Back to Search
Start Over
Idiopathic pneumonia syndrome after hematopoietic cell transplantation: evidence of occult infectious etiologies
- Source :
- Blood
- Publication Year :
- 2015
- Publisher :
- American Society of Hematology, 2015.
-
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.
- Subjects :
- Adult
Male
Adolescent
Immunology
Congenital cytomegalovirus infection
Biology
medicine.disease_cause
Biochemistry
Asymptomatic
Cohort Studies
Young Adult
Idiopathic pneumonia syndrome
medicine
Aspergillosis
Humans
Child
Pathogen
Lung
Transplantation
medicine.diagnostic_test
Hematopoietic Stem Cell Transplantation
Cell Biology
Hematology
Bacterial Infections
Lung Injury
Middle Aged
medicine.disease
Pneumonia
Bronchoalveolar lavage
Aspergillus
Virus Diseases
Female
Rhinovirus
medicine.symptom
Bronchoalveolar Lavage Fluid
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Blood
- Accession number :
- edsair.doi.dedup.....52c0af3c9a637c23680be4af99925831