Yonsei Med J.  2017 Mar;58(2):362-369. 10.3349/ymj.2017.58.2.362.

Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea

• Hong KW
• Choi SM
• Lee DG
• Cho SY
• Lee HJ
• Choi JK
• Kim SH
• Park SH
• Choi JH
• Yoo JH
• Lee JW

• KMID: 2427125
• DOI: http://doi.org/10.3349/ymj.2017.58.2.362

Abstract

PURPOSE
To describe the incidence, clinical courses, and risk factors for mortality of lower respiratory tract diseases (LRDs) caused by common respiratory viruses (CRVs) in stem cell transplantation (SCT) recipients.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 1038 patients who received SCT between January 2007 and August 2011 at a single center in Korea.
RESULTS
Seventy-one CRV-LRDs were identified in 67 (6.5%) patients. The human parainfluenza virus (HPIV) was the most common causative pathogen of CRV-LRDs at 100 days [cumulative incidence estimate, 23.5%; 95% confidence interval (CI), 3.3-43.7] and 1 year (cumulative incidence estimate, 69.2%; 95% CI, 45.9-92.5) following SCT. The 30-day overall mortality rates due to influenza-LRDs, respiratory syncytial virus-LRDs, HPIV-LRDs, and human rhinovirus-LRDs were 35.7, 25.8, 31.6, and 42.8%, respectively. Co-pathogens in respiratory specimens were detected in 23 (33.8%) patients. The overall mortality at day 30 after CRV-LRD diagnosis was 32.8% (22/67). High-dose steroid usage (p=0.025), a severe state of immunodeficiency (p=0.033), and lymphopenia (p=0.006) were significantly associated with death within 30 days following CRV-LRD diagnosis in a univariate analysis. Multivariate logistic regression analysis revealed that high-dose steroid usage [odds ratio (OR), 4.05; 95% CI, 1.12-14.61; p=0.033] and lymphopenia (OR, 6.57; 95% CI, 1.80-24.03; p=0.004) were independent risk factors for mortality within 30 days of CRV-LRDs.
CONCLUSION
CRV-LRDs among SCT recipients showed substantially high morbidity and mortality rates. Therefore, the implement of an active diagnostic approaches for CRV infections is required for SCT recipients with respiratory symptoms, especially those receiving high-dose steroids or with lymphopenia.

Keyword

Hematopoietic stem cell transplantation; human parainfluenza virus; influenza virus; respiratory syncytial virus; rhinovirus

MeSH Terms

Adult
Female
Hematopoietic Stem Cell Transplantation/adverse effects
Humans
Immunologic Deficiency Syndromes/mortality
Incidence
Influenza, Human/epidemiology/mortality/*virology
Lymphopenia/mortality
Male
Middle Aged
Republic of Korea
Respiratory Syncytial Virus Infections/epidemiology/mortality/*virology
*Respiratory Syncytial Viruses
Respiratory Tract Infections/epidemiology/mortality/*virology
Respirovirus Infections/epidemiology/mortality/*virology
Retrospective Studies
Risk Factors
*Stem Cell Transplantation/mortality
Steroids/administration & dosage
Steroids

Figure

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  Fig. 1 Distribution of lower respiratory tract diseases caused by common respiratory viruses in hematopoietic stem cell transplantation recipients according to the month of the year.

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  Fig. 2 Cumulative incidences of the first episodes of lower respiratory tract diseases caused by common respiratory viruses at 100 days (A) and 1 year (B) after hematopoietic stem cell transplantation. CRV, common respiratory virus; LRDs, lower respiratory tract diseases.

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