Reid G, Huprikar S, Patel G, Razonable R R, Mossad S, Levi M, Gregg K, Shoham S, Humar A, Adams W, Kumar D
Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois, USA.
Transpl Infect Dis. 2013 Oct;15(5):487-92. doi: 10.1111/tid.12116. Epub 2013 Jul 25.
Hematopoietic stem cell transplant (HSCT) recipients have increased morbidity from respiratory viral infections. Pandemic influenza A - A(H1N1)/pdm09 - in 2009-2010 was associated with increased severity of illness in patients with underlying co-morbidities including HSCT, but the factors that contribute to severe disease in HSCT patients are not well characterized.
We conducted a multicenter review of microbiologically proven influenza A(H1N1)pdm09 in the HSCT population between April 2009 and April 2010 to determine factors that are associated with severe disease.
We identified 37 adult patients (26 allogeneic and 11 autologous HSCT recipients). Median time from transplant to diagnosis was 411 days (range 4 days-14.9 years). Three cases were hospital acquired. Twenty-eight of 37 (75.7%) had confirmed A(H1N1)pdm09. Presumed viral lower respiratory tract infection was present in 12/37 (32.4%) patients. Antiviral therapy was given to 33/37 (89%) patients, primarily oseltamivir (n = 24) and oseltamivir before or after another antiviral (n = 8). Excluding those with nosocomial A(H1N1)pdm09, 18/34 (52.9%) were hospitalized and 6 (33%) required admission to an intensive care unit. Mortality within 30 and 60 days of symptom onset was 7/37 (18.9%) and 11/37 (29.7%), respectively. Factors associated with mortality included nosocomial acquisition (P = 0.023), receipt of mycophenolate mofetil (P = 0.001), or antilymphocyte antibody (P = 0.005) within the past 6 months, reduced-intensity conditioning (P = 0.027), and bacteremia (P = 0.021).
A(H1N1)pdm09 infection was particularly severe in HSCT recipients, specifically among those receiving augmented immunosuppression for graft-versus-host disease. The high mortality of the nosocomial cases highlights the need for strict infection-control measures in hospitals during influenza outbreaks.
造血干细胞移植（HSCT）受者因呼吸道病毒感染而出现的发病率增加。2009 - 2010年的甲型H1N1流感大流行与包括HSCT在内的有基础合并症患者的疾病严重程度增加有关，但导致HSCT患者出现严重疾病的因素尚未得到充分描述。
我们对2009年4月至2010年4月期间HSCT人群中经微生物学证实的甲型H1N1流感pdm09进行了多中心回顾，以确定与严重疾病相关的因素。
我们确定了37例成年患者（26例异基因和11例自体HSCT受者）。从移植到诊断的中位时间为411天（范围4天至14.9年）。3例为医院获得性感染。37例中有28例（75.7%）确诊为甲型H1N1流感pdm09。12/37（32.4%）的患者存在疑似病毒性下呼吸道感染。33/37（89%）的患者接受了抗病毒治疗，主要是奥司他韦（n = 24）以及在使用另一种抗病毒药物之前或之后使用奥司他韦（n = 8）。排除医院获得性甲型H1N1流感pdm09患者后，34例中有18例（52.9%）住院，6例（33%）需要入住重症监护病房。症状出现后30天和60天内的死亡率分别为7/37（18.9%）和11/37（29.7%）。与死亡率相关的因素包括医院获得性感染（P = 0.023）、在过去6个月内接受霉酚酸酯（P = 0.001）或抗淋巴细胞抗体（P = 0.005）、减低强度预处理（P = 0.027）以及菌血症（P = 0.021）。
甲型H1N1流感pdm09感染在HSCT受者中尤为严重，特别是在那些因移植物抗宿主病而接受强化免疫抑制的患者中。医院获得性病例的高死亡率凸显了流感暴发期间医院采取严格感染控制措施的必要性。
