Wang Lin, Allen John, Diong Colin, Goh Yeow-Tee, Gopalakrishnan Sathish, Ho Aloysius, Hwang William, Lim Francesca, Oon Lynette, Tan Thuan-Tong, Linn Yeh-Ching, Tan Ban Hock
Haematology, Singapore General Hospital, Singapore.
Academic Medicine Research Institute, Duke-NUS Medical School, Singapore.
Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12693. Epub 2017 Apr 27.
Respiratory virus infection (RVI) is a prevalent infection in patients after allogeneic hematopoietic stem cell transplant (allo-HSCT) and can result in significant morbidity and mortality. Ability to assess the potential severity of RVI is important in the management of such patients.
We reviewed the cases of RVI in allo-HSCT recipients and explored the predictive value of the immunodeficiency scoring index (ISI) established for respiratory syncytial virus (RSV) and its applicability for RVI caused by other respiratory viruses.
RVI occurred year-round in our tropical transplant center, with peaks in the middle and end of the year. Ninety-five of the 195 recipients developed a total of 191 episodes of RVI, giving a cumulative incidence of 28% by 6 months and 52% by 24 months for the first episode of RVI. RSV, influenza, rhinovirus, and parainfluenza were the most common viruses. Pneumonia occurred in 63.64%, 42.31%, and 32.42% of adenovirus, influenza, and RSV RVI episodes, respectively, but was also non-negligible in the more benign viruses, such as coronavirus (31.58%) and rhinovirus (23.68%). Nineteen of the 63 episodes of viral pneumonia required mechanical ventilation and 14 deaths occurred within 6 weeks of the RVI. Receiver operating characteristic analysis showed that an ISI of ≥8 predicted pneumonia with a positive predictive value of >80% for RVI caused by RSV, influenza, adenovirus, and parainfluenza, while it was not predictive for coronavirus and rhinovirus.
The ISI is a useful aid for decision-making during clinic consultation for patients presenting with symptoms suggestive of an RVI.
呼吸道病毒感染（RVI）是异基因造血干细胞移植（allo-HSCT）患者中常见的感染，可导致显著的发病率和死亡率。评估RVI潜在严重程度的能力在这类患者的管理中很重要。
我们回顾了allo-HSCT受者的RVI病例，并探讨了为呼吸道合胞病毒（RSV）建立的免疫缺陷评分指数（ISI）的预测价值及其对其他呼吸道病毒引起的RVI的适用性。
在我们的热带移植中心，RVI全年都有发生，年中及年末为发病高峰。195名受者中有95人共发生191次RVI发作，RVI首次发作的累积发病率在6个月时为28%，24个月时为52%。RSV、流感病毒、鼻病毒和副流感病毒是最常见的病毒。腺病毒、流感病毒和RSV RVI发作分别有63.64%、42.31%和32.42%发生肺炎，但在冠状病毒（31.58%）和鼻病毒（23.68%）等较温和的病毒感染中，肺炎发生率也不容忽视。63例病毒性肺炎中有19例需要机械通气，14例在RVI发生后6周内死亡。受试者工作特征分析表明，ISI≥8可预测肺炎，对RSV、流感病毒、腺病毒和副流感病毒引起的RVI，其阳性预测值>80%，而对冠状病毒和鼻病毒则无预测价值。
对于出现提示RVI症状的患者，ISI在临床会诊时有助于决策。
