Atilla Erden, Sahin Didem, Atilla Pinar Ataca, Dolapci Istar, Tekeli Alper, Bozdag Sinem Civriz, Yuksel Meltem Kurt, Toprak Selami Kocak, Ilhan Osman, Arslan Onder, Ozcan Muhit, Gurman Gunhan, Topcuoglu Pervin
Department of Hematology, Ankara University School of Medicine, Ankara, Turkey.
Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey.
Antivir Ther. 2018;23(6):523-527. doi: 10.3851/IMP3224.
Community respiratory viruses (CRVs) are associated with upper respiratory viral infections (URI), pneumonia or life-threatening respiratory disease in patients with allogeneic haematopoietic stem cell transplantation (allo-HSCT). Our aim is to demonstrate our URI experience related to CRVs after allo-HSCT.
From January 2013 to November 2015, 39 post allo-HSCT patients with acute URI symptoms were included in the study. We evaluated CRVs by multiplex PCR from nasopharyngeal wash and throat swabs.
The median age of the patients was 39 (range 20-67 years). A total of 25 patients (64%) had viral panel positivity at a median 140 days post-transplant (range 3-617 days). The most common agents detected were respiratory syncytial virus (32%) and parainfluenza (32%). The patients with viral panel positivity had significantly lower lymphocyte count (1.05×10/l versus 3.09×10/l; P=0.013). During follow-up, 20 patients (80%) were diagnosed with pneumonia. Patients with concurrent bacterial or fungal infections were more likely to have pneumonia (100% versus 68%; P=0.023). 10 patients (40%) died due to pneumonia and related complications. Lower lymphocyte counts and higher C-reactive protein levels at the time of viral panel positivity were risk factors for mortality (1.5×10/l versus 0.39×10/l, P=0.007; 74.2 versus 199.7, P=0.006).
The viral panel was positive in 64% of patients with acute URI symptoms. Lower lymphocyte count was detected in CRV-positive patients. The onset of concomitant bacterial or fungal infections increased the risk of lower respiratory infection disease. Indeed, prospective studies should be designed for risks and outcomes of CRVs in allo-HSCT recipients.
社区呼吸道病毒（CRV）与异基因造血干细胞移植（allo-HSCT）患者的上呼吸道病毒感染（URI）、肺炎或危及生命的呼吸道疾病相关。我们的目的是展示我们在allo-HSCT后与CRV相关的URI经验。
2013年1月至2015年11月，39例allo-HSCT后出现急性URI症状的患者纳入研究。我们通过对鼻咽冲洗液和咽拭子进行多重聚合酶链反应（PCR）来评估CRV。
患者的中位年龄为39岁（范围20 - 67岁）。共有25例患者（64%）在移植后中位140天（范围3 - 617天）病毒检测呈阳性。检测到的最常见病原体是呼吸道合胞病毒（32%）和副流感病毒（32%）。病毒检测呈阳性的患者淋巴细胞计数显著更低（1.05×10⁹/L对3.09×10⁹/L；P = 0.013）。随访期间，20例患者（80%）被诊断为肺炎。合并细菌或真菌感染的患者更易发生肺炎（100%对68%；P = 0.023）。10例患者（40%）因肺炎及相关并发症死亡。病毒检测呈阳性时较低的淋巴细胞计数和较高的C反应蛋白水平是死亡的危险因素（1.5×10⁹/L对0.39×10⁹/L，P = 0.007；74.2对199.7，P = 0.006）。
64%有急性URI症状的患者病毒检测呈阳性。CRV阳性患者检测到淋巴细胞计数较低。合并细菌或真菌感染的发生增加了下呼吸道感染疾病的风险。确实，应针对allo-HSCT受者中CRV的风险和结局设计前瞻性研究。
