Community respiratory virus infections in patients with hematologic malignancies

Background and Objective. Pneumonia occurs frequently in patients receiving treatment for hematologic disorders, particularly after hematopoietic stem cell transplant. Some of these pneumonias have a viral etiology, herpesvirus and cytomegalovirus being classically recognized pathogens. The increased awareness of the importance of community respiratory viruses in this setting led us to conduct a survey of the cases of pneumonia occurring in patients with hematologic malignancies over an eight year period. Design and Methods. From January 1991 to November 1998, 224 bronchoalveolar lavages (BAL) were performed in 204 patients with hematologic malignancies and a suspected lower respiratory tract infection (RTI). Results. A community respiratory virus was isolated from the BAL of 21 patients (9% of BAL). The viruses isolated were influenza A (8), non-polio enterovirus (8), adenovirus (3), parainfluenza (2) and rhinovirus (1). All the non-transplanted patients with RTI were adults while half the stem cell transplant (SCT) recipients with RTI were children (100% vs 50%, p < 0.04). Overall, 76% of patients in whom respiratory viruses were found in the BAL developed pneumonia and 10 died from it (48% overall and 63% with pneumonia). There were no differences in the overall incidence of community respiratory virus infection of mortality rate between patients receiving autologous and allogeneic transplants. No difference in the occurrence of pneumonia between the SCT and non-SCT groups was observed, although more SCT recipients died from their pneumonia. Neutropenia was not an apparent risk factor for the development of pneumonia or mortality. Interpretation and Conclusions. In conclusion, our single-center experience confirms the importance of conventional respiratory viruses in serious lower respiratory tract infections. These infections are associated with a high mortality rate in SCT recipients. (C) 1999, Ferrata Storti Foundation.