Incidence, significance, and persistence of human coronavirus infection in hematopoietic stem cell transplant recipients

Abstract

Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of respiratory viral infections and their associated complications. Unlike other respiratory viruses, little is known about the clinical significance of human coronavirus infection (HCoV) in this population. We retrospectively identified all HSCT recipients who were transplanted between May 2013 and June 2017 at our institution and characterized the cumulative incidence of post-transplant HCoV infection. Of 678 patients who underwent HSCT during the study period, 112 (17%) developed HCoV infection, making HCoV the fourth most common respiratory viral infection. Thirty-four (30%) HCoV-infected patients progressed to proven or probable lower respiratory tract infection (LRTI). Age ≥50, graft-versus-host disease, corticosteroids, hypoalbuminemia, and inpatient status at the time of infection were independently associated with progression to LRTI. Twenty-seven (59%) patients who underwent repeat NP swab had persistent viral shedding for ≥21 days, with a median duration of 4 weeks of viral shedding. We conclude that HCoV is common and clinically significant in HSCT recipients, with nearly one-third of patients progressing to proven or probable LRTI. Evaluating for LRTI risk factors found in this study may identify patients who require closer surveillance and aggressive supportive care when infected with HCoV.

Fig. 1

a Cumulative incidence of post-transplant respiratory viral infection in 678 hematopoietic stem cell transplant (HSCT) recipients from May 2013 through June 2017. Incidence is expressed as a percent of all HSCT recipients infected. b Infection by coronavirus (HCoV) serotype expressed as a percentage of total HCoV infections in 112 patients transplanted between May 2013 and July 2017. The four serotypes were OC43, NL63, HKU1, and 229E. Multiple denotes patients infected with 2 strains: 4 patients had HKU1 and OC43, 2 patients had HKU1 and 229E, 1 patient had NL63 and OC43, and 1 patient had NL63 and 229E

Fig. 2

Seasonality of human coronavirus (HCoV) infections in hematopoietic stem cell transplant (HSCT) recipients, by HCoV serotype from May 2013 through June 2017. HCoV infection was more common in the winter months (December through March)

Fig. 3

a A representative CT scan of a patient infected with coronavirus (HCoV) who progressed to proven lower respiratory tract infection (LRTI) without co-infection with a secondary respiratory virus. The CT demonstrates diffuse ground glass opacities, interlobular septal thickening in the airways and bilateral pleural effusions. b A representative CT scan of another patient infected with coronavirus (HCoV) who progressed to a proven lower respiratory tract infection (LRTI). The scan demonstrates focal areas of consolidation with air bronchograms and left lingular and left lower lobe ground glass opacities

Fig. 4

Respiratory co-pathogens in coronavirus (HCoV)-infected hematopoietic stem cell transplant recipients who progressed to proven or probable lower respiratory tract infection (LRTI)