Detection of community-acquired respiratory viruses in allogeneic stem-cell transplant recipients and controls-A prospective cohort study.
BACKGROUND
Community-acquired respiratory viruses (CARV) cause upper and lower respiratory tract infections (URTI/LRTI) and may be life-threatening for recipients of an allogeneic stem cell transplantation (allo-SCT).


METHODS
In a prospective study encompassing 4 winter-seasons, we collected throat gargles (TG) at random time points from allo-SCT recipients (patients) and controls and followed them up for at least 3 weeks including repetitive sampling and documentation of symptoms. A Multiplex-PCR system to identify 20 CARV and Mycoplasma pneumoniae was used to detect CARV.


RESULTS
One hundred ninety-four patients with 426 TG and 273 controls with 549 TG were included. There were more patients with a positive test result (25% vs 11% in the controls), and the patients had a higher number of positive TG (70 = 16%) compared to controls (32 = 6%) (P < .001). Altogether, 115 viruses were detected. Multiple viruses in one TG (11/48, 34%) and prolonged shedding were only observed in patients (13/48, 27%). Patients had more RSV (18/83, 26%) and adenovirus (15/83, 21%) than controls (both viruses 2/32, 6%). Independent risk factors for the detection of CARV included age >40 years (OR 3.38, 95% CI 1.8-6.4, P < .001) and presence of URTI-symptoms (OR 3.22, 95% CI 1.9-5.5, P < .001). No controls developed a LRTI or died whereas 4/48 (8%) patients developed a LRTI (coronavirus in 2, RSV in 1 and influenza A H1N1 in 1 patient). One patient died of CARV (influenza A H1N1).


CONCLUSION
Allo-SCT-recipients have more CARV-infections, exhibit a different epidemiology, have more cases of co-infection or prolonged shedding and have a higher rate of LRTI and mortality.
['Rachow|Tobias|T|', 'Lamik|Toni|T|', 'Kalkreuth|Jana|J|', 'Kurze|Stephanie|S|', 'Wagner|Kathleen|K|', 'Stier|Pia|P|', 'Hammersen|Friedrich J|FJ|', 'Rüthrich|Maria Madeleine|MM|', 'Winkelmann|Nils|N|', 'Klink|Anne|A|', 'Hilgendorf|Inken|I|', 'Hermann|Beate|B|', 'Lang|Susanne|S|', 'Hochhaus|Andreas|A|', 'von Lilienfeld-Toal|Marie|M|https://orcid.org/0000-0002-9756-3541']
D000256:Adenoviridae D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D017714:Community-Acquired Infections D003332:Coronaviridae D005260:Female D006801:Humans D007165:Immunosuppression Therapy D053118:Influenza A Virus, H1N1 Subtype D008297:Male D008875:Middle Aged D009177:Mycoplasma pneumoniae D011446:Prospective Studies D012136:Respiratory Syncytial Viruses D012141:Respiratory Tract Infections D012307:Risk Factors D033581:Stem Cell Transplantation D066027:Transplant Recipients D014184:Transplantation, Homologous D014777:Virus Diseases D017201:Virus Shedding D055815:Young Adult
CARV epidemiology immunosuppression