Castejon-Ramirez Sandra, Chaisavaneeyakorn Sujittra, Ferrolino Jose A, Allison Kim J, Peterson Megan, Dallas Ronald H, Suliman Ali, Hayden Randall T, Maron Gabriela, Hijano Diego R
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, USA.
J Pediatric Infect Dis Soc. 2024 Jan 29;13(1):75-83. doi: 10.1093/jpids/piad106.
Respiratory viral infections are common among pediatric transplant patients, with human rhinovirus (HRV) being the most frequent. In pediatric patients undergoing hemopoietic cell transplant (HCT), infection with HRV has been associated with progression to lower respiratory tract infection (LRTI) and adverse outcomes. We describe the clinical presentation and outcomes of HRV infection in children undergoing HCT.
Single-center retrospective study. HCT recipients who were positive for HRV/EV (HRV+) or negative for any respiratory virus (VN) by BioFire® FilmArray® panel between October 2014 and December 2017, were included. Primary outcomes were progression to LRTI, ICU admission, all-cause mortality at 3 and 6 months, and respiratory event-related mortality at 6 months.
227 patients (160 allogeneic HCT) were included. Of all patients, 108/227 (47.6%) were HRV+. From all HRV+, 95/108 (88%) were symptomatic and 68/107 (63.6%) of the diagnosis were made pretransplant. The median age of HRV+ was significantly lower than VN patients (5 vs 10 years). Cough and rhinorrhea were more frequently observed in HRV+ (53.7 and 60% vs 19.8 and 22.8%, respectively). No differences were found between both groups pretransplant and overall in rates progression to LRTI, ICU admission, mechanical ventilation, all-cause within 3 and 6 months, and mortality related with respiratory failure. No significant association was found between the severity of respiratory disease and the type of conditioning, type of transplant, or absolute lymphocyte count.
HRV infection is frequently detected in HCT recipients but is not associated with severity of respiratory disease, need for intensive care unit or mortality, including those diagnosed before transplant, suggesting that delaying HCT in this scenario may not be needed. Multicenter larger studies are required to confirm these findings.
呼吸道病毒感染在儿科移植患者中很常见，其中人类鼻病毒（HRV）最为频繁。在接受造血细胞移植（HCT）的儿科患者中，HRV感染与进展为下呼吸道感染（LRTI）及不良结局相关。我们描述了接受HCT的儿童中HRV感染的临床表现和结局。
单中心回顾性研究。纳入2014年10月至2017年12月期间通过BioFire® FilmArray®检测板检测HRV/EV呈阳性（HRV+）或任何呼吸道病毒呈阴性（VN）的HCT受者。主要结局为进展为LRTI、入住重症监护病房（ICU）、3个月和6个月时的全因死亡率以及6个月时与呼吸事件相关的死亡率。
纳入227例患者（160例同种异体HCT）。所有患者中，108/227（47.6%）为HRV+。在所有HRV+患者中，95/108（哈8%）有症状，68/107（63.6%）的诊断在移植前做出。HRV+患者的中位年龄显著低于VN患者（5岁对10岁）。HRV+患者中咳嗽和流涕更为常见（分别为53.7%和60%，而VN患者分别为19.8%和22.8%）。两组在移植前及总体上在进展为LRTI、入住ICU、机械通气、3个月和6个月内的全因死亡率以及与呼吸衰竭相关的死亡率方面均未发现差异。在呼吸道疾病严重程度与预处理类型、移植类型或绝对淋巴细胞计数之间未发现显著关联。
在HCT受者中经常检测到HRV感染，但与呼吸道疾病严重程度、入住重症监护病房的需求或死亡率无关，包括移植前诊断的患者，这表明在这种情况下可能无需推迟HCT。需要多中心更大规模的研究来证实这些发现。
