Mowrer Clayton, Lee Brian R, Goyal Rakesh, Selvarangan Rangaraj, Schuster Jennifer E
Department of Pediatrics, Children's Mercy, Kansas City, Missouri.
Department of Pediatrics, Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, Missouri.
Pediatr Transplant. 2018 Dec;22(8):e13301. doi: 10.1111/petr.13301. Epub 2018 Oct 19.
Rhinoviruses are commonly detected in symptomatic and asymptomatic children prior to HCT. Unlike pre-HCT detection of other respiratory viruses, it is not known whether RV detection, with or without clinical symptoms, is associated with worse outcomes in children post-HCT. In a retrospective study of children undergoing allogeneic HCT from January 2009 to February 2015, 91 children underwent allogeneic HCT, and 62 children had RPP testing within 30 days pre-HCT. Fifty-six (90%) children had either no pathogen (n = 34, 55%) or single RV detection (n = 22, 35%), which was the most common pathogen identified. Compared with virus negative children, children with pre-HCT RV detection were not more likely to require ventilated support and did not have longer length of stay, higher mortality, or less days alive and out of the hospital within the first 100 days post-HCT. In a secondary analysis of all 56 patients with RPP testing and no pathogen or RV alone detected, the seven children with LRTI had less days alive and out of the hospital within the first 100 days post-HCT compared with the 49 children who were either asymptomatic or had URTI (10 vs 60 days, P = 0.002). In a bootstrapped regression model, presence of LRTI, not RV detection, was significantly associated with decreased days alive and out of the hospital within the first 100 days post-HCT. Thus, pre-HCT detection of RV, without associated LRTI, does not always warrant HCT delay.
在造血干细胞移植（HCT）前，有症状和无症状的儿童中普遍能检测到鼻病毒。与HCT前检测其他呼吸道病毒不同，目前尚不清楚无论有无临床症状，检测到鼻病毒是否与HCT后儿童的不良预后相关。在一项对2009年1月至2015年2月接受异基因HCT的儿童的回顾性研究中，91名儿童接受了异基因HCT，62名儿童在HCT前30天内进行了呼吸道病原体检测（RPP）。56名（90%）儿童要么未检测到病原体（n = 34，55%），要么仅检测到单一鼻病毒（n = 22，35%），这是最常见的病原体。与病毒阴性的儿童相比，HCT前检测到鼻病毒的儿童并不更需要通气支持，住院时间也没有更长，死亡率没有更高，在HCT后100天内存活且出院的天数也没有更少。在对所有56名进行了RPP检测且未检测到病原体或仅检测到鼻病毒的患者的二次分析中，与49名无症状或患有上呼吸道感染（URTI）的儿童相比，7名患有下呼吸道感染（LRTI）的儿童在HCT后100天内存活且出院的天数更少（10天对60天，P = 0.002）。在一个自抽样回归模型中，是LRTI的存在，而非鼻病毒检测，与HCT后100天内存活且出院天数减少显著相关。因此，HCT前检测到鼻病毒且无相关LRTI时，并不总是需要推迟HCT。
