ABSTRACT

Background:

The possible role of human coronaviruses (HCoV) in lower respiratory tract disease (LRTD) in hematopoietic cell transplant (HCT) recipients and patients with hematologic malignancies (HM) has not been well studied.

Methods:

We conducted a retrospective review of HCT/HM patients with HCoV detected in bronchoalveolar lavage (BAL). HCoV strains were identified in BAL samples using strain-specific PCR. Mortality rates were compared among HCT recipients with LRTD caused by HCoV, respiratory syncytial virus (RSV), influenza or parainfluenza virus (PIV) by multivariable Cox regression analysis.

Results:

We identified 35 patients (37 episodes) with HCoV LRTD. Among 23 available BAL samples, 48% were strain OC43, 22% were NL63, 17% were 229E and 13% were HKU1. Overall, 21 patients (60%) required oxygen therapy at diagnosis and 19 (54%) died within 90 days of diagnosis. Respiratory co-pathogens were detected in 21 episodes (57%), including viruses (N = 12), fungi (N = 10), and bacteria (N = 8). Mortality rates were not different between patients with and without co-pathogens (p = 0.65). In multivariable models, mortality associated with HCoV LRTD was similar to that seen with RSV, influenza and PIV LRTD in HCT recipients (adjusted hazard ratio 1.34, 95% CI 0.66-2.71, p = 0.41 versus RSV, adjusted for cell source, cytopenia, co-pathogens, oxygen use and steroid use).

Conclusions:

HCoV LRTD in patients with HCT or HM is associated with high rates of oxygen use and mortality. Mortality associated with HCoV LRTD in HCT recipients appears to be similar to that seen with RSV, influenza and PIV.

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