Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea
3
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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 commoncausative 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 regressionanalysis 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 receivinghigh-dose steroids or with lymphopenia.
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 commoncausative 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 regressionanalysis 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 receivinghigh-dose steroids or with lymphopenia.
참고문헌 (38)
- Gratwohl A, "Hematopoietic stem cell transplantation: a global perspective", JAMA, 303, pp.1617~1624 (2010)
- Mackall C, "Background to hematopoietic cell transplantation, including post transplant immune recovery", Bone Marrow Transplant, 44, pp.457~462 (2009)
- Duncan MD, "Transplant-related immunosuppression:a review of immunosuppression and pulmonary infections", Proc Am Thorac Soc, 2, pp.449~455 (2005)
- Boeckh M, "The challenge of respiratory virus infections in hematopoietic cell transplant recipients", Br J Haematol, 143, pp.455~467 (2008)
- Martino R, "Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies", Biol Blood Marrow Transplant, 11, pp.781~796 (2005)
- Chemaly RF, "Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center", Medicine (Baltimore), 85, pp.278~287 (2006)
- Lee DG, "Characteristics of respiratory tract infection in the hematopoietic stem cell transplantation population", Korean J Infect Dis, 33, pp.419~429 (2001)
- 이동건, "조혈모세포이식 환자에서 흔히 보는 감염", 대한내과학회지, 84(2), pp.158~167 (2013), 대한내과학회[DOI]
- Chemaly RF, "The characteristics and outcomes of parainfluenza virus infections in 200 patients with leukemia or recipients of hematopoietic stem cell transplantation", Blood, 119, pp.2738~2745 (2012)
- Ljungman P, "Respiratory virus infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation", Bone Marrow Transplant, 28, pp.479~484 (2001)
- De Pauw B, "Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer", Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC, Clin Infect Dis, pp.2008, 46[DOI]
- Espinosa-Aguilar L, "Novel H1N1 influenza in hematopoietic stem cell transplantation recipients: two centers’ experiences", Biol Blood Marrow Transplant, 17, pp.566~573 (2011)
- Choi SM, "Differences in clinical outcomes after 2009 influenza A", H1N1and seasonal influenza among hematopoietic cell transplant recipients, 2011, pp.117, 5050~5056
- Khanna N, "Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature", Clin Infect Dis, 46, pp.402~412 (2008)
- Nichols WG, "Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy", Clin Infect Dis, 39, pp.1300~1306 (2004)
- Weigt SS, "Respiratory viral infections in hematopoietic stem cell and solid organ transplant recipients", Semin Respir Crit Care Med, 32, pp.471~493 (2011)
- Avetisyan G, "Respiratory syncytial virus infection in recipients of allogeneic stem-cell transplantation: a retrospective study of the incidence, clinical features, and outcome", Transplantation, 88, pp.1222~1226 (2009)
- Hassan IA, "Respiratory viral infections after bone marrow", peripheral stem-cell transplantation:the Christie hospital experience, 2003, pp.32, 73~77
- Hirsch HH, "Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus", Clin Infect Dis, 56, pp.258~266 (2013)
- Nichols WG, "Community-acquired respiratory syncytial virus and parainfluenza virus infections after hematopoietic stem cell transplantation: the Fred Hutchinson Cancer Research Center experience", Biol Blood Marrow Transplant, (7 Suppl), pp.11S~15S (2001)
- Lewis VA, "Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipients", Clin Infect Dis, 23, pp.1033~1037 (1996)
- Nichols WG, "Parainfluenza virus infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome", Blood, 98, pp.573~578 (2001)
- Ustun C, "Human parainfluenza virus infection after hematopoietic stem cell transplantation: risk factors, management, mortality, and changes over time", Biol Blood Marrow Transplant, 18, pp.1580~1588 (2012)
- Maziarz RT, "Control of an outbreak of human parainfluenza virus 3 in hematopoietic stem cell transplant recipients", Biol Blood Marrow Transplant, 16, pp.192~198 (2010)
- Milano F, "Human rhinovirus and coronavirus detection among allogeneic hematopoietic stem cell transplantation recipients", Blood, 115, pp.2088~2094 (2010)
- Ghosh S, "Rhinovirus infections in myelosuppressed adult blood and marrow transplant recipients", Clin Infect Dis, 29, pp.528~532 (1999)
- Gutman JA, "Rhinovirus as a cause of fatal lower respiratory tract infection in adult stem cell transplantation patients: a report of two cases", Bone Marrow Transplant, 40, pp.809~811 (2007)
- Ison MG, "Rhinovirus infections in hematopoietic stem cell transplant recipients with pneumonia", Clin Infect Dis, 36, pp.1139~1143 (2003)
- Renaud C, "Changing epidemiology of respiratory viral infections in hematopoietic cell transplant recipients and solid organ transplant recipients", Curr Opin Infect Dis, 24, pp.333~343 (2011)
- Debur MC, "Human metapneumovirus infection in hematopoietic stem cell transplant recipients", Transpl Infect Dis, 12, pp.173~179 (2010)
- Erard V, "Airflow decline after myeloablative allogeneic hematopoietic cell transplantation: the role of community respiratory viruses", J Infect Dis, 193, pp.1619~1625 (2006)
- Avadhanula V, "Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner", J Virol, 80, pp.1629~1636 (2006)
- Avetisyan G, "Evaluation of immune responses to seasonal influenza vaccination in healthy volunteers and in patients after stem cell transplantation", Transplantation, 86, pp.257~263 (2008)
- Pauksen K, "Granulocyte-macrophage colony-stimulating factor as immunomodulating factor together with influenza vaccination in stem cell transplant patients", Clin Infect Dis, 30, pp.342~348 (2000)
- Boudreault AA, "Impact of corticosteroid treatment and antiviral therapy on clinical outcomes in hematopoietic cell transplant patients infected with influenza virus", Biol Blood Marrow Transplant, 17, pp.979~986 (2011)
- Choi SM, "Influenza viral RNA detection in blood as a marker to predict disease severity in hematopoietic cell transplant recipients", J Infect Dis, 206, pp.1872~1877 (2012)
- Campbell AP, "Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT", J Infect Dis, 201, pp.1404~1413 (2010)
- Erard V, "Quantitative real-time polymerase chain reaction for detection of adenovirus after T cell-replete hematopoietic cell transplantation: viral load as a marker for invasive disease", Clin Infect Dis, 45, pp.958~965 (2007)