Virus infection facilitates the development of severe pneumonia in transplant patients with hematologic malignancies

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective therapy for patients with hematologic malignancies. Severe pneumonia is associated with high mortality rate in HSCT recipients. Viral co-infection indicates a poor prognosis of HSCT recipients. In this study, a total of 68 allogeneic HSCT recipients were included. Cytomegalovirus (CMV) and Respiratory syncytial virus (RSV) infection was assessed by testing peripheral blood and oropharynx swabs, respectively, collected in the first 180 days after transplantation. We analysed the correlation of CMV and RSV co-infection with severe pneumonia and mortality. The incidence of CMV and RSV co-infection was 26.5% (18/68). Severe pneumonia was diagnosed in 61% (11/18) cases with co-infection compared to only 10% (5/50) cases with mono-infection or no infection. The analysis of potential risk factors for severe pneumonia showed that CMV and RSV co-infection was significantly associated with severe pneumonia (p < 0.001). The 5 patients who died of severe pneumonia were all co-infected with CMV and RSV. In conclusion, CMV and RSV co-infection appears to be an important factor and facilitates the development of severe pneumonia in allogeneic HSCT patients with hematologic malignancies.

Community‐acquired respiratory virus lower respiratory tract disease in allogeneic stem cell transplantation recipient: Risk factors and mortality from pulmonary virus‐bacterial mixed infections

“…Another relevant finding of this study was the identification of 3 RFs for mortality easily identifiable at the time of CARVs LRTD. These RFs have already been identified as prognostic markers for progression to LRTD (ie, lymphopenia) in several studies among different respiratory virus or as RFs for mortality (ie, lymphopenia <0.5 × 109/L, oxygen requirement, and CMV DNAemia‐RAT) . With these 3 RFs we built a risk score that was able to discriminate 3 groups with different risk of mortality irrespective of the co‐infective status that merit to be validated in further studies.…”

“…First, our study showed that bacterial co‐infection had a significant negative effect on clinical outcome in contrast to respiratory virus and IA co‐infections. Second, there is an increased evidence in the mechanism whereby viral infections enhance and aggravate bacterial co‐infection, the former favoring the growth of bacterial agents by multiple factors, including local destruction of antibacterial barriers at epithelial surfaces, suppression of antibacterial immunity, and induction of apoptosis in immune cells . Third, RFs for respiratory virus co‐infection are expected to be different from those affecting bacterial co‐infection since respiratory virus transmission depend upon epidemiologic situation such as the recipients house‐hold contacts, contact with children, vaccination status, which has not been captured in our data base.…”

“…Some studies have reported that pooled co‐infections (bacteremia, fungal infections, CMV reactivations, herpes simplex virus, human herpesvirus 6, and Epstein‐Barr virus) significantly increased mortality of allo‐HSCT recipients in several CARV types, but others failed to demonstrate such a negative effect . In such reports, there is a lack of comparisons with mono‐infections counterpart.…”

“…Currently, there is a lack of studies analyzing in detail the incidence, characteristics, and consequences of co‐infective pathogens in the LRT in the setting of CARVs LRTD after allo‐HSCT. Some studies have reported that the presence of co‐infective agents at the time of CARVs LRTD may increase overall mortality . However, it is still unknown to what extent such increase in mortality could only be attributed to the co‐infection by itself or by the aggressiveness of the concurrent co‐infective pathogens.…”

Co-infections of human herpesviruses (CMV, HHV-6, HHV-7 and EBV) in non-transplant acute leukemia patients undergoing chemotherapy

“…In patients with hematological malignancies or prior HSCT, lymphocytopenia was significantly associated with serious CMV pneumonia [5] which leads more frequently to death than other infections. In fact, Caifeng Yue et al showed that CMV and respiratory syncytial virus (RSV) co-infection facilitates the development of severe pneumonia [58]. Direct herpesvirus mediated tissue injury (e.g.…”