BK Virus

Dr G Lokeshwari

Introduction
Human Polyomaviruses JCV, BK virus, SV 40. Family - Polyomaviridae BK virus - first isolated from urine of Renal transplant recipient in 1971

BK virus

Virion Physiological properties

Icosahedral virion 40nm diameter Non-encapsulated virus Genome -5.1 Kbp dsDNA with closed circular supercoiled conformation.

Viral replication occurs in nucleus

BK virus genome

The BKV genome comprises three regions: 1. the NCCR 2. the structural region coding for early T proteins 3. the late structural region encoding the viral capsid proteins (VP1-3) and agnoprotein

 The NCCR contains (a) the origin of replication (ori) and (b) the regulatory regions containing enhancer elements that can alter viral transcription, genome replication and host/tissue tropism. T antigen binds to tumor suppressor proteins Rb and p53 and initiates the cell cycle in host cells.

 VP1, VP2 and VP3 are structural proteins that make up the viral capsid. The VP1 gene displays considerable genetic heterogeneity, and this genetic variation has led to recognition of viral genotypes I, II, III and IV. Agnoprotein plays a role in several cellular processes, including cell cycle progression, DNA repair, viral capsid assembly and virion release from cell

Epidemiology
World wide Seroconversion in approximately 70% of population between 5 to 8 years. MOT : Thro inhalation. other routes: Transplacental, urine, semen, organ transplants. Primary infection in childhood - upper respiratory tract- usually asymptomatic. Latent infection in Renal and solid organ transplant recipients.

Clinical manifestations
Haemorrhagic / Non-Haemorrhagic cystitis Ureteral stenosis Polyoma virus assosiated Nephropathy ( due to intensive immunosuppression and it occurs in first year of life)

Diagnosis
Specimen Urine Investigations: i. Direct detection : a. Microscopy Decoy cells b. Antigen detection with the help of polyclonal antibody specific for BKV c. PCR ii. Isolation and culture Primary cell lines and continuous cell lines

 Cytopathic effect: 1. Nuclear enlargement 2. Continual peeling of cells from the monolayer

iii. Serology: a. HAI b. EIA Ab to PV1 protein detection.

Diagnostic tests for Bkvirus - summary

S.No Disease 1. Cystitis specimen Urine Diagnostic test Cytology comment Decoy cells

NAAT
2. PVAN Urine Cytology NAAT

Qualitative PCR is adequate

Less sensitive than NAAT Qualitatitive for screening and quantitative for presumptive diagnosis.

Plasma

NAAT

Quantitative for presumptive diagnosis

Definitive diagnostic test.

Renal biopsy

Histology, IHC

Screening for BK virus

Every three months for 2 years. Followed by annual screening for 5 years.

Treatment
PVAN Cidofovir and Leflunomide Cystitis Cidofovir In both the above conditions decrease the immunosuppression.

Thank YOU