Khanna Nina, Widmer Andreas F, Decker Michael, Steffen Ingrid, Halter Jörg, Heim Dominik, Weisser Maja, Gratwohl Alois, Fluckiger Ursula, Hirsch Hans H
Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Clin Infect Dis. 2008 Feb 1;46(3):402-12. doi: 10.1086/525263.
Respiratory syncytial virus (RSV) causes significant mortality in patients with hematological diseases, but diagnosis and treatment are uncertain.
We retrospectively identified RSV-infected patients with upper or lower respiratory tract infection (RTI) by culture, antigen testing, and polymerase chain reaction from November 2002 through April 2007. Patients with severe immunodeficiency (SID; defined as transplantation in the previous 6 months, T or B cell depletion in the previous 3 months, graft-versus-host disease [grade, >or=2], leukopenia, lymphopenia, or hypogammaglobulinemia) preferentially received oral ribavirin, intravenous immunoglobulin, and palivizumab. The remaining patients with moderate immunodeficiency (MID) preferentially received ribavirin and intravenous immunoglobulin.
We identified 34 patients, 22 of whom had upper RTI (10 patients with MID and 12 with SID) and 12 of whom had lower RTI (2 with MID and 10 with SID). Thirty-one patients were tested by polymerase chain reaction (100% of these patients had positive results; median RSV load, 5.46 log(10) copies/mL), 30 were tested by culture (57% had positive results), and 25 were tested by antigen testing (40% had positive results). RSV-attributed mortality was 18% (6 patients died) and was associated with having >or=2 SID factors (P=.04), lower RTI (P=.01), and preengraftment (P=.012). Among 12 patients with MID (7 of whom received treatment), no progression or death occurred. Nine patients with SID and upper RTI received treatment (7 patients received ribavirin, intravenous immunoglobulin, and palivizumab); infection progressed to the lower respiratory tract in 2 patients, and 1 patient died. Ten patients with SID and lower RTI were treated, 5 of whom died, including 4 of 6 patients who received ribavirin, intravenous immunoglobulin, and palivizumab. The duration of RSV shedding correlated with the duration of symptoms in patients with SID but exceeded symptom duration in patients with MID (P<.05).
Lower RTI, >or=2 SID criteria, and preengraftment are risk factors for RSV-attributed mortality. Polymerase chain reaction may optimize diagnosis and monitoring. Oral ribavirin therapy seems safe, but trials are needed to demonstrate its efficacy.
呼吸道合胞病毒（RSV）在血液病患者中可导致显著的死亡率，但诊断和治疗方法尚不明确。
我们回顾性地确定了2002年11月至2007年4月期间通过培养、抗原检测和聚合酶链反应确诊的上呼吸道或下呼吸道感染（RTI）的RSV感染患者。严重免疫缺陷患者（SID；定义为在过去6个月内进行移植、在过去3个月内T或B细胞耗竭、移植物抗宿主病[分级，≥2级]、白细胞减少、淋巴细胞减少或低丙种球蛋白血症）优先接受口服利巴韦林、静脉注射免疫球蛋白和帕利珠单抗治疗。其余中度免疫缺陷（MID）患者优先接受利巴韦林和静脉注射免疫球蛋白治疗。
我们共确定了34例患者，其中22例为上呼吸道RTI（10例MID患者和12例SID患者），12例为下呼吸道RTI（2例MID患者和10例SID患者）。31例患者接受了聚合酶链反应检测（这些患者全部检测结果为阳性；RSV载量中位数为5.46 log(10)拷贝/mL），30例接受了培养检测（57%结果为阳性），25例接受了抗原检测（40%结果为阳性）。RSV导致的死亡率为18%（6例患者死亡），与≥2个SID因素（P = 0.04）、下呼吸道RTI（P = 0.01）和植入前状态（P = 0.012）相关。在12例MID患者中（7例接受了治疗），未出现病情进展或死亡。9例SID和上呼吸道RTI患者接受了治疗（7例患者接受了利巴韦林、静脉注射免疫球蛋白和帕利珠单抗治疗）；2例患者感染进展至下呼吸道，1例患者死亡。10例SID和下呼吸道RTI患者接受了治疗，其中5例死亡，包括6例接受利巴韦林、静脉注射免疫球蛋白和帕利珠单抗治疗患者中的4例。RSV排毒持续时间与SID患者的症状持续时间相关，但超过了MID患者的症状持续时间（P < 0.05）。
下呼吸道RTI、≥2个SID标准和植入前状态是RSV导致死亡的危险因素。聚合酶链反应可能有助于优化诊断和监测。口服利巴韦林治疗似乎安全，但需要试验来证明其疗效。
