Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea

Hong, Kyung-Wook; Choi, Su-Mi; Lee, Dong-Gun; Cho, Sung-Yeon; Lee, Hyo-Jin; Choi, Jae-Ki; Kim, Si-Hyun; Park, Sun Hee; Choi, Jung-Hyun; Yoo, Jin-Hong; Lee, Jong-Wook

The characteristics of the LRDs caused by the various CRVs are described in Table 2 . The most common type and extent of radiographic infiltration of influenza-caused LRDs were alveolar pattern (64.3%) and bilateral lung field (85.7%), respec-tively. Seven (50%) of 14 patients with influenza-LRDs received antiviral therapy, and all received it within 48 hours following influenza-LRD diagnosis. However, early antiviral therapy within 48 hours after symptom onset was performed for only 3 (21.4%) patients. One patient received combination therapy with peramivir (600 mg/day for 8 days) and oseltamivir (300 mg/day for 15 days). Five (35.7%) patients experienced mechanical ventilation, and the 30-day overall mortality rate of these patients was 35.7% (5/14) . Two patients were diagnosed with the influenza A (H1N1) pdm09 virus, of which one died due to respiratory failure on day 28 following the diagnosis. Of the 31 patients with RSV-LRDs, 41.9% (13/31) were hospitalacquired and 9.7% (3/31) received antiviral therapy. The 30day overall mortality rate was 25.8% (8/31) for these patients. Two patients with RSV-LRDs were treated with oral ribavirin, one with aerosolized ribavirin, and all received intravenous immunoglobulin (IVIG; 1-1.5 g/kg for 1-2 days). The patient who received aerosolized ribavirin and IVIG survived, whereas the two patients treated with oral ribavirin died. Seven (36.8%) of the 19 patients with HPIV-LRDs received oral ribavirin (800 mg/day for 11-26 days). The 30-day overall mortality rate of patients with HPIV-LRDs was 31.6% (6/19). Four (57.1%) of seven patients with HRhV-LRDs required mechanical ventilation, and the 30-day mortality rate for these patients was 14.3% (1/7). Co-pathogens isolated from respiratory specimens were detected in 33.8% (23/67) of patients with CRV-LRDs. The most common bacterial co-pathogen was Acinetobacter baumannii (n=7; 10.4%), followed by Pseudomonas aeruginosa (n=5; 7.4%) and Streptococcus pneumoniae (n=4; 5.9%). Aspergillus species were detected in 6 patients and CMV-PCR of the BAL fluid was positive for two patients. Only 2 patients died without pneumonia being the cause of death, one due to septic shock as a result of infectious colitis and one due to diffuse alveolar hemorrhage.