INFECCIÓN POR VIRUS RESPIRATORIOS EN PACIENTES INMUNOCOMPROMETIDOS CON ENFERMEDADES HEMATOLÓGICAS (ICH)

Introduccion. Los virus respiratorios (VR) pueden causar enfermedad grave y a veces mortal en pacientes con inmunocompromiso hematologico (ICH), especialmente en receptores de trasplante de celulas progenitoras hematopoyeticas (TCPH). Estos pacientes presentan mayores viremias, eliminacion viral mas prolongada, progresion a neumonia y compromiso extrapulmonar. Tambien tienen menor respuesta inmunologica a la vacuna contra la influenza. Objetivo. Conocer la incidencia de VR de pacientes con ICH que consultaron por cuadros de enfermedad tipo influenza (ETI) en la Unidad de Trasplante de Medula Osea (UTMO) del Hospital R. Rossi de La Plata. Describir las caracteristicas clinico-epidemiologicas de los pacientes positivos para VR. Material y metodos. Estudio prospectivo observacional realizado en la UTMO de enero a agosto de 2015. Se analizaron eventos de ETI en pacientes con ICH mayores de 18 anos ambulatorios o internados. Se considero ETI un cuadro febril agudo y/o sintomas respiratorios y sistemicos como odinofagia, coriza, cefalea, mialgias y tos. El diagnostico se realizo mediante panel viral (inmunofluorescencia para influenza A y B, parainfluenza 1, 2 y 3, metapneumovirus, virus sincicial respiratorio (VSR) y adenovirus) en muestras de hisopado nasofaringeo y reaccion en cadena de la polimerasa (RCP) para influenza en aquellos con panel viral negativo. Se registro enfermedad de base, quimioterapia, vacunacion previa para influenza, convivientes con ETI, presentacion clinica, tratamiento y evolucion. Resultados. Se obtuvieron muestra de 90 eventos de ETI en 64 pacientes. Se confirmo etiologia viral en 15 muestras de 14 pacientes (16,6%). Se aislo: influenza A, en 8; VSR, en 5, y parainfluenza 3, en 2. Edad promedio: 47 anos (rango: 18-75). Sexo: razon masculino:femenino, 5:9. Sintomas clinicos: tos, en 14; coriza, en 14; fiebre, en 8, y cefalea, en 6. Enfermedad de base: mieloma multiple, en 5; linfomas, en 5; leucemias agudas, en 4. Tres de estos pacientes habian recibido TCPH autologo, pero solo en un caso la enfermedad ocurrio durante el periodo de trasplante. Nueve pacientes recibieron quimioterapia durante el mes previo. Convivientes con ETI: 4. Vacunacion antigripal: 7/14. Cinco pacientes con influenza no estaban vacunados. El inicio fue ambulatorio en 11 casos, y se mantuvo asi en 5 y en 6 el cuadro motivo la internacion. Las radiografias de cinco pacientes mostraron patologia, y uno presento como complicacion neumonia por estafilococo. El VSR predomino en el mes de junio (4/5) y la influenza y la parainfluenza, en julio y agosto (9/10). El tratamiento incluyo antivirales en 13 casos (oseltamivir, 9; rivabirina oral, 5) y antibioticos, 8. De los pacientes con influenza, siete tuvieron el tratamiento empirico adecuado con oseltamivir. No se registro mortalidad durante los eventos. Conclusiones. El porcentaje de positividad de las muestras fue bajo. En concordancia con la literatura, los pacientes con ICH y VR presentaron mayor morbilidad, reflejada en la radiologia patologica y la necesidad de internacion. No obstante, todos tuvieron buena evolucion. La influenza fue el virus predominante, y tambien ocurri en pacientes vacunados. Palabras clave . Infeccion, virus respiratorio, inmunocompromiso, enfermedad hematologica. VIRAL RESPIRATORY INFECTIONS IN IMMUNOCOMPROMISED PATIENTS WITH HEMATOLOGICAL MALIGNANCIES (IHM) Abstract Introduction. Respiratory viruses (RVs) can cause a severe and sometimes fatal disease in hematologically immunocompromised (HIC) patients, especially in hematopoietic progenitor cell transplant (HPCT) recipients. In these patients, levels of viremia are higher, viral elimination is slower, their condition develops into pneumonia, and there is extrapulmonary involvement. These patients also show less immune response to the influenza vaccine. Purpose. To know the incidence of RVs in HIC patients who sought advice regarding influenza-like symptoms (ILS) in the Bone Marrow Transplant Unit (UTMO) of the Hospital R. Rossi in La Plata. To describe the clinical-epidemiological characteristics of patients positive for RV. Materials and methods . Prospective, observational study conducted at the UTMO from January to August 2015. ILS events were analyzed in outpatients, or in hospitalized patients with ILS who were older than 18 years. An acute febrile condition and/or respiratory and systemic symptoms such as odynophagia, coryza, headache, myalgia, and cough were deemed to be ILS. The methods of diagnosis used were the respiratory viral panel (immunofluorescence for influenza A and B, parainfluenza 1, 2 and 3, metapneumovirus, respiratory syncytial virus [RSV] and adenovirus) in nasopharyngeal swab samples, and polymerase chain reaction (PCR) for influenza in those patients with negative viral panel. Underlying disease, chemotherapy, previous influenza vaccination, persons with ILS living with the patient, clinical presentation, treatment, and development were recorded. Results. Samples of 90 ILS events were obtained in 64 patients. Viral etiology was confirmed in 15 samples from 14 patients (16.6%). The following was isolated: Influenza A, in 8; RSV in 5, and parainfluenza 3, in 2. Average age: 47 years (range: 18-75). Gender: male:female ratio, 5:9. Clinical symptoms: cough, in 14; coryza, in 14; fever, in 8, and headache, in 6. Underlying disease: multiple myeloma, in 5; lymphomas, in 5; acute leukemias in 4. Three of these patients had received autologous HPCT, but only in one case, it took place during the transplant period. Nine patients received chemotherapy during the previous month. Persons with ILS living with the patient: 4. Flu vaccination: 7/14. Five patients with influenza were not vaccinated. Treatment was ambulatory in 11 cases, and remained so in 5, so in 6, symptoms led to hospitalization. The X-rays of five patients showed a pathology, and one patient developed staphylococcal pneumonia as a complication. RSV prevailed in June (4/5), and influenza and parainfluenza, in July and August (9/10). Treatment included antivirals in 13 cases (oseltamivir, 9; oral rivabirin, 5), and antibiotics, 8. Of the patients with influenza, seven received the appropriate empiric therapy with oseltamivir. There was no mortality during the events. Conclusions. The percentage of positive samples was low. In agreement with the literature, patients with HIC and RVs had a higher morbidity, as reflected in the pathological radiology, and in the need for hospitalization. However, all of them made good progress. Influenza was the predominant virus, and it also affected vaccinated patients. Key words. Infection, respiratory virus, immunocompromised, hematological disease.