Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection.
The incidence of respiratory virus infection after hematopoietic cell transplantation (HCT) has probably been underestimated with conventional testing methods in symptomatic patients. This prospective study assessed viral infection episodes by testing weekly respiratory samples collected from HCT recipients, with and without symptoms reported by questionnaire, for 100 days after HCT. Samples were tested by culture and direct fluorescent antibody testing for respiratory syncytial virus (RSV), parainfluenza virus (PIV), and influenza A and B, and by quantitative reverse transcription-polymerase chain reaction for RSV, PIV, influenza A and B, and metapneumovirus (MPV). Of 122 patients, 30 (25%) had 32 infection episodes caused by RSV (5), PIV (17), MPV (6), influenza (3), RSV, or influenza (1). PIV, with a cumulative incidence estimate of 17.9%, was the only virus for which asymptomatic infection was detected. Lower virus copy number in patients with no or one symptom compared with 2 or more symptoms was found for all viruses in all patients (P < .001), with PIV infection having a similar virus-specific comparison (P = .004). Subclinical infection with PIV may help explain why infection-control programs that emphasize symptoms are effective against RSV and influenza but often not against PIV.
Peck
Angela J
AJ
Department of Pediatrics, Children's Hospital and Regional Medical Center and University of Washington, Seattle, WA, USA.
Englund
Janet A
JA
Kuypers
Jane
J
Guthrie
Katherine A
KA
Corey
Lawrence
L
Morrow
Rhoda
R
Hackman
Robert C
RC
Cent
Anne
A
Boeckh
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002460:Cell Line; D002648:Child; D002675:Child, Preschool; D002522:Chlorocebus aethiops; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000628:therapy / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D011446:Prospective Studies; D012328:RNA Viruses / Q000235:genetics; D012367:RNA, Viral / Q000032:analysis / Q000235:genetics; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018571:Sentinel Surveillance; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014776:Virus Cultivation
D012367:RNA, Viral