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Pérez A, Gómez D, Montoro J, Chorão P, Hernani R, Guerreiro M, Villalba M, Albert E, Carbonell-Asins JA, Hernández-Boluda JC, Navarro D, Solano C, Piñana JL. Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease. Bone Marrow Transplant 2024; 59:1118-1126. [PMID: 38730040 DOI: 10.1038/s41409-024-02304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.
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Affiliation(s)
- Ariadna Pérez
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Carlos Hernández-Boluda
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain.
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Piñana JL, Cesaro S, Mikulska M, Verweij PE, Bergeron A, Neofytos D, Styczynski J, Sánchez-Ortega I, Greco R, Onida F, Yakoub-Agha I, Averbuch D, Cámara RDL, Ljungman P. Pitfalls in definitions on respiratory viruses and particularities of Adenovirus infection in hematopoietic cell transplantation patients: Recommendations from the EBMT practice harmonization and guidelines committee. Curr Res Transl Med 2024; 72:103461. [PMID: 39032263 DOI: 10.1016/j.retram.2024.103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
In 2023, the EBMT Practice harmonization and Guidelines Committee partnered with the EBMT Infection Diseases Working Party (IDWP) to undertake the task of delivering best practice recommendations, aiming to harmonize by expert consensus, the already existing definitions and future epidemiological and clinical studies among centers of the EBMT network. To attain this objective, a group of experts in the field was convened. The workgroup identified and discussed some critical aspects in definitions of community-acquired respiratory viruses (CARV) and adenovirus (ADV) infections in recipient of hematopoietic cell transplant (HCT). The methodology involved literature review and expert consensus. For CARV, expert consensus focused on defining infection severity, infection duration, and establishing criteria for lower respiratory tract disease (LRTD). For ADV, the expert consensus focused on surveillance methods and the definitions of ADV infection, certainty levels of disease, response to treatment, and attributable mortality. This consensus workshop provided indications to EBMT community aimed at facilitating data collection and consistency in the EBMT registry for respiratory viral infectious complications.
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Affiliation(s)
- José Luis Piñana
- Department of Hematology. Hospital Clínico Universitario of Valencia, INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paul E Verweij
- Department of Medical Microbiology and Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne Bergeron
- Division of Pulmonology, University Hospitals of Geneva, Geneva, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, Division of Infectious Diseases, University Hospitals Geneva, Geneva, Switzerland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun UMK, University Hospital, Bydgoszcz, Poland
| | | | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Onida
- Hematology and BMT Unit ASST Fatebenefratelli, Sacco University of Milan, Italy
| | | | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | | | - Per Ljungman
- Dept. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden; Dept. of Medicine Huddinge, Karolinska Institutet (KI), Stockholm, Sweden.
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Pérez A, Montoro J, Chorão P, Gómez D, Guerreiro M, Giménez E, Villalba M, Sanz J, Hernani R, Hernández-Boluda JC, Lorenzo I, Navarro D, Solano C, Ljungman P, Piñana JL. Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy. Infection 2024:10.1007/s15010-024-02213-0. [PMID: 38653955 DOI: 10.1007/s15010-024-02213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND This retrospective study focused on analyzing community-acquired respiratory virus (CARV) infections, in particular human parainfluenza virus (hPIV) after allogeneic stem cell transplant (allo-SCT) in adults recipients. It aimed to assess the impact of ribavirin treatment, clinical characteristics, and risk factors associated with lower respiratory tract disease (LRTD) progression and all-cause mortality. PATIENTS AND METHODS The study included 230 allo-SCT recipients diagnosed with hPIV between December 2013 and June 2023. Risk factors for the development of LRTD, disease severity, and mortality were analyzed. Ribavirin treatment was administered at physician discretion in 61 out of 230 cases (27%). RESULTS Risk factors for LRTD progression in multivariate analysis were corticosteroids > 30 mg/day (Odds ratio (OR) 3.5, 95% Confidence Interval (C.I.) 1.3-9.4, p = 0.013), fever at the time of hPIV detection (OR 3.89, 95% C.I. 1.84-8.2, p < 0.001), and absolute lymphocyte count (ALC) < 0.2 × 109/L (OR 4.1, 95% C.I. 1.42-11.9, p = 0.009). In addition, the study found that ribavirin therapy significantly reduced progression to LRTD [OR 0.19, 95% C.I. 0.05-0.75, p = 0.018]. Co-infections (OR 5.7, 95% C.I. 1.4-23.5, p = 0.015) and ALC < 0.2 × 109/L (OR 17.7, 95% C.I. 3.6-87.1, p < 0.001) were independently associated with higher day + 100 after hPIV detection all-cause mortality. There were no significant differences in all-cause mortality and infectious mortality at day + 100 between the treated and untreated groups. CONCLUSION ALC, corticosteroids, and fever increased the risk for progression to LRTD while ribavirin decreased the risk. However, mortality was associated with ALC and co-infections. This study supports further research of ribavirin therapy for hPIV in the allo-HSCT setting.
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Affiliation(s)
- Ariadna Pérez
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Carlos Hernández-Boluda
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Per Ljungman
- Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet (KI), Huddinge, Sweden
| | - José Luis Piñana
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain.
- Division of Clinical Hematology, Hospital Clinico Universitario de Valencia, Avda. Blasco Ibañez, N 17, 46010, Valencia, Spain.
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Piñana JL, Tridello G, Xhaard A, Wendel L, Montoro J, Vazquez L, Heras I, Ljungman P, Mikulska M, Salmenniemi U, Perez A, Kröger N, Cornelissen J, Sala E, Martino R, Geurten C, Byrne J, Maertens J, Kerre T, Martin M, Pascual MJ, Yeshurun M, Finke J, Groll AH, Shaw PJ, Blijlevens N, Arcese W, Ganser A, Suarez-Lledo M, Alzahrani M, Choi G, Forcade E, Paviglianiti A, Solano C, Wachowiak J, Zuckerman T, Bader P, Clausen J, Mayer J, Schroyens W, Metafuni E, Knelange N, Averbuch D, de la Camara R. Upper and/or Lower Respiratory Tract Infection Caused by Human Metapneumovirus After Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2024; 229:83-94. [PMID: 37440459 DOI: 10.1093/infdis/jiad268] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area. METHODS This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT. RESULTS We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
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Affiliation(s)
- Jose Luis Piñana
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Gloria Tridello
- Azienda Ospedaliera, Universitaria Integrata Verona, Verona, Italy
| | - Aliénor Xhaard
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - Lotus Wendel
- Leiden Study Unit, EBMT, Leiden, The Netherlands
| | - Juan Montoro
- Hematology División, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lourdes Vazquez
- Hematology Department, Hospital Clinico Universitario de Salamanca, Salamanca, Spain
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Dipartimento di scienze della salute, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Urpu Salmenniemi
- Hematology Department, Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ariadna Perez
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Cornelissen
- Hematology Department, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Claire Geurten
- Hematology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
- Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Jenny Byrne
- Hematology Department, Nottingham University, Nottingham, United Kingdom
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Tessa Kerre
- Hematology Department, Ghent University Hospital, Gent, Belgium
| | - Murray Martin
- Hematology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Petach-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jürgen Finke
- Hematology Department, University of Freiburg, Freiburg, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Peter J Shaw
- The Children`s Hospital at Westmead, Sydney, Australia
| | | | - William Arcese
- Hematology Department, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Carlos Solano
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology, and Hematopoietic Cell Transplantation, University of Medical Sciences, Poznan, Poland
| | | | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Pediatrics and Adolescent Medicine, University Hospital, Goethe University, Frankfurt, Germany
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz-Elisabethinen, Johannes Kepler University, Linz, Austria
| | - Jiri Mayer
- Masaryk University Hospital Brno, Brno, Czech Republic
| | | | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e EmatologiaGemelli Research Institute, Fondazione Policlinico Universitario Agostino Gemelli Research Institute, Roma, Italy
| | | | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Rafael de la Camara
- Hematology Department, Hospital de la Princesa, Madrid, Spain
- Hematology Department, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain
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Matsui T, Ogimi C. Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients. Curr Opin Infect Dis 2023; 36:529-536. [PMID: 37729657 DOI: 10.1097/qco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management. RECENT FINDINGS The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs. SUMMARY Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.
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Affiliation(s)
- Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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6
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Randi BA, Higashino HR, Silva VPD, Xavier EM, Rocha V, Costa SF. COVID-19 in hematopoietic stem-cell transplant recipients: A systematic review and meta-analysis of clinical characteristics and outcomes. Rev Med Virol 2023; 33:e2483. [PMID: 37794598 DOI: 10.1002/rmv.2483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Patients who undergo hematopoietic stem-cell transplantation (HSCT) are more susceptible to developing severe forms of COVID-19 with an increased risk of mortality. The aim of this study was to analyze, by performing a systematic review and meta-analysis, all studies that evaluated COVID-19 in HSCT adult recipients and present clinical characteristics and outcomes. Studies were eligible for inclusion if they: (I) described the clinical characteristics of COVID-19 in adult (aged 18 years old or above) HSCT recipients; (II) described outcomes of COVID-19 in this population, mainly lethality; (III) were full-text articles. We searched MedLine, Embase, SCOPUS, LILACS and Web of Science for full-text studies that evaluated COVID-19 in adult HSCT patients until 26 Apr 2023. Two independent reviewers screened the articles and extracted the data. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess quality of the included studies. Meta-analysis was performed and the pooled prevalence of severe/critical disease and of death with a 95% CI was calculated with the random-effects model. Sixteen studies were included; seven (43.7%) were multicenter. Most of the studies were from Europe (37.5%). All of them had a low risk of bias using the JBI Checklist. A total of 1186 patients were included. Allogeneic HSCT patients were the majority in most studies, with a total of 861 patients (72.5%). The symptomatic rate was 79.4%. The pooled prevalence of severe/critical COVID-19 was 24.0% (95% CI 0.13-0.36; I2 = 94%; n = 334/990). The pooled prevalence of death for the entire population was 17% (95% CI 0.13-0.22; I2 = 76%; n = 221/1117), 17% (95% CI 0.12-0.23; I2 = 67%; n = 152/822) for allogeneic-HSCT and 14% (95% CI 0.08-0.22; I4 = 65%; n = 48/293) for autologous-HSCT. In conclusion, frequently the infection of SARS-CoV-2 in HSCT was symptomatic and lethality is higher than in general population. Thus, it is essential to focus on the implementation of measures to mitigate the risk of SARS-CoV-2 infection in this population, as well as to carefully assess HSCT recipients who develop COVID-19.
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Affiliation(s)
- Bruno Azevedo Randi
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hermes Ryoiti Higashino
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vinícius Ponzio da Silva
- Médico do grupo de infecção em imunodeprimidos da Unifesp/ Escola Paulista de Medicina, São Paulo, Brazil
| | - Erick Menezes Xavier
- Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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7
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Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
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Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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Piñana JL, Heras I, Aiello TF, García-Cadenas I, Vazquez L, Lopez-Jimenez J, Chorão P, Aroca C, García-Vidal C, Arroyo I, Soler-Espejo E, López-Corral L, Avendaño-Pita A, Arrufat A, Garcia-Gutierrez V, Arellano E, Hernández-Medina L, González-Santillana C, Morell J, Hernández-Rivas JÁ, Rodriguez-Galvez P, Mico-Cerdá M, Guerreiro M, Campos D, Navarro D, Cedillo Á, Martino R, Solano C. Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients. Viruses 2023; 15:2066. [PMID: 37896843 PMCID: PMC10612015 DOI: 10.3390/v15102066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir. METHODS This study aims to address this issue by using a retrospective observational registry, created by the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group, spanning from 27 December 2021 to 30 April 2023. RESULTS This study included 466 patients, 243 (52%) who were treated with remdesivir and 223 (48%) with nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir was primarily used for mild cases, resulting in a lower COVID-19-related mortality rate (1.3%), while remdesivir was preferred for moderate to severe cases (40%), exhibiting a higher mortality rate (9%). A multivariate analysis in the remdesivir cohort showed that male gender (odds ratio (OR) 0.35, p = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, p < 0.001) and co-infection (OR 2.8, p = 0.047) were linked to a higher mortality risk. Prolonged virus shedding was common, with 52% of patients shedding the virus for more than 25 days. In patients treated with remdesivir, factors associated with prolonged shedding included B-cell malignancy as well as underlying disease, severe disease, a later onset of and shorter duration of remdesivir treatment and a higher baseline viral load. Nirmatrelvir/ritonavir demonstrated a comparable safety profile to remdesivir, despite a higher risk of drug interactions. CONCLUSIONS Nirmatrelvir/ritonavir proved to be a safe and effective option for treating mild cases in the outpatient setting, while remdesivir was preferred for severe cases, where corticosteroids and co-infection significantly predicted worse outcomes. Despite antiviral therapy, prolonged shedding remains a matter of concern.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Inmaculada Heras
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | | | - Irene García-Cadenas
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | - Lourdes Vazquez
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Javier Lopez-Jimenez
- Hematology Division, Hospital Ramon y Cajal, 28029 Madrid, Spain; (J.L.-J.); (V.G.-G.)
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, 46017 Valencia, Spain; (P.C.); (M.G.)
| | - Cristina Aroca
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | - Carolina García-Vidal
- Infectious Disease Division, Hospital Clinic, 08193 Barcelona, Spain; (T.F.A.); (C.G.-V.)
| | - Ignacio Arroyo
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Eva Soler-Espejo
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | - Lucia López-Corral
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Alejandro Avendaño-Pita
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Anna Arrufat
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | | | - Elena Arellano
- Hematology Division, Hospital Universitario Virgen Macarena, 41092 Sevilla, Spain;
| | - Lorena Hernández-Medina
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | | | - Julia Morell
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | | | - Paula Rodriguez-Galvez
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Mireia Mico-Cerdá
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, 46017 Valencia, Spain; (P.C.); (M.G.)
| | - Diana Campos
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
- Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Brain, Behavior and Metabolism (CBBM), University of Lübeck, 23562 Lübeck, Germany
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
- Department of Medicine, School of Medicine. University of Valencia, 46010 Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC) Office, 28029 Madrid, Spain;
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
- Department of Medicine, School of Medicine. University of Valencia, 46010 Valencia, Spain
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9
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Oshiro NN, Nogueira LDA, dos Santos YH, Guimarães PRB, Kalinke LP. Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19. Rev Lat Am Enfermagem 2023; 31:e3995. [PMID: 37729248 PMCID: PMC10508220 DOI: 10.1590/1518-8345.6688.3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. METHOD observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. RESULTS general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). CONCLUSION the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.
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Affiliation(s)
- Natália Naome Oshiro
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
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10
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Li Y, Wang Y, Li Y, de Vries AC, Li P, Peppelenbosch MP, Pan Q. Seasonal coronavirus infections trigger NLRP3 inflammasome activation in macrophages but is therapeutically targetable. Antiviral Res 2023; 216:105674. [PMID: 37459896 DOI: 10.1016/j.antiviral.2023.105674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
Seasonal coronaviruses widely circulate in the global population, and severe complications can occur in specific vulnerable populations. Little is known on their pathogenic mechanisms and no approved treatment is available. Here, we present anecdotal evidence that the level of IL-1β, a hallmark of inflammasome activation, appears elevated in a subset of seasonal coronavirus infected patients. We found that cultured human macrophages support the full life cycle of three cultivatable seasonal coronaviruses. Their infections effectively activate NLRP3 inflammasome activation through TLR4 ligation and NF-κB activation. This activation can be attenuated by specific pharmacological inhibitors and clinically used medications including dexamethasone and flufenamic acid. Interestingly, combination of antiviral and anti-inflammatory drugs simultaneously inhibit seasonal coronavirus-triggered inflammatory response and viral replication. Collectively, these findings show that the TLR4/NF-κB/NLRP3 axis drives seasonal coronavirus triggered-inflammatory response, which in turn represents a viable therapeutic target.
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Affiliation(s)
- Yang Li
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Yining Wang
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Yunlong Li
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Pengfei Li
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands.
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11
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Nyagwange J, Kutima B, Mwai K, Karanja HK, Gitonga JN, Mugo D, Sein Y, Wright D, Omuoyo DO, Nyiro JU, Tuju J, Nokes DJ, Agweyu A, Bejon P, Ochola-Oyier LI, Scott JAG, Lambe T, Nduati E, Agoti C, Warimwe GM. Serum immunoglobulin G and mucosal immunoglobulin A antibodies from prepandemic samples collected in Kilifi, Kenya, neutralize SARS-CoV-2 in vitro. Int J Infect Dis 2023; 127:11-16. [PMID: 36476349 PMCID: PMC9721188 DOI: 10.1016/j.ijid.2022.11.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVES Many regions of Africa have experienced lower COVID-19 morbidity and mortality than Europe. Pre-existing humoral responses to endemic human coronaviruses (HCoV) may cross-protect against SARS-CoV-2. We investigated the neutralizing capacity of SARS-CoV-2 spike reactive and nonreactive immunoglobulin (Ig)G and IgA antibodies in prepandemic samples. METHODS To investigate the presence of pre-existing immunity, we performed enzyme-linked immunosorbent assay using spike antigens from reference SARS-CoV-2, HCoV HKU1, OC43, NL63, and 229E using prepandemic samples from Kilifi in coastal Kenya. In addition, we performed neutralization assays using pseudotyped reference SARS-CoV-2 to determine the functionality of the identified reactive antibodies. RESULTS We demonstrate the presence of HCoV serum IgG and mucosal IgA antibodies, which cross-react with the SARS-CoV-2 spike. We show pseudotyped reference SARS-CoV-2 neutralization by prepandemic serum, with a mean infective dose 50 of 1: 251, which is 10-fold less than that of the pooled convalescent sera from patients with COVID-19 but still within predicted protection levels. The prepandemic naso-oropharyngeal fluid neutralized pseudo-SARS-CoV-2 at a mean infective dose 50 of 1: 5.9 in the neutralization assay. CONCLUSION Our data provide evidence for pre-existing functional humoral responses to SARS-CoV-2 in Kilifi, coastal Kenya and adds to data showing pre-existing immunity for COVID-19 from other regions.
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Affiliation(s)
- James Nyagwange
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya.
| | | | - Kennedy Mwai
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Henry K Karanja
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - John N Gitonga
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - Daisy Mugo
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - Yiakon Sein
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - Daniel Wright
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | | | - Joyce U Nyiro
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - James Tuju
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya; The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, CV4 7AL, United Kingdom; School of Life Sciences, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | | | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street WC1E 7HT, London, United Kingdom
| | - Teresa Lambe
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Eunice Nduati
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - Charles Agoti
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme,PO Box 230, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
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12
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Schaffrath J, Brummer C, Wolff D, Holtick U, Kröger N, Bornhäuser M, Kraus S, Hilgendorf I, Blau IW, Penack O, Wittke C, Steiner N, Nachbaur D, Thurner L, Hindah H, Zeiser R, Maier CP, Bethge W, Müller LP. High mortality of COVID-19 early after allogeneic stem cell transplantation – a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. Transplant Cell Ther 2022; 28:337.e1-337.e10. [PMID: 35296445 PMCID: PMC8918088 DOI: 10.1016/j.jtct.2022.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Recipients of allogeneic stem cell transplantation (alloSCT) are at high risk for contracting infectious diseases with high morbidity and mortality. Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that can lead to severe pneumonia and acute respiratory distress syndrome, with a potentially fatal outcome. In this retrospective study conducted on behalf of the German Cooperative Transplant Study Group, we aimed to analyze risk factors, disease course, and outcomes of COVID-19 in patients who underwent alloSCT. AlloSCT recipients who became infected with SARS-CoV-2 at German and Austrian transplant centers between February 2020 and July 2021 were included. Classification of COVID-19 severity into mild, moderate-severe, or critical disease and division of the course of the pandemic into 4 phases were done according to the German Robert Koch Institute. The main endpoint was overall mortality at the end of follow-up. We further analyzed the need for treatment in an intensive care unit (ICU) and the severity of disease. Risk factors were evaluated using univariate and multivariate analyses, and survival analysis was performed using Kaplan-Meier method. The study cohort comprised 130 patients from 14 transplant centers, with a median age at diagnosis of COVID-19 of 59 years (range, 20 to 81 years) and a median interval between alloSCT and COVID-19 of 787 days (range, 19 to 8138 days). The most common underlying diseases were acute myeloid leukemia (45.4%) and lymphoma (10.8%). The majority of patients (84.9%) were infected in the later phases of the pandemic; 20.8% had moderate-severe disease, 12.3% had critical disease, and 19.2% were treated in an ICU. After a median follow-up of 127 days, overall mortality was 16.2%, 52.0% among patients treated in an ICU. Risk factors for mortality in multivariate analysis were active disease (odds ratio [OR], 4.46), infection with SARS-CoV-2 ≤365 days after alloSCT (OR, 5.60), age >60 years (OR, 5.39), and ongoing immunosuppression with cyclosporine (OR, 8.55). Risk factors for developing moderate-severe or critical disease were concurrent immunosuppression (OR, 4.06) and age >40 years (OR, 4.08). Patients after alloSCT exhibit a substantially increased mortality risk after COVID-19 infection compared with the normal population, without considerable improvement over the course of the pandemic. Risk factors include age, early infection post-alloSCT, and active immunosuppression. Further studies are needed to improve prevention and treatment in this high-risk patient group.
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13
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Ogimi C, Xie H, Waghmare A, Jerome KR, Leisenring WM, Ueda Oshima M, Carpenter PA, Englund JA, Boeckh M. Novel factors to predict respiratory viral disease progression in allogeneic hematopoietic cell transplant recipients. Bone Marrow Transplant 2022; 57:649-657. [PMID: 35173288 PMCID: PMC8853301 DOI: 10.1038/s41409-022-01575-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022]
Abstract
We assessed novel factors and the immunodeficiency scoring index (ISI) to predict progression to lower respiratory tract infection (LRTI) among hematopoietic cell transplant (HCT) recipients presenting with upper respiratory tract infection (URTI) with 12 viruses in the PCR era. We retrospectively analyzed the first respiratory virus detected by multiplex PCR in allogeneic HCT recipients (4/2008–9/2018). We used Cox proportional hazards models to examine factors for progression to LRTI within 90 days among patients presenting with URTI. A total of 1027 patients (216 children and 811 adults) presented with URTI only. Among these, 189 (18%) progressed to LRTI (median: 12 days). Multivariable models demonstrated a history of >1 transplant, age ≥40 years, time post-HCT (≤30 days), systemic steroids, hypoalbuminemia, hyperglycemia, cytopenia, and high ISI (scores 7–12) were associated with an increased risk of progression to LRTI. Respiratory syncytial virus and human metapneumovirus showed the highest progression risk. Patients with ≥3 independent risk factors or high ISI scores were highly likely to progress to LRTI. We identified novel risk factors for progression to LRTI, including history of multiple transplants and hyperglycemia, suggesting an intervention opportunity with glycemic control. ISI and number of risk factors appear to predict disease progression across several viruses.
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Affiliation(s)
- Chikara Ogimi
- Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, WA, USA. .,Department of Pediatrics, University of Washington, Seattle, WA, USA. .,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Pediatric Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan.
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alpana Waghmare
- Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Masumi Ueda Oshima
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Paul A Carpenter
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Pediatric Hematology Oncology, Seattle Children's Hospital, Seattle, WA, USA
| | - Janet A Englund
- Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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14
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Rhinovirus Infections among Hematopoietic Stem Cell Transplant Recipients: A Pre-Transplant Dilemma? Viruses 2022; 14:v14020267. [PMID: 35215861 PMCID: PMC8879386 DOI: 10.3390/v14020267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022] Open
Abstract
Respiratory viral infections (RVIs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can be of concern due to the patients’ depressed immune status, but few data are available about the significance of a pre-transplant positive testing. In this retrospective observational study, we analyzed a cohort of patients that were transplanted between 1 January 2010 and 31 October 2019 in the Geneva University Hospitals with at least one RVI before or after transplantation. At least one RVI was detected in 319/533 (63.5%) transplanted patients. Rhinoviruses were most frequently identified (37%), followed by human coronaviruses (17.1%), parainfluenza viruses (13.9%), and influenza viruses (9.9%). First infection in the post-transplant period occurred at a mean time of 334 days (SD 338). Specific analysis of a subgroup of 65 patients with pre-transplant RVIs was performed. Among them, 39 (59%) patients had symptoms and 14 (21.2%) had a lower respiratory tract infection. Four patients (6.1%) (three rhinovirus and one influenza) needed an intensive care unit admission, of which, three (4.5%) (two rhinovirus and one influenza) were intubated. The patient with influenza infection diagnosed the day of the transplantation died within the first 30 days of the infection. Two patients with rhinovirus infection died within 3 months of unrelated causes. Our data show that rhinovirus infections are predominant in allo-HSCT patients, including among pre-transplant infections; however, mortality due to pre-transplant RVI is low and was only clearly identified in one patient with influenza infection. RVI within the month preceding allo-HSCT is not associated with direct morbidity or mortality in this cohort.
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15
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Lan Q, Xia S, Lu L. Coronavirus Entry Inhibitors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1366:101-121. [DOI: 10.1007/978-981-16-8702-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Severe acute respiratory syndrome coronavirus 2 infection in the stem cell transplant recipient - clinical spectrum and outcome. Curr Opin Infect Dis 2021; 34:654-662. [PMID: 34751184 PMCID: PMC8577303 DOI: 10.1097/qco.0000000000000790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Focusing on large multicenter cohorts reported over the last months, this review aims at summarizing the available evidence by July 2021 on the impact of coronavirus disease 2019 (COVID-19) on hematopoietic stem cell transplant (HSCT) recipients in terms of epidemiology, clinical features, and outcome. RECENT FINDINGS The incidence of COVID-19 in institutional cohorts varied according to different regions and study periods from 0.4% to 8.3%. Clinical presentation was overall comparable to other immunocompromised hosts and the general population. Microbiologically confirmed superinfection occurred in 13-25% of recipients, with most episodes due to hospital-acquired bacteria and few reported cases of COVID-19-associated aspergillosis. Prolonged nasopharyngeal severe acute respiratory syndrome coronavirus 2 shedding has been demonstrated for as long as 210 days. Mortality rates were similar across studies (14.8-28.4%) and did not markedly differ from those observed in nontransplant hematological patients during the first wave. Older age and shorter time from transplantation were associated with mortality, as well as underlying disease status and amount of immunosuppression. No outcome differences were found in most studies between allogeneic and autologous procedures. SUMMARY Considerable advances have been achieved in the characterization of COVID-19 in the HSCT population, although uncertainties remain in the optimal therapeutic management.
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Boonyaratanakornkit J, Sholukh AM, Gray M, Bossard EL, Ford ES, Corbett KS, Corey L, Taylor JJ. Methods to Measure Antibody Neutralization of Live Human Coronavirus OC43. Viruses 2021; 13:2075. [PMID: 34696505 PMCID: PMC8540522 DOI: 10.3390/v13102075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 01/13/2023] Open
Abstract
The human Betacoronavirus OC43 is a common cause of respiratory viral infections in adults and children. Lung infections with OC43 are associated with mortality, especially in hematopoietic stem cell transplant recipients. Neutralizing antibodies play a major role in protection against many respiratory viral infections, but to date a live viral neutralization assay for OC43 has not been described. We isolated a human monoclonal antibody (OC2) that binds to the spike protein of OC43 and neutralizes the live virus derived from the original isolate of OC43. We used this monoclonal antibody to develop and test the performance of two readily accessible in vitro assays for measuring antibody neutralization, one utilizing cytopathic effect and another utilizing an ELISA of infected cells. We used both methods to measure the neutralizing activity of the OC2 monoclonal antibody and of human plasma. These assays could prove useful for studying humoral responses to OC43 and cross-neutralization with other medically important betacoronaviruses.
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Affiliation(s)
- Jim Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Anton M Sholukh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Matthew Gray
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Emily L Bossard
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Emily S Ford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kizzmekia S Corbett
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Justin J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Immunology, University of Washington, Seattle, WA 98109, USA
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18
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Li Z, Meng S, Zheng Q, Wu T. Complicated pulmonary human coronavirus-NL63 infection after a second allogeneic hematopoietic stem cell transplantation for acute B-lymphocytic leukemia: A case report. Medicine (Baltimore) 2021; 100:e26446. [PMID: 34160438 PMCID: PMC8238287 DOI: 10.1097/md.0000000000026446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/04/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Viruses are the most common pathogens that can cause infection-related non-recurrent death after transplantation, occurring mostly from the early stages of hematopoietic stem cell transplantation (HSCT) to within 1 year after transplantation. Human coronavirus (HCoV)-NL63 is a coronavirus that could cause mortality among patients with underlying disease complications. Serological tests are of limited diagnostic value in immunocompromised hosts and cases of latent infection reactivation. In contrast, macro-genomic high-throughput (DNA and RNA) sequencing allows for rapid and accurate diagnosis of infecting pathogens for targeted treatment. PATIENT CONCERNS In this report, we describe a patient who exhibited acute B-lymphocytic leukemia and developed complicated pulmonary HCoV-NL63 infection after a second allogeneic HSCT (allo-HSCT). Six months after the second allo-HSCT, he developed sudden-onset hyperthermia and cough with decreased oxygen saturation. Chest computed tomography (CT) suggested bilateral multiple rounded ground-glass opacities with the pulmonary lobules as units. DIAGNOSES HCoV-NL63 was detected by metagenomic next-generation sequencing (NGS), and HCoV-NL63 viral pneumonia was diagnosed. INTERVENTIONS The treatment was mainly based on the use of antiviral therapy, hormone administration, and gamma-globulin. OUTCOMES After the therapy, the body temperature returned to normal, the chest CT findings had improved on review, and the viral copy number eventually became negative. LESSONS The latest NGS is an effective method for early infection diagnosis. The HCoV-NL63 virus can cause inflammatory factor storm and alter the neutrophil-to-lymphocyte ratio (NLR). This case suggests that the patient's NLR and cytokine levels could be monitored during the clinical treatment to assess the disease and its treatment outcome in a timely manner.
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MESH Headings
- Antiviral Agents/administration & dosage
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Coronavirus Infections/immunology
- Coronavirus Infections/virology
- Coronavirus NL63, Human/genetics
- Coronavirus NL63, Human/immunology
- Coronavirus NL63, Human/isolation & purification
- Drug Therapy, Combination/methods
- Hematopoietic Stem Cell Transplantation/adverse effects
- High-Throughput Nucleotide Sequencing
- Humans
- Immunocompromised Host
- Leukemia, B-Cell/immunology
- Leukemia, B-Cell/therapy
- Lung/diagnostic imaging
- Male
- Metagenomics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/immunology
- Pneumonia, Viral/virology
- Tomography, X-Ray Computed
- Transplantation, Homologous/adverse effects
- Young Adult
- gamma-Globulins/administration & dosage
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Affiliation(s)
- Zhihui Li
- Department of Bone Marrow Transplantation
| | - Shuo Meng
- Department of Bone Marrow Transplantation
| | - Qinlong Zheng
- Laboratory of Molecular Diagnostics, Beijing Boren Hospital, Beijing, China
| | - Tong Wu
- Department of Bone Marrow Transplantation
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19
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Risk factors for seasonal human coronavirus lower respiratory tract infection after hematopoietic cell transplantation. Blood Adv 2021; 5:1903-1914. [PMID: 33792629 PMCID: PMC8015796 DOI: 10.1182/bloodadvances.2020003865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 12/25/2022] Open
Abstract
We demonstrate risk factors for HCoV LRTI in allogeneic HCT recipients and significance of virologic documentation by BAL on mortality. Hyperglycemia associated with steroid use appears to be a strong predictor of HCoV disease progression.
Data are limited regarding risk factors for lower respiratory tract infection (LRTI) caused by seasonal human coronaviruses (HCoVs) and the significance of virologic documentation by bronchoalveolar lavage (BAL) on outcomes in hematopoietic cell transplant (HCT) recipients. We retrospectively analyzed patients undergoing allogeneic HCT (4/2008-9/2018) with HCoV (OC43/NL63/HKU1/229E) detected by polymerase chain reaction during conditioning or post-HCT. Risk factors for all manifestations of LRTI and progression to LRTI among those presenting with HCoV upper respiratory tract infection (URTI) were analyzed by logistic regression and Cox proportional hazard models, respectively. Mortality rates following HCoV LRTI were compared according to virologic documentation by BAL. A total of 297 patients (61 children and 236 adults) developed HCoV infection as follows: 254 had URTI alone, 18 presented with LRTI, and 25 progressed from URTI to LRTI (median, 16 days; range, 2-62 days). Multivariable logistic regression analyses showed that male sex, higher immunodeficiency scoring index, albumin <3 g/dL, glucose >150 mg/dL, and presence of respiratory copathogens were associated with occurrence of LRTI. Hyperglycemia with steroid use was associated with progression to LRTI (P < .01) in Cox models. LRTI with HCoV detected in BAL was associated with higher mortality than LRTI without documented detection in BAL (P < .01). In conclusion, we identified factors associated with HCoV LRTI, some of which are less commonly appreciated to be risk factors for LRTI with other respiratory viruses in HCT recipients. The association of hyperglycemia with LRTI might provide an intervention opportunity to reduce the risk of LRTI.
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20
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Ladner JT, Henson SN, Boyle AS, Engelbrektson AL, Fink ZW, Rahee F, D'ambrozio J, Schaecher KE, Stone M, Dong W, Dadwal S, Yu J, Caligiuri MA, Cieplak P, Bjørås M, Fenstad MH, Nordbø SA, Kainov DE, Muranaka N, Chee MS, Shiryaev SA, Altin JA. Epitope-resolved profiling of the SARS-CoV-2 antibody response identifies cross-reactivity with endemic human coronaviruses. CELL REPORTS MEDICINE 2021; 2:100189. [PMID: 33495758 PMCID: PMC7816965 DOI: 10.1016/j.xcrm.2020.100189] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/11/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
The SARS-CoV-2 proteome shares regions of conservation with endemic human coronaviruses (CoVs), but it remains unknown to what extent these may be cross-recognized by the antibody response. Here, we study cross-reactivity using a highly multiplexed peptide assay (PepSeq) to generate an epitope-resolved view of IgG reactivity across all human CoVs in both COVID-19 convalescent and negative donors. PepSeq resolves epitopes across the SARS-CoV-2 Spike and Nucleocapsid proteins that are commonly targeted in convalescent donors, including several sites also recognized in some uninfected controls. By comparing patterns of homologous reactivity between CoVs and using targeted antibody-depletion experiments, we demonstrate that SARS-CoV-2 elicits antibodies that cross-recognize pandemic and endemic CoV antigens at two Spike S2 subunit epitopes. We further show that these cross-reactive antibodies preferentially bind endemic homologs. Our findings highlight sites at which the SARS-CoV-2 response appears to be shaped by previous CoV exposures and which have the potential to raise broadly neutralizing responses. PepSeq enables fully in vitro, highly multiplexed peptide-based antibody assays Epitope mapping shows preexisting antibody reactivity to SARS-CoV-2 antigens Antibodies cross-recognize endemic and pandemic antigens in the Spike S2 subunit Cross-reactive antibodies raised by SARS-CoV-2 preferentially bind endemic homologs
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Affiliation(s)
- Jason T Ladner
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Sierra N Henson
- The Translational Genomics Research Institute (TGen), Phoenix and Flagstaff, AZ, USA
| | - Annalee S Boyle
- The Translational Genomics Research Institute (TGen), Phoenix and Flagstaff, AZ, USA
| | - Anna L Engelbrektson
- The Translational Genomics Research Institute (TGen), Phoenix and Flagstaff, AZ, USA
| | - Zane W Fink
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Fatima Rahee
- The Translational Genomics Research Institute (TGen), Phoenix and Flagstaff, AZ, USA
| | | | | | - Mars Stone
- Vitalant Research Institute and Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Wenjuan Dong
- Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Sanjeet Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, CA, USA
| | - Jianhua Yu
- Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Michael A Caligiuri
- Hematologic Malignancies and Stem Cell Transplantation Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Piotr Cieplak
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Magnar Bjørås
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona H Fenstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Svein A Nordbø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Medical Microbiology, St. Olavs Hospital, Trondheim, Norway
| | - Denis E Kainov
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Sergey A Shiryaev
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - John A Altin
- The Translational Genomics Research Institute (TGen), Phoenix and Flagstaff, AZ, USA
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21
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Cimolai N. Complicating Infections Associated with Common Endemic Human Respiratory Coronaviruses. Health Secur 2020; 19:195-208. [PMID: 33186086 DOI: 10.1089/hs.2020.0067] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronaviruses OC43, 229E, NL63, and HKU1 are endemic human respiratory coronaviruses that typically cause mild to moderate upper respiratory infections, similar to the common cold. They also may cause simple and complicated lower respiratory infections, otitis media, asthma exacerbations, gastroenteritis, and a few systemic complications. These viruses are usually seasonal (with winter dominance) and affect nearly all age groups. The seasonal and annual variation in virus prevalence has implications for understanding the concept of acquired immunity and its persistence or diminution. Coronaviruses generally have outbreak potential in susceptible populations of any age, particularly in patients with comorbidities, who tend to have increased clinical disease. These 4 coronaviruses are often found in the context of what appears to be coinfection with other pathogens, but especially other viruses. If coronaviruses are not specifically tested for, the sole detection of a viral copathogen would suggest the pathogen is the causative agent, when a coronavirus may be culpable, or both. The detection of these viruses in circumstances where respiratory viruses are generally sought in clinical samples is, therefore, justified. These pathogens can be chronically shed from the respiratory tract, which is more likely to occur among immunocompromised and complicated patients. These viruses share the potential for genetic drift. The genome is among the largest of RNA viruses, and the capability of these viruses to further change is likely underestimated. Given the potential disease among humans, it is justified to search for effective antiviral chemotherapy for these viruses and to consider uses in niche situations should effective therapy be defined. Whereas SARS-CoV-2 may follow the epidemiological pattern of SARS-CoV and extinguish slowly over time, there is yet concern that SARS-CoV-2 may establish itself as an endemic human respiratory coronavirus similar to OC43, 2299E, NL63, and HKU1. Until sufficient data are acquired to better understand the potential of SARS-CoV-2, continued work on antiviral therapy and vaccination is imperative.
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Affiliation(s)
- Nevio Cimolai
- Nevio Cimolai, MD, FRCPC, is a Professor, Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia; he is also Medical Staff, Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia; both in Vancouver, Canada
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