title: Human rhinovirus infections of the lower respiratory tract in hematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Human rhinoviruses (HRVs) are a common cause of upper respiratory infection (URI) in hematopoietic stem cell transplant (HSCT) recipients; yet, their role in lower respiratory illness is not well understood.
  
  
  METHODS
  We performed a retrospective chart review of HSCT recipients with HRV infection from the time molecular detection methods were implemented at our institution in 2008. Factors associated with proven or possible HRV pneumonia at the first HRV detection were evaluated by univariate and multivariate analysis. We then characterized all episodes of proven and possible HRV pneumonia from the initial HRV infection through a 1-year follow-up period.
  
  
  RESULTS
  Between 2008 and 2011, 63 HSCT recipients had ≥1 documented HRV infections. At first HRV detection, 36 (57%) patients had HRV URI and 27 (43%) had proven or possible HRV pneumonia; in multivariate analysis, hypoalbuminemia (odds ratio [OR] 9.5, 95% confidence interval [CI] 1.3-71.7; P = 0.03) and isolation of respiratory co-pathogen(s) (OR 24.2, 95% CI 2.0-288.4; P = 0.01) were independently associated with pneumonia. During the study period, 22 patients had 25 episodes of proven HRV pneumonia. Fever (60%), cough (92%), sputum production (61%), and dyspnea (60%) were common symptoms. Fifteen (60%) episodes demonstrated bacterial (n = 7), fungal (n = 5), or viral (n = 3) co-infection. Among the remaining 10 (40%) cases of HRV monoinfection, patients' oxygen saturations ranged from 80% to 97% on ambient air, and computed tomography scans showed peribronchiolar, patchy, ground glass infiltrates.
  
  
  CONCLUSIONS
  HRV pneumonia is relatively common after HSCT and frequently accompanied by bacterial co-infection. As use of molecular assays for respiratory viral diagnosis becomes widespread, HRV will be increasingly recognized as a significant cause of pneumonia in immunocompromised hosts.
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Jacobs
authors.forename: R
authors.initials: R
authors.lastname: Soave
authors.forename: T B
authors.initials: TB
authors.lastname: Shore
authors.forename: M J
authors.initials: MJ
authors.lastname: Satlin
authors.forename: A N
authors.initials: AN
authors.lastname: Schuetz
authors.forename: C
authors.initials: C
authors.lastname: Magro
authors.forename: S G
authors.initials: SG
authors.lastname: Jenkins
authors.forename: T J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology; D060085:Coinfection; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000382:microbiology; D010850:Picornaviridae Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D011024:Pneumonia, Viral / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000821:virology; D012189:Retrospective Studies; D012229:Rhinovirus / Q000302:isolation & purification*; D012621:Seasons; D055815:Young Adult
keywords: HSCT; hematopoietic stem cell transplantation; human rhinovirus; lower respiratory infections; viral pneumonia
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