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Comparative Study
. 2005 Mar 1;40(5):662-9.
doi: 10.1086/427801. Epub 2005 Feb 7.

Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture

Marian G J van Kraaij  1 , Leontine J R van Elden, Anton M van Loon, Karin A W Hendriksen, Laurens Laterveer, Adriaan W Dekker, Monique Nijhuis
Affiliations
Comparative Study

Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture

Marian G J van Kraaij et al. Clin Infect Dis. .

Abstract

Background: Respiratory virus infections have been recognized as important causes of severe pneumonia in patients who have undergone stem cell transplantation (SCT). Reported incidences of respiratory virus infection in adult SCT recipients vary in the literature from 3.5% to 36% when determined by viral culture. However, a more sensitive method to assess the presence of respiratory viruses in the lower airways may be important for delineation of the true incidence of respiratory virus-associated pneumonia and may be essential for guidance on implementation of antiviral therapy and prevention or limitation of nosocomial spread of infection with respiratory viruses.

Methods: To determine the incidence and severity of respiratory tract illness (RTI) and to assess the diagnostic value of real-time reverse-transcriptase polymerase chain reaction (RT-PCR) versus viral culture, 72 SCT recipients were monitored during a 6-month period.

Results: A respiratory virus was detected in 21% of episodes of RTI by viral culture and in 63% of RTI episodes by real-time RT-PCR (P<.0001). In lower respiratory tract illness, real-time RT-PCR was much more sensitive than viral culture for detection of respiratory virus (73% vs. 9%; P=.008). The mortality rate for patients with respiratory virus-associated lower respiratory tract illness (25%) was similar to rates reported elsewhere. Respiratory viruses (predominantly rhinovirus) were detected by real-time RT-PCR in 9% of samples obtained from symptom-free SCT recipients at predetermined times by real-time RT-PCR and by viral culture in 1% (P<.0001), indicating that asymptomatic shedding of respiratory viruses also occurs.

Conclusion: We conclude that, although asymptomatic shedding of respiratory virus occurs, respiratory viruses are frequent causes of RTI in SCT recipients.

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Figures

Table 1
Table 1
Characteristics of stem cell transplant (SCT) recipients.
Table 2
Table 2
Comparison between episodes of respiratory tract illnesses with or without a detectable respiratory virus present.
Table 3
Table 3
Respiratory viruses detected either by viral culture or by real-time RT-PCR in 52 episodes of respiratory tract illness (RTI).
Table 4
Table 4
Differences between patients who received allogeneic stem cell transplants (SCTs) from a sibling donor, those who received SCTs from a voluntary, unrelated donor (VUD), and those who received autologous SCTs.
Table 5
Table 5
Findings for 259 surveillance nose-throat samples analyzed with viral culture and real-time RT-PCR in a study of respiratory tract illness.
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References

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