1103. Clinical Features of Human Rhinovirus Infections in Hematopoietic Stem Cell Transplant Recipients
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Viral respiratory tract infections are associated with significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT). Few studies have characterized the clinical spectrum of human rhinovirus (HRV)-associated respiratory infections in HSCT recipients.

Methods:  At our institution, all patients admitted to the HSCT service with upper or lower respiratory tract symptoms are routinely screened for a panel of 12 respiratory viruses including influenza A, respiratory syncytial virus (RSV) and HRV by real-time polymerase chain reaction. A retrospective study of HSCT recipients testing positive for HRV in nasopharyngeal or bronchoalveolar lavage (BAL) specimens between March 2008 and April 2011 was performed. Demographic, clinical, and laboratory data were abstracted from existing medical records.

Results:  After influenza A and RSV, HRV was the most commonly isolated respiratory virus. During the study period, HRV was detected in 32 HSCT recipients, of whom 25 (78%) underwent allogeneic HSCT and seven (22%) underwent autologous HSCT. HRV was initially detected from nasopharyngeal swab specimens in 25 patients and from BAL in seven patients. The median time from transplantation to HRV detection was 147 days. Fourteen (44%) patients tested positive within 90 days after transplant. In 27 (84%) patients, HRV was the only pathogen isolated, while viral co-infection occurred in two patients (influenza A and human metapneumovirus). Fourteen (44%) patients had one or more subsequent bacterial pneumonias requiring hospitalization; 11 (76%) readmissions occurred within 90 days of HRV detection. At the time of subsequent bacterial pneumonia, 12 patients were re-tested for HRV, of whom nine were still positive. In eight (25%) patients that underwent subsequent bronchoscopy due to persistent respiratory symptoms, all had HRV detected by BAL.

Conclusion:  In a subset of HSCT recipients with HRV, nearly half required hospital readmission for bacterial pneumonia. HRV was commonly detected in the lower respiratory tract of symptomatic patients. A better understanding of the factors associated with HRV infection and its impact on subsequent respiratory infections in the HSCT population is needed.


Subject Category: O. Transplant infectious diseases

Samantha Jacobs, MD, Infectious Diseases, New York Presbyterian Hospital/ Weill Cornell , New York, NY, Audrey N. Schuetz, MD, MPH, Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, Tsiporah Shore, MD, Hematology and Oncology, Weill Cornell Medical College/ NewYork-Presbyterian Hospital, New York, NY, Thomas Walsh, MD, FIDSA, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical College, New York, NY, Michael J. Satlin, MD, Weill Cornell Medical College, New York, NY, Stephen Jenkins, PhD, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY and Rosemary Soave, MD, Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY

Disclosures:

S. Jacobs, None

A. N. Schuetz, None

T. Shore, None

T. Walsh, None

M. J. Satlin, None

S. Jenkins, Pfizer: Scientific Advisor, Consulting fee
Forest : Scientific Advisor, Consulting fee
Bayer: Scientific Advisor, Consulting fee

R. Soave, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.