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
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
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DOI：
10.1086/651662
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发表时间：
2010-05-01
影响因子：
6.4
通讯作者：
Boeckh, Michael
中科院分区：
文献类型：
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作者：
Campbell, Angela P.;Chien, Jason W.;Boeckh, Michael
背景目前关于呼吸道病毒相关性肺炎造血细胞移植（HCT）受者下呼吸道样本中呼吸道病毒定量和血清中呼吸道病毒检测的数据很少。我们回顾性地确定了在支气管肺泡灌洗（BAL）样本中检测到呼吸道合胞病毒（RSV）、副流感病毒、流感病毒、偏肺病毒（MPV）和冠状病毒（CoV）的HCT接受者，并通过定量聚合酶链反应检测了储存的BAL和/或血清样本。在82例患者的85份BAL样本中，中位病毒载量如下：RSV（n = 35），2.6 x 10（6）拷贝/mL;副流感病毒（n = 35），4.9 x 10（7）拷贝/mL;流感病毒（n = 9），6.8 x 10（5）拷贝/mL; MPV（n = 7），3.9 x 10（7）拷贝/mL;对于CoV（n = 4），1.8 x 10（5）拷贝/mL。定量病毒载量与机械通气或死亡无关。在6/66例患者的血清样本中检出病毒RNA：4/41例RSV肺炎患者、1例B型流感患者和1例MPV/甲型流感病毒/CoV合并感染患者（检出甲型流感病毒和MPV RNA）。血清RSV检测与BAL样本中的高病毒载量相关（P = 0.05），血清病毒RNA检测与死亡显著相关（校正率比，1.8; P = 0.02）。定量聚合酶链反应检测来自患有呼吸道病毒性肺炎的HCT接受者的BAL样本中的高病毒载量。RSV、流感和MPV肺炎患者的血清中也可检测到病毒RNA，并且可能与疾病的严重程度相关。
Background. Few data exist on respiratory virus quantitation in lower respiratory samples and detection in serum from hematopoietic cell transplant (HCT) recipients with respiratory virus-associated pneumonia.Methods. We retrospectively identified HCT recipients with respiratory syncytial virus (RSV), parainfluenza virus, influenza virus, metapneumovirus (MPV), and coronavirus (CoV) detected in bronchoalveolar lavage (BAL) samples, and we tested stored BAL and/or serum samples by quantitative polymerase chain reaction.Results. In 85 BAL samples from 82 patients, median viral loads were as follows: for RSV (n = 35), 2.6 x 10(6) copies/mL; for parainfluenza virus (n = 35), 4.9 x 10(7) copies/mL; for influenza virus (n = 9), 6.8 x 10(5) copies/mL; for MPV (n = 7), 3.9 x 10(7) copies/mL; and for CoV (n = 4), 1.8 x 10(5) copies/mL. Quantitative viral load was not associated with mechanical ventilation or death. Viral RNA was detected in serum samples from 6 of 66 patients: 4 of 41 with RSV pneumonia, 1 with influenza B, and 1 with MPV/influenza A virus/CoV coinfection (influenza A virus and MPV RNA detected). RSV detection in serum was associated with high viral load in BAL samples (P = .05), and viral RNA detection in serum was significantly associated with death (adjusted rate ratio, 1.8; P = .02).Conclusion. Quantitative polymerase chain reaction detects high viral loads in BAL samples from HCT recipients with respiratory virus pneumonia. Viral RNA is also detectable in the serum of patients with RSV, influenza, and MPV pneumonia and may correlate with the severity of disease.