title: Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea.
abstract: OBJECTIVE
  To describe the incidence, clinical courses, and risk factors for mortality of lower respiratory tract diseases (LRDs) caused by common respiratory viruses (CRVs) in stem cell transplantation (SCT) recipients.
  
  
  METHODS
  We retrospectively reviewed the medical records of 1038 patients who received SCT between January 2007 and August 2011 at a single center in Korea.
  
  
  RESULTS
  Seventy-one CRV-LRDs were identified in 67 (6.5%) patients. The human parainfluenza virus (HPIV) was the most common causative pathogen of CRV-LRDs at 100 days [cumulative incidence estimate, 23.5%; 95% confidence interval (CI), 3.3-43.7] and 1 year (cumulative incidence estimate, 69.2%; 95% CI, 45.9-92.5) following SCT. The 30-day overall mortality rates due to influenza-LRDs, respiratory syncytial virus-LRDs, HPIV-LRDs, and human rhinovirus-LRDs were 35.7, 25.8, 31.6, and 42.8%, respectively. Co-pathogens in respiratory specimens were detected in 23 (33.8%) patients. The overall mortality at day 30 after CRV-LRD diagnosis was 32.8% (22/67). High-dose steroid usage (p=0.025), a severe state of immunodeficiency (p=0.033), and lymphopenia (p=0.006) were significantly associated with death within 30 days following CRV-LRD diagnosis in a univariate analysis. Multivariate logistic regression analysis revealed that high-dose steroid usage [odds ratio (OR), 4.05; 95% CI, 1.12-14.61; p=0.033] and lymphopenia (OR, 6.57; 95% CI, 1.80-24.03; p=0.004) were independent risk factors for mortality within 30 days of CRV-LRDs.
  
  
  CONCLUSIONS
  CRV-LRDs among SCT recipients showed substantially high morbidity and mortality rates. Therefore, the implement of an active diagnostic approaches for CRV infections is required for SCT recipients with respiratory symptoms, especially those receiving high-dose steroids or with lymphopenia.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Kyung Wook
authors.initials: KW
authors.lastname: Hong
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Su Mi
authors.initials: SM
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. symonlee@catholic.ac.kr.
authors.forename: Dong Gun
authors.initials: DG
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyo Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jae Ki
authors.initials: JK
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine-Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Yoo
authors.affiliation: The Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000401:mortality; D015994:Incidence; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D008231:Lymphopenia / Q000401:mortality; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D010253:Respirovirus Infections / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000401:mortality; D013256:Steroids / Q000008:administration & dosage
chemical_list: D013256:Steroids
keywords: Hematopoietic stem cell transplantation; human parainfluenza virus; influenza virus; respiratory syncytial virus; rhinovirus