Magira Eleni E, Chemaly Roy F, Jiang Ying, Tarrand Jeffrey, Kontoyiannis Dimitrios P
Department of Infectious Disease, Infection Control and Employee Health.
Department of Microbiology, The University of Texas MD Anderson Cancer Center, Houston.
Open Forum Infect Dis. 2019 Jul 19;6(7):ofz247. doi: 10.1093/ofid/ofz247. eCollection 2019 Jul.
Data regarding invasive pulmonary aspergillosis (IPA) following respiratory viral infections (RVIs) in patients with leukemia and/or hematopoietic stem cell transplantation (LHSCT) are limited.
We conducted a retrospective case-control study of post-RVI IPA (2006-2016). Cases were patients who underwent LHSCT and had RVI due to respiratory syncytial virus (RSV), influenza virus (INF), or parainfluenza virus (PIV) followed by culture-documented IPA within 6 weeks. Controls had IPA only.
We identified 54 cases and 142 controls. Among cases, 29 (54%) had PIV infection, 14 (26%) had INF infection, and 11 (20%) had RSV infection. The median time to IPA after RVI was 7 days. A greater percentage of cases (37 [69%]) than controls (52 [37%]) underwent allogeneic HSCT ( < .0001). Cases were more likely to be nonneutropenic (33 [61%] vs 56 [39%]; = .009) and in hematologic remission (27 [50%] vs 39 [27%]; = .003) before IPA. Cases were more likely to have monocytopenia (45 [83%] vs 99 [70%]; = .05) and less likely to have severe neutropenia (21 [39%] vs 86 [61%]; = .007) at IPA diagnosis. Prior use of an -active triazole was more common in cases (27 of 28 [96%] vs 50 of 74 [68%]; = .0017). Median time to empirical antifungal therapy initiation was 2 days in both groups. Crude 42-day mortality rates did not differ between cases (22%) and controls (27%), but the 42-day mortality rate was higher among cases with IPA after RSV infection (45%) than among those with IPA following INF or PIV infection (13%; = .05).
IPA had comparable outcomes when it followed RVI in patients who underwent LHSCT, and post-RVI IPA occurred more frequently in patients with prior allogeneic HSCT and was associated with leukemia relapse and neutropenia.
关于白血病和/或造血干细胞移植（LHSCT）患者呼吸道病毒感染（RVI）后侵袭性肺曲霉病（IPA）的数据有限。
我们对2006年至2016年RVI后发生的IPA进行了一项回顾性病例对照研究。病例为接受LHSCT且因呼吸道合胞病毒（RSV）、流感病毒（INF）或副流感病毒（PIV）发生RVI，随后在6周内有培养证实的IPA的患者。对照仅患有IPA。
我们确定了54例病例和142例对照。在病例中，29例（54%）有PIV感染，14例（26%）有INF感染，11例（20%）有RSV感染。RVI后至IPA的中位时间为7天。与对照（52例[37%]）相比，更多比例的病例（37例[69%]）接受了异基因造血干细胞移植（P <.0001）。病例在发生IPA之前更可能为非中性粒细胞减少（33例[61%]对56例[39%]；P =.009）且处于血液学缓解期（27例[50%]对39例[27%]；P =.003）。病例在IPA诊断时更可能有单核细胞减少（45例[83%]对99例[70%]；P =.05）且不太可能有严重中性粒细胞减少（21例[39%]对86例[61%]；P =.007）。病例中更常见预先使用活性三唑类药物（28例中的27例[96%]对74例中的50例[68%]；P =.0017）。两组开始经验性抗真菌治疗的中位时间均为2天。病例（22%）和对照（27%）的42天粗死亡率无差异，但RSV感染后发生IPA的病例中42天死亡率（45%）高于INF或PIV感染后发生IPA的病例（13%；P =.05）。
接受LHSCT的患者RVI后发生IPA时预后相当，RVI后IPA在既往接受异基因造血干细胞移植的患者中更频繁发生，且与白血病复发和中性粒细胞减少相关。
