Queensland Children's Hospital, Brisbane, Qld, Australia.
University of Queensland, Brisbane, Qld, Australia.
Transpl Infect Dis. 2021 Aug;23(4):e13580. doi: 10.1111/tid.13580. Epub 2021 Feb 18.
Viral infections pose a serious risk for children undergoing hematopoietic stem cell transplant (HSCT). There are few published case series of prevalence, risk factors, and outcomes examining multiple viruses simultaneously, and no pediatric Australasian data published to date. We describe the real-life experience of viremia in pediatric HSCT in a single tertiary center.
All episodes of viremia in children undergoing HSCT between 2000 and 2018 were identified by matching HSCT patients' unique identification numbers with positive blood polymerase chain reaction (PCR) results for human adenovirus (HAdV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 6 (HHV-6). Paper or electronic charts and electronic pathology results were used to extract the study variables.
Viremia was detected in 177/445 (39.8%) HSCT episodes, of which 46% were allogeneic and 19% autologous transplants. Viremia was disseminated in 96 (21.6%) episodes, with 80 (18%) having more than one virus. HAdV was detected in 108 (24.3% of total episodes) and frequently in autologous transplants, CMV in 71 (16.0%), EBV in 60 (13.5%), and HHV-6 in 38 (8.5%). Of 174 children, 19 (10.9%) died of a viral-associated cause, with viral mortality highest in CMV (18.3%), lowest in HHV-6 (2.6%) with HAdV and EBV similar (6.6% and 6.7%). Adenoviral (but not other virus) dissemination was significantly associated with lower lymphocyte count at time of first detection. CMV dissemination and death were significantly associated with initial and highest CMV viral loads (copies/mL).
This study presents the first pediatric-specific Australasian data for viremia in HSCT. Findings may help guide clinicians in prophylaxis and treatment decisions.
病毒感染对接受造血干细胞移植（HSCT）的儿童构成严重威胁。目前，很少有关于同时检测多种病毒的患病率、危险因素和结果的已发表病例系列，也没有迄今为止发表的澳大利亚儿科数据。我们描述了在单一三级中心进行的儿童 HSCT 中病毒血症的真实临床经验。
通过将 HSCT 患者的唯一识别号码与血液聚合酶链反应（PCR）阳性结果（人腺病毒（HAdV）、巨细胞病毒（CMV）、EB 病毒（EBV）和人类疱疹病毒 6（HHV-6））相匹配，确定 2000 年至 2018 年间所有接受 HSCT 的儿童的病毒血症发作。使用纸质或电子图表和电子病理学结果提取研究变量。
在 445 例 HSCT 发作中，有 177 例（39.8%）检测到病毒血症，其中 46%为异基因移植，19%为自体移植。96 例（21.6%）出现播散性病毒血症，80 例（18%）有多种病毒。108 例（总发作的 24.3%）检测到 HAdV，常发生于自体移植，71 例（16.0%）检测到 CMV，60 例（13.5%）检测到 EBV，38 例（8.5%）检测到 HHV-6。在 174 名儿童中，有 19 名（10.9%）死于病毒相关原因，其中 CMV 死亡率最高（18.3%），HHV-6 最低（2.6%），HAdV 和 EBV 相似（6.6%和 6.7%）。腺病毒（而非其他病毒）播散与首次检测时淋巴细胞计数较低显著相关。CMV 播散和死亡与初始和最高 CMV 病毒载量（拷贝数/mL）显著相关。
本研究首次提供了澳大利亚儿科 HSCT 病毒血症的具体数据。研究结果可能有助于指导临床医生在预防和治疗决策中的应用。
