title: Respiratory virus infection after allogeneic hematopoietic stem cell transplant in a tropical center: Predictive value of the immunodeficiency scoring index.
abstract: BACKGROUND
  Respiratory virus infection (RVI) is a prevalent infection in patients after allogeneic hematopoietic stem cell transplant (allo-HSCT) and can result in significant morbidity and mortality. Ability to assess the potential severity of RVI is important in the management of such patients.
  
  
  METHODS
  We reviewed the cases of RVI in allo-HSCT recipients and explored the predictive value of the immunodeficiency scoring index (ISI) established for respiratory syncytial virus (RSV) and its applicability for RVI caused by other respiratory viruses.
  
  
  RESULTS
  RVI occurred year-round in our tropical transplant center, with peaks in the middle and end of the year. Ninety-five of the 195 recipients developed a total of 191 episodes of RVI, giving a cumulative incidence of 28% by 6 months and 52% by 24 months for the first episode of RVI. RSV, influenza, rhinovirus, and parainfluenza were the most common viruses. Pneumonia occurred in 63.64%, 42.31%, and 32.42% of adenovirus, influenza, and RSV RVI episodes, respectively, but was also non-negligible in the more benign viruses, such as coronavirus (31.58%) and rhinovirus (23.68%). Nineteen of the 63 episodes of viral pneumonia required mechanical ventilation and 14 deaths occurred within 6 weeks of the RVI. Receiver operating characteristic analysis showed that an ISI of ≥8 predicted pneumonia with a positive predictive value of >80% for RVI caused by RSV, influenza, adenovirus, and parainfluenza, while it was not predictive for coronavirus and rhinovirus.
  
  
  CONCLUSIONS
  The ISI is a useful aid for decision-making during clinic consultation for patients presenting with symptoms suggestive of an RVI.
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Academic Medicine Research Institute, Duke-NUS Medical School, Singapore.
authors.forename: John
authors.initials: J
authors.lastname: Allen
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Colin
authors.initials: C
authors.lastname: Diong
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Yeow-Tee
authors.initials: YT
authors.lastname: Goh
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Sathish
authors.initials: S
authors.lastname: Gopalakrishnan
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ho
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: William
authors.initials: W
authors.lastname: Hwang
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lim
authors.affiliation: Pathology, Singapore General Hospital, Singapore.
authors.forename: Lynette
authors.initials: L
authors.lastname: Oon
authors.affiliation: Infectious Disease, Singapore General Hospital, Singapore.
authors.forename: Thuan-Tong
authors.initials: TT
authors.lastname: Tan
authors.affiliation: Haematology, Singapore General Hospital, Singapore.
authors.forename: Yeh-Ching
authors.identifier: http://orcid.org/0000-0001-8098-2590
authors.initials: YC
authors.lastname: Linn
authors.affiliation: Infectious Disease, Singapore General Hospital, Singapore.
authors.forename: Ban Hock
authors.initials: BH
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006402:Hematologic Diseases / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000453:epidemiology* / Q000276:immunology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012327:RNA Virus Infections / Q000453:epidemiology* / Q000821:virology; D012328:RNA Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014184:Transplantation, Homologous / Q000009:adverse effects; D014329:Tropical Climate / Q000009:adverse effects; D055815:Young Adult
keywords: immunodeficiency scoring index; pneumonia; respiratory virus infection