Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

Abstract

Common respiratory viral infections (CRVIs) frequently complicate hematopoietic stem cell transplantation (HSCT). We conducted a retrospective, single-center, observational cohort study to determine the incidence of CRVI in patients who received an allogeneic (allo) or autologous (auto) HSCT at the Royal Adelaide Hospital between 2009 and 2017. The median follow-up was 8.9 and 4.5 years for auto-and allo-HSCT recipients, respectively. There were 149 CRVI episodes in 74 patients, with rhinovirus being the most commonly isolated virus (n = 81, 47%). The majority of CRVIs (113/149, 75.8%) occurred more than 100 days post-HSCT and 67% were diagnosed in the outpatient setting. There was evidence of lower respiratory tract infection (LRTI) in 45.6% (68/149) of CRVIs. On multivariate logistic regression analysis, coviral infections and cytomegalovirus viremia were independent risk factors for progression of CRVI to LRTI. Ten (6.7%) CRVI episodes resulted in admission to intensive care for ventilatory support and 8 (5.4%) patients died within 30 days of CRVI diagnosis. In our study, 10.4% of HSCT recipients experienced a CRVI post-transplant, primarily causing late morbidity and potentially mortality. Prevention with strict infection control practices, vaccination, and patient education is essential.

Infecciones respiratorias virales en episodios de fiebre en niños con trasplante de precursores hematopoyéticos

“…La presencia de los distintos tipos de virus fue concordante con la circulación estacional habitual y rinovirus prevaleció durante todo el año sin diferencias significativas. Tanto en nuestro estudio como en otras publicaciones sobre virus respiratorios en TPH 4,5,31 , el virus respiratorio detectado con mayor frecuencia fue rinovirus. La detección de IRV en niños receptores de TPH se asoció a diagnóstico de IRA, con sintomatología respiratoria al ingreso en más de 90% de los casos (con tos y rinorrea como síntomas frecuentes) y 69% de ellos con diagnóstico de IRA baja.…”

Viral Respiratory Infections in Hematological Patients

“…The T cell-mediated immune response is fundamental to protecting humans from viral infections. As this mechanism may be lacking in patients who undergo stem cell transplantation or who undergo immunosuppressive therapies, hematological patients are particularly susceptible to viral infections and to related complications [8].…”

“…The following risk factors for symptomatic progression to LRTI are known for RSV and PiV infections: advanced age, history of smoking, allogeneic HSCT, myeloablative regimen, neutropenia, lymphocytopenia, non-correspondent or unrelated donor transplant, graft-versus-host disease (GVHD), pre-engraftment status or early post-transplant period, and systemic use of corticosteroids [8].…”

“…In other cases, as in influenza virus infection, the typical manifestations may be absent [2]. Dyspnea, hypoxemia and possible lung infiltrates may appear on chest x-ray with progression to LRTI [8]. Neutropenia is not a pivotal clinical fact but is rather a condition that predisposes patients to bacterial infections [4].…”

“…Marinelli et al estimate that, in patients treated with autologous stem cell transplantation, hRV is the most common community-acquired virus (47%) followed by PiV (14.1%), influenza (11.2%), RSV (11.8%) and hMPV (8.8%) [8]. Viruses that most frequently cause respiratory infections in the HSCT candidate patient include: RSV, AdV, influenza, PIV, hMPV, RhV, CoV and hBoV [15].…”