Viral Infections in Hematopoietic Stem Cell Transplant Recipients

Clinical features and outcome of 2009-influenza A (H1N1) after allogeneic hematopoietic SCT

“…H1N1-related LRTI developed in 50%, of patients, which is in the range of 31-68% of almost all other series. [14][15][16]18,19,26,27 The 30% mechanical ventilation and 20% case fatality rates observed in our study correspond to those found in other small series, 16,18,19,[27][28][29] but are higher than the frequencies reported in larger series (4.0-13.5% and 3.0-7.3%, respectively). 14,22,26 Although this may reflect a reporting bias if patients with more severe illness were more likely to come to medical attention, we believe that allo-HSCT recipients are at higher risk for severe complications, notably in case of development of H1N1 oseltamivir-resistant strains 15,19 or concomitant respiratory pathogens.…”

“…15,18 Close contact with children was the most common presumed mode of transmission in our series, which is not surprising as this has been previously reported as the most significant risk factor of developing RVIs. 1 Indeed, approximately one child in every three was infected with H1N1 in England, 24 whereas in the United States, the rate of secondary outbreaks in households was 13% with children at increased risk for infection by a factor of 4.…”

“…Several studies have described H1N1 infection in allo-HSCT (Table 2), [14][15][16][17][18][19] but its clinical spectrum is still being defined. Here, we report the impact of the H1N1 epidemic in a population of allo-HSCT recipients who were followed up in the long term in a clinic using standardized guidelines.…”

“…Interestingly, LRTI, prolonged viral shedding, hospitalization, longer antiviral treatment, ventilator requirement and H1N1 resistance were documented only in SID patients. Lymphopenia, which has been previously reported as a risk factor for LRTI, both for community-acquired RVI [1][2][3][4]33 and for H1N1 influenza 9,[14][15][16][17][18]26 was observed in six patients at the time of diagnosis. Chronic GvHD and its corollary of long-term immunosuppression has also been associated with the risk of developing RVI and LRTI.…”

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] days. Patients UPN 4 and 7 died of respiratory failure within 54 and 94 days of symptom onset, respectively, resulting in a case fatality rate of 20%.…”