Related Experiment Videos
Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study
S Chakrabarti1, K E Collingham, R H Stevens
1Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK.
Abstract:
We prospectively examined stool specimens for enteric viruses in 75 stem cell transplant recipients (autologous 48, allogeneic 27) to determine the frequency and significance of these infections. Only six patients (8%) had a positive isolate. Five of these were allograft recipients (18%) compared to one autograft recipient (2%) (P = 0.02). Unrelated donor BMT recipients were at the highest risk for a viral isolate (OR = 10.5). Adenovirus was the commonest isolate (four patients). One patient each had an echovirus, enterovirus and small round structured virus identified. No correlation was found between the severity of gastro-intestinal symptoms and detection of a viral pathogen. There was no correlation with GVHD or CMV status. The only risk factor identified for isolation of an enterovirus was allogeneic BMT from an unrelated donor. There was a negative correlation with PBSC grafts. All the patients infected with an enteric virus had concomitant infection with other pathogens, compared to only 18% of uninfected patients (P = 0.001). The non-relapse mortality of the infected patients was 50% and only 7% in the uninfected patients (P = 0.01, OR = 12.5), although the isolated virus was the direct cause of death in one patient only. This study indicates a low rate of enteric virus isolation in recipients of PBSC grafts, both autologous and allogeneic. However, unrelated donor BMT is associated with a higher risk of enteric virus infection and an adverse outcome. Bone Marrow Transplantation (2000) 25, 277-282.
Insights
Enteric virus infections are rare in stem cell transplant recipients, especially those receiving PBSC grafts. However, unrelated donor bone marrow transplants (BMT) carry a higher risk and are linked to adverse outcomes.
Area of Science:
- Infectious Diseases
- Hematology
- Transplantation Immunology
Background:
- Enteric viral infections can complicate stem cell transplantation.
- Understanding the frequency and impact of these infections is crucial for patient management.
Purpose of the Study:
- To determine the incidence and clinical significance of enteric viral infections in stem cell transplant recipients.
- To identify risk factors associated with enteric virus isolation.
Main Methods:
- Prospective stool specimen analysis in 75 stem cell transplant recipients (48 autologous, 27 allogeneic).
- Analysis of viral isolates, patient characteristics, and clinical outcomes.
- Statistical analysis to identify correlations and risk factors.
Main Results:
- Only 8% of patients had positive viral isolates; higher in allogeneic (18%) vs. autologous (2%) recipients.
- Unrelated donor bone marrow transplant (BMT) recipients had the highest risk (OR=10.5).
- Adenovirus was the most common isolate; no correlation with GI symptoms, GVHD, or CMV status. Infected patients had higher non-relapse mortality (50% vs. 7%).
Conclusions:
- Enteric virus isolation is infrequent in PBSC graft recipients (autologous and allogeneic).
- Allogeneic BMT from unrelated donors significantly increases the risk of enteric virus infection and adverse outcomes.
- Concomitant infections were more frequent in virus-positive patients, contributing to higher mortality.