title: 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.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA. angela.campbell@seattlechildrens.org
authors.forename: Angela P
authors.initials: AP
authors.lastname: Campbell
authors.forename: Jason W
authors.initials: JW
authors.lastname: Chien
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D017934:Coronavirus; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D029121:Metapneumovirus; D008875:Middle Aged; D009975:Orthomyxoviridae; D011024:Pneumonia, Viral / Q000209:etiology / Q000821:virology*; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D012136:Respiratory Syncytial Viruses; D018108:Respirovirus; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D012367:RNA, Viral