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Upper and/or lower respiratory tract infection caused by human metapneumovirus after allogeneic hematopoietic stem cell transplantation
Piñana, J. L., Tridello, G., Xhaard, A., Wendel, L., Montoro, J., Vazquez, L., Heras, I., Ljungman, P., Mikulska, M., Salmenniemi, U., et al
The Journal of infectious diseases. 2023
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Abstract
PATIENTS AND METHODS This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allogeneic stem cell transplantation (allo-HCT). RESULTS We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
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Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: a multicenter nationwide study
Zajac-Spychala, O., Pieczonka, A., Wachowiak, J., Fraczkiewicz, J., Salamonowicz, M., Kalwak, K., Gorczynska, E., Kazanowska, B., Wrobel, G., Chybicka, A., et al
Journal of medical virology. 2020
Abstract
The aim was to evaluate the incidence, clinical course and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72-month period, all-in 5,599 children with cancer: 2,441 patients with hematological malignancy (HM) and 3,158 with solid tumors (ST) and 971 patients after transplantation: 741 after allogeneic (allo-HSCT) and 230 after autologous (auto-HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; p<0.001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (p<0.001), including 78 (10.5%) patients after allo-HSCT and 3 (1.3%) after auto-HSCT. Time to develop AdVI was short, especially after allo-HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first-line therapy was cidofovir. None of the cancer patients died due to adenoviral infection, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients AdVIs are rare and associated with very good prognosis, even without specific treatment. However, in allo-HSCT recipients disseminated disease with fatal outcome is more likely to occur This article is protected by copyright. All rights reserved.