Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients

Abstract

Purpose of review Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management. Recent findings The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs. Summary Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.

CMV antiviral stewardship in transplantation – the next frontier

“…The ability to accurately predict the progression of upper respiratory tract viral infections to lower respiratory tract disease is an important clinical issue in immune-compromised hematopoietic cell transplant recipients as discussed by Matsui and Ogimi [14]. Host immunodeficiency factors, viral factors, and more recently other newly identified modifiable risk factors such as hyperglycemia, hypoalbuminemia, and broad-spectrum antibiotics are discussed.…”