Format

Send to

Choose Destination
Blood. 2015 Jun 11;125(24):3789-97. doi: 10.1182/blood-2014-12-617035. Epub 2015 Apr 27.

Idiopathic pneumonia syndrome after hematopoietic cell transplantation: evidence of occult infectious etiologies.

Author information

1
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
2
Department of Microbiology and Immunology, University of Montreal, Montreal, Canada;
3
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA;
4
Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA;
5
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
6
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medicine, and.
7
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA; Department of Pathology, University of Washington, Seattle, WA;
8
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pathology, University of Washington, Seattle, WA;
9
Department of Laboratory Medicine, University of Washington, Seattle, WA;
10
Department of Pediatrics, Samsung Medical Center, Sungkyungkwan University, School of Medicine, Seoul, Korea; and.
11
Hematopoietic Stem Cell Transplantation Division, National Cancer Research Center Hospital, Tokyo, Japan.
12
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medicine, and.
13
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medicine, and.

Abstract

Newer diagnostic methods may link more idiopathic pneumonia syndrome (IPS) cases to an infectious agent. Bronchoalveolar lavage (BAL) samples from 69 hematopoietic cell transplant (HCT) recipients with IPS diagnosed between 1992 and 2006 were tested for 28 pathogens (3 bacteria and 25 viruses) by quantitative polymerase chain reaction and for Aspergillus by galactomannan assay. Research BALs from 21 asymptomatic HCT patients served as controls. Among 69 HCT patients with IPS, 39 (56.5%) had a pathogen detected. The most frequent pathogens were human herpesvirus-6 (HHV-6) (N = 20 [29%]) followed by human rhinovirus (HRV), cytomegalovirus (CMV), and Aspergillus (N = 8 [12%] in each). HHV-6 and HRV were rarely detected in controls, whereas CMV and Aspergillus were occasionally detected with low pathogen load. Patients with pathogens had worse day-100 survival than those without (hazard ratio, 1.88; P = .03). Mortality in patients with only pathogens of "uncertain" significance in lung was similar to that in patients with pathogens of "established" significance. Metagenomic next-generation sequencing did not reveal additional significant pathogens. Our study demonstrated that approximately half of patients with IPS had pathogens detected in BAL, and pathogen detection was associated with increased mortality. Thus, an expanded infection detection panel can significantly increase the diagnostic precision for idiopathic pneumonia.

PMID:
25918347
PMCID:
PMC4463739
DOI:
10.1182/blood-2014-12-617035
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center