Table 3.
Clinical Presentation and Outcome of 83 Episodes of Clinically Symptomatic Infections by Respiratory Viruses in Posttransplantation Patients
| FLUAV (n = 33) or FLUBV (n = 6) |
HRSV (n = 19) |
HAdV (n = 11) |
HPIV 1–3 (n = 8) |
HEV (n = 5) |
HRV (n = 3) |
HMPV (n = 16) |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Variable | Allo | Auto | Allo | Auto | Allo | Auto | Allo | Auto | Allo | Auto | (Allo Only) | Allo | Auto |
| Total related to type of HSCT, n* | 24 | 15 | 12 | 7 | 7 | 4 | 4 | 4 | 3 | 2 | 3 | 9 | 7 |
| Nosocomial infection | 8 (67) | 6 (40) | 5 (42) | 3 (43) | 2 (29) | 2 (50) | 3 (75) | — | — | 2 | 5 (56) | 3 (43) | |
| Seasonal occurrence in autumn or winter | 3 (14) | 1 (7) | 2 (17) | — | 1 (14) | 1 (25) | — | 2 (50) | 1 (34) | 1 | 2 | 2 (22) | 1 (14) |
| 14 (54) | 8 (53) | 9 (75) | 6 (86) | 4 (57) | 2 (50) | 1 (25) | 1 (25) | 2 (66) | 1 | 3 (33) | 3 (43) | ||
| Period after HSCT | |||||||||||||
| Early (< 30 d) | 9 (37) | 5 (33) | 3 (25) | 3 (43) | 1 (14) | 1 (25) | 2 (50) | 1 (25) | 2 | 4 (44) | 4 (57) | ||
| Intermediate (31–90 d) | 4 (17) | 5 (33) | 4 (33) | 3 (43) | 1 (14) | 1 | 2 (50) | 1 (25) | 1 (34) | — | 1 | 1 (11) | 2 (29) |
| Late (91 d to 1 y) and very late (> 1 y) | 11 (46) | 5 (33) | 5 (42) | 1 (14) | 5 (71) | 2 (50) | — | 2 (50) | 2 (66) | 2 (100) | 4 (44) | 1 (14) | |
| Documented sites of infection | |||||||||||||
| URTI only, n = 50 (25/25) | 11 (45) | 11 (74) | 4 (33) | 4 (57) | 3 (43) | 4 (100) | 1 (25) | 3 (75) | 2 (66) | 2 (100) | 3 (100) | 5 (56) | 6 (86) |
| URTI - LRTI, n = 23 (16/7) | |||||||||||||
| Initial URTI - LRTI, n = 8 (5/3) | 2 (8) | 2 (13) | 2 (16) | 3 (43) | 1 (14) | — | — | — | 1 (34) | — | — | — | |
| URTI followed by LRTI, n = 15 (11/4) | 3 (13) | 2 (13) | 3 (25) | 1 (14) | 2 (28) | — | 3 (75) | — | 2 (22) | 1 (14) | |||
| LRTI only, n = 14 (13/1) | 8 (34) | — | 3 (25) | — | 1 (14) | — | — | 1 (25) | 2 (22) | — | |||
| Symptoms in patients with URTI† | n = 30 | n = 13 | n = 10 | n = 7 | n = 5 | n = 2 | n = 10 | ||||||
| Rhinorrhea | 22 (73) | 9 (69) | 9 (90) | 7 (100) | 5 (100) | 2 (100) | 9 (90) | ||||||
| Nasal congestion and/or sneezing | 19 (63) | 9 (69) | 10 (100) | 6 (86) | 5 (100) | 2 (100) | 10 (100) | ||||||
| Sinusitis | 2 (7) | — | — | — | — | — | 2 (20) | ||||||
| Pharyngitis-laryngitis | 6 (20) | — | 2 (20) | 2 (29) | — | 2 (100) | 6 (60) | ||||||
| Frontal headache | 2 (7) | 5 (38) | 3 (30) | — | 2 (40) | — | 6 (60) | ||||||
| Conjunctivitis | — | 3 (23) | 2 (20) | — | 4 (67) | 2 (100) | 2 (20) | ||||||
| Tracheobronchial cough (no pneumonia) | 14 (47) | 4 (40) | 3 (30) | 6 (36) | 4 (80) | — | 4 (40) | ||||||
| Fever (> 37.5°C) | 13 (43) | 2 (15) | 5 (50) | 4 (57) | 5 (100) | 2 (100) | 6 (60) | ||||||
| Number of weekly follow-up NPA performed‡ | |||||||||||||
| 1 wk | 12/18 | 7/14 | 6/9 | 4/5 | 1/4 | 1/3 | 2/4 | 2/2 | NA | NA | NA | ||
| 2 wk | 7/11 | 2/4 | 4/5 | 2/2 | 1/1 | 0/3 | 0/3 | 0/2 | |||||
| ≥3 wk | 5/10 | 1/2 | 2/7 | 1/2 | 1/1 | 0/1 | — | ||||||
| Specific antiviral therapy: total treated n (%) | 16 (67) | 7 (47) | 10 (83) | 4 (57) | 4 (57) | — | 2 (50) | 1 (25) | NA | NA | NA | ||
| Death attributed to RV (n, % with LRTI) | 3 (23) | 0/4 | 2 (25) | 0/3 | 2 (50) | — | 0/3 | 6/1 | 0/1 | — | 2 (50) | 0/1 | |
| No other copathogens found | 1 | — | 1 | — | 1 | — | — | — | |||||
| Other copathogens involved | 2 | — | 1 | — | 2 (50) | — | |||||||
| Invasive aspergillosis | 2 | — | 2 | — | |||||||||
| Grant-negative bacilli | 1 | — | — | — | |||||||||
| Cytomegalovirus | 1 | — | 1 | — | 1 | — | 1 | — | |||||
Data are n (%) unless otherwise indicated.
There were 51 alloHSCTs and 32 auto HSCTs.
HSCT indicates hematopoietic stem cell transplantation; RV, respiratory virus; URTI, upper respiratory tract infection; LRTI, lower respiratory tract infection; NPA, nasopharyngeal aspirate; NA, not applicable.
The number of respiratory viruses was 101 in 83 episodes, because mixed viral episodes (> 1 respiratory virus isolated) occurred in 9 alloHSCT and 7 autoHSCT recipients (detailed in Table 2).
Specific URTI symptoms for each virus include both alloHSCT and autoHSCT because there were no differences in any symptom between the 2 transplant groups.
Numbers refer to still-positive NPAs in follow-up samples/number of patients who were resampled at each time point.