Prospective study of respiratory viral infections in pediatric hemopoietic stem cell transplantation patients.

Bredius, Robbert G M; Templeton, Kate E; Scheltinga, Sitha A; Claas, Eric C J; Kroes, Aloys C M; Vossen, Jaak M

BACKGROUND Community-acquired respiratory viruses are an important cause of respiratory disease in pediatric patients undergoing hemopoietic stem cell transplantation. However, there are no studies examining the impact of more rapid and sensitive diagnosis by real time polymerase chain reaction (PCR) in this population. We performed a prospective study to assess the impact of real time PCR diagnosis as well as protective isolation for community-acquired respiratory virus infections in pediatric patients undergoing hemopoietic stem cell transplantation. METHODS During a 2-year period, 39 pediatric patients undergoing hemopoietic stem cell transplantation were analyzed for presence of respiratory viruses. Samples were taken at regular intervals and analyzed by culture and newly developed real time PCR methods. All patients were cared for in protective isolation. RESULTS Respiratory symptoms were observed in 10 of the 39 cases (26%) and a virus was identified in 8 and 6 of these cases by PCR and culture, respectively. The PCR detected the respiratory infection a median of 8 days before culture. However, the morbidity of the respiratory infections was generally mild, and no mortality was observed. Additionally all infections were observed pretransplant or after discharge; no nosocomial infections were observed. CONCLUSIONS The real time PCR assay is more rapid and sensitive than culture and could be used to screen patients before transplant or as respiratory symptoms present for timely diagnosis.