1550. Human Rhinovirus Infections in Patients with Hematologic Malignancy in the Greater New York City Area: an Interim Clinical and Molecular Epidemiologic Analysis
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Human rhinoviruses (HRVs) are the most common cause of upper respiratory infection (URI) in hematologic malignancy (HM) patients; however, predictors of lower respiratory disease including the impact of distinct HRV species and genotypes are poorly understood. 

Methods: At Weill Cornell Medical Center, symptomatic HM patients are routinely tested for 15 respiratory viruses via multiplex real-time PCR (BioFire Diagnostics, Inc. Salt Lake City, UT) on nasopharyngeal swab and/or bronchoalveolar lavage fluid specimens.  From March – November 2012, we prospectively collected HRV-positive respiratory specimens and performed genotyping by partial sequencing of viral protein 1 region.  Clinical data were abstracted from electronic medical records.  Factors associated with HRV pneumonia were evaluated by univariate analysis using Fisher's exact and Mann Whitney U tests and by multivariate analysis using logistic regression. 

Results: Sixty-three HM patients had HRV infection, including 47 (75%) and 16 (25%) episodes of URI and pneumonia, respectively.   Bacterial (N=4) and/or fungal (N=3) co-pathogens were detected in 6 (38%) cases of HRV pneumonia.  Among 52 patients with typeable HRVs, 43 were HRV-A, 1 was HRV-B, 8 were HRV-C, and 32 distinct HRV genotypes were detected.  Rates of pneumonia between patients infected with HRV-A (28%) versus HRV-C (12%) genotypes were similar (OR 2.7, 95%CI 0.3 – 24.4; p=0.4).  In univariate analysis, absolute lymphocyte count ≤ 200 cells/μl (OR 3.8, 95%CI 1.1 – 13.2; p=0.04), co-infection with another respiratory pathogen (OR 13.5, 95%CI 2.4 – 77; p=0.003), hypoalbuminemia (p=0.06) and absence of recent corticosteroid use (OR 7.0, 95%CI 0.8 – 58.3; p=0.07) were associated with HRV pneumonia.  Only lymphopenia remained associated with pneumonia in multivariate analysis (OR 4.7, 95%CI 0.9 – 24.7; p=0.06).  Four (9%) patients with URI on initial presentation progressed to HRV pneumonia within 30 days.  In the total cohort, pneumonia was the cause of death in one patient.

Conclusion: Lower respiratory disease is relatively common in immunocompromised hosts with HRV infection.  In this interim analysis of HM patients in the greater New York City area, the clinical spectrum of HRV infection was not attributable to HRV species or genotype.  Lymphopenia may be associated with HRV pneumonia.

Samantha Jacobs, MD1, Daryl Lamson, MT(ASCP)2, Rosemary Soave, MD1, Tsiporah Shore, MD1, Ellen Ritchie, MD1, Michael J. Satlin, MD1, Dana Zappetti, MD1, Audrey N. Schuetz, MD, MPH1, Stephen Jenkins, PhD1, Kirsten St. George, MD2 and Thomas J. Walsh, MD, FIDSA1, (1)Weill Cornell Medical Center/ New York Presbyterian Hospital, New York, NY, (2)Wadsworth Center, New York State Department of Health, Albany, NY

Disclosures:

S. Jacobs, None

D. Lamson, None

R. Soave, None

T. Shore, None

E. Ritchie, None

M. J. Satlin, None

D. Zappetti, None

A. N. Schuetz, None

S. Jenkins, None

K. St. George, None

T. J. Walsh, None

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