Viral Respiratory Tract Infections After Hematopoetic Stem Cell Transplantation in Pediatric Patients

Abstract

Viral respiratory tract infections (VRTI) after hematopoietic stem cell/ bone marrow transplantation (HSCT) are associated with severe morbidity and mortality. Although protective measures have been increased from VRTI for HSCT patients in recent years, these infections are still a serious problem. Treatment regimens which applied for preparation of HSCT and immunosuppressive treatments, used to prevent graft versus host disease (GVHD), especially in patients who underwent allogeneic stem cell transplantation, can lead to suppression of the patients immune system and become more sensitive to the respiratory viral infectious agents. Early diagnosis and treatment are very important because they can prevent serious complications which can cause of these infections and ensure the infection control measures. Nucleic acid-based tests have begun to use widely in recent years, have provided rapid, accurate and reliable diagnosis of respiratory viral infectious agents. In particular, with the introduction of the multiplex molecular assays that able to simultaneously detect many pathogens, has facilitated the diagnosis of some pathogens which couldn't detected by conventional methods previously. In this article, VRTI, and viral respiratory infections agents encountered in HSCT performed children are presented as a literature review.

Respiratory Viral Infections in the Pediatric Hematopoietic Stem Cell Transplant Population

“…In allogeneic HSCT recipients, rhinoviruses, detected at rates as high as 22.3% within 100 days of transplantation, are the most common cause of respiratory tract infections. Rhinovirus infection was also found in 40% of asymptomatic HSCT patients 13,17,18. In our study, rhinovirus was the most frequently detected agent at a rate of 65.9% among all recorded RVI episodes.…”

“…Rhinovirus infection was also found in 40% of asymptomatic HSCT patients. 13,17,18 In our study, rhinovirus was the most frequently detected agent at a rate of 65.9% among all recorded RVI episodes. In immunocompromised patients, these infections are also notable for prolonged viral shedding and late airflow obstruction and this situation may facilitate the nosocomial spread of viruses.…”

“…6,12 RVIs are slightly more common in children undergoing allogeneic stem cell transplantation (6.5% to 21%) than among autologous transplant recipients (6.2% to 13%). 13 As different viral factors can lead to similar clinical pictures, a specific diagnosis can only be reached with laboratory examinations. As previous studies were based on less sensitive methods, such as viral culture and direct fluorescent antigen testing, the incidence of RVIs was generally found to be lower.…”

“…Pediatric patients undergoing HSCT are susceptible to viral infections owing to their compromised immune systems, and viral respiratory tract infections in these patients may present as a wide range of clinical syndromes from asymptomatic infection to severe pneumonia and death 6,12. RVIs are slightly more common in children undergoing allogeneic stem cell transplantation (6.5% to 21%) than among autologous transplant recipients (6.2% to 13%) 13. As different viral factors can lead to similar clinical pictures, a specific diagnosis can only be reached with laboratory examinations.…”