Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May 1;201(9):1404-13.
doi: 10.1086/651662.

Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT

Angela P Campbell  1 , Jason W Chien, Jane Kuypers, Janet A Englund, Anna Wald, Katherine A Guthrie, Lawrence Corey, Michael Boeckh
Affiliations

Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT

Angela P Campbell et al. J Infect Dis. .

Abstract

Background: Few data exist on respiratory virus quantitation in lower respiratory samples and detection in serum from hematopoietic cell transplant (HCT) recipients with respiratory virus-associated pneumonia.

Methods: We retrospectively identified HCT recipients with respiratory syncytial virus (RSV), parainfluenza virus, influenza virus, metapneumovirus (MPV), and coronavirus (CoV) detected in bronchoalveolar lavage (BAL) samples, and we tested stored BAL and/or serum samples by quantitative polymerase chain reaction.

Results: In 85 BAL samples from 82 patients, median viral loads were as follows: for RSV (n = 35), 2.6 x 10(6) copies/mL; for parainfluenza virus (n = 35), 4.9 x 10(7) copies/mL; for influenza virus (n = 9), 6.8 x 10(5) copies/mL; for MPV (n = 7), 3.9 x 10(7) copies/mL; and for CoV (n = 4), 1.8 x 10(5) copies/mL. Quantitative viral load was not associated with mechanical ventilation or death. Viral RNA was detected in serum samples from 6 of 66 patients: 4 of 41 with RSV pneumonia, 1 with influenza B, and 1 with MPV/influenza A virus/CoV coinfection (influenza A virus and MPV RNA detected). RSV detection in serum was associated with high viral load in BAL samples (p = .05), and viral RNA detection in serum was significantly associated with death (adjusted rate ratio, 1.8; (p = .02).

Conclusion: Quantitative polymerase chain reaction detects high viral loads in BAL samples from HCT recipients with respiratory virus pneumonia. Viral RNA is also detectable in the serum of patients with RSV, influenza, and MPV pneumonia and may correlate with the severity of disease.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest: A.P.C. has received research support from MedImmune. J.A.E. has received research support from Sanofi Pasteur, MedImmune, ADMA Biologics, Adamas Pharmaceuticals, and Novartis. M.B. has received research support from ADMA Biologics, Adamas Pharmaceuticals, and Roche Pharmaceuticals and is a consultant for Roche Pharmaceuticals and Novartis. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Specimens available for testing from 104 hematopoietic cell transplant (HCT) recipients. BAL, bronchoalveolar lavage.
Figure 2.
Figure 2.
Respiratory virus-specific quantitative viral loads in bronchoalveolar lavage (BAL) fluid. The BAL sample with the maximum viral load per pneumonia episode is shown and was used to calculate the median value for each virus. A, Eighty-five BAL samples from 82 hematopoietic cell transplant (HCT) recipients (the total for viruses is 90 because 3 samples included multiple viruses). B, Forty-nine BAL samples from 44 HCT recipients with corresponding BAL and serum samples (the total for viruses is 49 because 2 samples included multiple viruses and 2 patients had 2 episodes of pneumonia). Black markers (2 for respiratory syncytial virus [RSV], 2 for influenza virus [Flu], and 1 for metapneumovirus [MPV]) indicate that viral RNA was detected in the corresponding serum sample; white markers indicate that the serum sample was negative for the same respiratory virus. Parenthetical values on the horizontal axis indicate the number of positive samples for each virus; medians are shown at the top of the graph. Horizontal bars represent the median value for each virus. PIV, parainfluenza virus; CoV, coronavirus.
Figure 3.
Figure 3.
Median quantitative bronchoalveolar lavage (BAL) viral load from the first positive BAL samples associated with respiratory virus pneumonia in 77 patients, in the presence or absence of clinical characteristics.
Table 2.
Table 2.
Quantitative Reverse-Transcription Polymerase Chain Reaction Results for Serum Samples from 66 Hematopoietic Cell Transplant Recipients
Table 4.
Table 4.
Outcomes among Allogeneic Hematopoietic Cell Transplant (HCT) Recipients with Post-HCT Pneumonia, With and Without Viral RNA Detection in Serum, Shown Separately for Patients with Pneumonia Due to All Viral Infections and Patients with Respiratory Syncytial Virus (RSV) Pneumonia Alone
Table 1.
Table 1.
Characteristics of 104 Hematopoietic Cell Transplant (HCT) Recipients with Virologically Confirmed Respiratory Virus Pneumonia, Grouped by Stored Samples Available for Respiratory Virus Testing by Quantitative Reverse-Transcription Polymerase Chain Reaction
Table 3.
Table 3.
Characteristics of 6 Hematopoietic Cell Transplant (HCT) Recipients with Pneumonia and Respiratory Virus RNA Detected in Serum Samples
See this image and copyright information in PMC

References

    1. Boeckh M, Berrey MM, Bowden RA, Crawford SW, Balsley J, Corey L. Phase 1 evaluation of the respiratory syncytial virus-specific monoclonal antibody palivizumab in recipients of hematopoietic stem cell transplants. J Infect Dis. 2001;184:350–354. - PubMed
    1. Champlin RE, Whimbey E. Community respiratory virus infections in bone marrow transplant recipients: the M.D. Anderson Cancer Center experience. Biol Blood Marrow Transplant. 2001;7(suppl):8S–10S. - PubMed
    1. Ljungman P, Gleaves CA, Meyers JD. Respiratory virus infection in immunocompromised patients. Bone Marrow Transplant. 1989;4:35–40. - PubMed
    1. Martino R, Porras RP, Rabella N, et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Biol Blood Marrow Transplant. 2005;11:781–796. - PMC - PubMed
    1. Nichols WG, Corey L, Gooley T, Davis C, Boeckh M. Parainfluenza virus infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood. 2001;98:573–578. - PubMed

Publication types

MeSH terms