Pulmonary enterovirus infections in stem cell transplant recipients

Abstract

Summary:In recent years, it has been recognised that the community respiratory viruses are a frequent cause of upper and lower respiratory tract infections in immunocompromised hosts such as bone marrow transplant recipients. By contrast, infections by non-polio enteroviruses have rarely been reported after stem cell transplantation. We present four cases of acute respiratory illness with enterovirus isolated as the sole pathogen from bronchoalveolar lavage. All four patients developed pneumonia and three died of progressive pneumonia, which reflects the severity of this complication. We conclude that enteroviral pulmonary infections may be a cause of severe pneumonia in immunocompromised hosts. Keywords: enterovirus; pulmonary infection; immunocompromised host Pneumonia is a frequent infectious complication in patients with hematologic malignancies, particularly following stem cell transplantation (SCT). Most viral pneumonias in these patients have been traditionally associated with herpes viruses. In recent years, however, an increasing number of reports have shown the importance of upper and lower respiratory tract infections in SCT recipients and other immunocompromised hosts caused by community respiratory viruses, mainly respiratory syncytial virus, influenza A and B, parainfluenza, adenovirus and picornaviruses. [1][2][3][4][5][6] The human picornaviruses (family Picornaviridae) which cause respiratory infections include rhinoviruses and enteroviruses, which in turn are classified into polioviruses, coxsackieviruses A and B, echoviruses and enterovirus 68-71. Infections by non-polio enteroviruses have rarely been reported in SCT recipients. Herein, we describe the presentation and clinical course of four highly immunocompromised SCT recipients with an acute respiratory illness who had enterovirus isolated from the bronchoalveolar lavage (BAL). Case reportsOne hundred and forty-four patients with hematologic malignancies received an allogeneic SCT and 414 patients received an autologous SCT between January 1990 and November 1997 at our institution. During this period, 190 BAL were performed in SCT recipients with an acute lower respiratory illness. All specimens were submitted for virological studies including antigen detection of respiratory viruses and tissue culture inoculation for cytomegalovirus, herpes simplex virus, enteroviruses and conventional respiratory viruses. An enterovirus was isolated as the sole pathogen in the BAL from four patients, whose characteristics are summarized in Table 1. UPN 463A 6-year-old male underwent an autologous bone marrow transplant (ABMT) for acute lymphocytic leukemia (ALL) in second complete remission (CR). The leukemia relapsed 9 months post-ABMT, and he received salvage chemotherapy with ICE (idarubicin, standard-dose cytarabine and etoposide). On day 20 of chemotherapy, neutropenic fever developed and empiric treatment with ceftazidime and amikacin was begun. Fever persisted and on day 24 he developed a nonproductive cough with a normal chest Xray, and on subse...

Comparison of the NucliSens Basic Kit (Nucleic Acid Sequence-Based Amplification) and the Argene Biosoft Enterovirus Consensus Reverse Transcription-PCR Assays for Rapid Detection of Enterovirus RNA in Clinical Specimens

“…However, EVs have been reported as a cause of pneumonia in bone marrow transplant patients. Thus, testing of respiratory samples may be indicated (4). One could also argue that since the only therapy available on compassionate plea for EV or rhinovirus is pleconaril, the distinction between the two groups may not be clinically relevant (18).…”

Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study

“…However, enteric viruses such as adenovirus, rotavirus and enteroviruses have been reported to cause serious infection in these patients. [1][2][3][4][5][6] The role of enteric viruses has been prospectively investigated in only a few studies to date. 7,8 Previous studies have indicated a high incidence of viral gastro-enteritis in bone marrow transplant recipients.…”

“…[4][5][6] The role of cell-mediated immunity in the genesis of enteroviral infections is not clear. It is predominantly observed in patients with defects in the humoral arm of the immune system manifesting often as meningoencephalitis.…”

“…Systemic bacterial and fungal infections and infections caused by herpes viruses have been implicated during both early and late post-transplant periods. Enteric viruses such as adenoviruses [1][2][3] and enteroviruses [4][5][6] have been reported to cause both localised and systemic disease in these patients, but only a few prospective studies have addressed the role of enteric pathogens in causing post-transplant infection and disease. Viral pathogens have been isolated from stools of both autologous and allogeneic BMT recipients.…”

Rapid and Sensitive Routine Detection of All Members of the Genus Enterovirus in Different Clinical Specimens by Real-Time PCR

“…Life-threatening enterovirus infections may occur, especially in at-risk individuals such as immunocompromised patients. Recently, bone marrow transplantation patients have been found to be infected with enteroviruses, resulting in serious complications such as pneumonia (6,19). The relatively immunodeficient neonate is also at risk for severe enterovirus infections, resulting in serious febrile illnesses in the first weeks of life (23,26).…”