infectieuses. 42 (5): 181–187. doi:10.1016/j.medmal.2012.04.011. ISSN 0399-077X. PMID 22621826. Archived from the original on 27 April 2024. Retrieved 15 February 2025.
  14. ↑ Lusco, Mark A.; Fogo, Agnes B.; Najafian, Behzad; Alpers, Charles E. (December 2016). "AJKD Atlas of Renal Pathology: Polyomavirus Nephropathy". American Journal of Kidney Diseases. 68 (6): e37 – e38. doi:10.1053/j.ajkd.2016.10.007. PMID 27884285.
  15. ↑ Saleh, Ahmed; El Din Khedr, Mohamed Salah; Ezzat, Abeer; Takou, Anna; Halawa, Ahmed (November 2020). "Update on the Management of BK Virus Infection". Experimental and Clinical Transplantation: Official Journal of the Middle East Society for Organ Transplantation. 18 (6): 659–670. doi:10.6002/ect.2019.0254. ISSN 2146-8427. PMID 32552624.
  16. ↑ Sawinski, Deirdre; Goral, Simin (1 February 2015). "BK virus infection: an update on diagnosis and treatment". Nephrology Dialysis Transplantation. 30 (2): 209–217. doi:10.1093/ndt/gfu023. ISSN 0931-0509. Retrieved 12 March 2025.
  17. ↑ Vats, Abhay; Randhawa, Parmjeet S.; Shapiro, Ron (2006). "Diagnosis and treatment of BK virus-associated transplant nephropathy". Advances in Experimental Medicine and Biology. 577: 213–227. doi:10.1007/0-387-32957-9_16. ISSN 0065-2598.
  18. ↑ Gardner SD, Field AM, Coleman DV, Hulme B (June 1971). "New human papovavirus (B.K.) isolated from urine after renal transplantation". Lancet. 1 (7712): 1253–7. doi:10.1016/s0140-6736(71)91776-4. PMID 4104714.
  19. ↑ "BK and JC Virus DNA Standard Reference Materials". NIST. Archived from the original on 2 February 2025. Retrieved 21 February 2025.
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