Background
CARV infections are significant causes of morbidity and mortality in adult HSCT recipients. In 2008, the FDA approved the use of multiplex PCR assay to detect respiratory viruses. CARV infections have been studied mostly in the HSCT population where lymphopenia has been identified as a risk factor for poor outcomes. These infections have been less well studied in the acute leukemia population. This report, however, encompasses both patient populations.
Study Design
This is a retrospective cohort study of adult patients (>=18yrs) with acute leukemia and/or after HSCT diagnosed with laboratory documented CARV infections.
Results
Between Sep 1st 2009 and Nov 1st 2014, there were 493 episodes of CARV infections in 291 patients. Out of these, 228 patients were post-HSCT and 63 patients had acute leukemia. In these episodes, rhinovirus was found in 193, coronavirus in 80, parainfluenza in 62, influenza in 56 (IFV), RSV in 52, metapneumovirus in 29, adenovirus in 19, and 1 each of bocavirus and enterovirus. In 29 episodes, more than one virus was documented. 450 episodes were initially diagnosed as an upper respiratory tract infection (URI). There were 67 episodes (13.6%) of LRI; of these 24 had a prior URI with rhinovirus (n=9), IFV (n=4), parainfluenza (n=4), metapneumovirus (n=3), coronavirus (n=2), RSV (n=2) while 43 episodes were LRI at initial presentation (10 RSV, 9 parainfluenza, 7 rhinovirus, 6 metapneumovirus, 5 coronavirus, 3 IFV, 2 adenovirus, 1 enterovirus). Out of the 291 patients there were 23 deaths (7.9%). Per univariate analysis, only lymphopenia (<300/dl) at the time of diagnosis was associated with death (p-value = 0.01) and lymphopenia was also a risk for LRI and progression from URI to LRI p-value = 0.03.
Conclusion
In patients with acute leukemia and HSCT recipients lymphopenia at the time of RVI is an independent risk factor for LRI and death.
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