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Persistent human rhinovirus type C infection of the lower respiratory tract in a pediatric cord blood transplant recipient

Bone Marrow Transplantation volume 48, pages 747–748 (2013)Cite this article

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Human rhinoviruses (HRV) are a common cause of respiratory tract infections (RTI) in hematopoietic SCT (HSCT) patients, although not often associated with severe disease. The clinical spectrum of HRV infection can range from asymptomatic to severe lower RTI and association with post-transplant mortality.1, 2, 3, 4, 5, 6, 7 HRV have been isolated from the upper and lower respiratory tracts (U/LRT) as sole infecting pathogens and with copathogens.1, 2, 3, 4, 5, 6, 7 Recently, infection with a newly discovered, genetically distinct HRV, termed HRV type C (HRV-C), has been identified during acute respiratory tract illness in both healthy and immunocompromised children.8 Data suggest that HRV-C infection can be associated with more severe respiratory illness than infection with other types of HRV.6, 9 Currently, little is known regarding the incidence, pathogenicity and duration of HRV-C infection in the pediatric HSCT population. We describe a case of persistent LRTI with a single strain of HRV-C in a pediatric HSCT patient with monosomy 7 juvenile myelomonocytic leukemia (JMML).

A 6-month-old boy was diagnosed with JMML and, owing to significant tumor burden, required chemotherapy and decompressive surgery with splenectomy pre-transplant. At the age of 12 months, he underwent reduced intensity allogeneic SCT with fludarabine and melphalan conditioning and 5/6 DRB1 Ag mismatch cord blood. He received tacrolimus and sirolimus for graft-versus-host disease prophylaxis until day 80 post transplant and 4 weeks of IFN starting on day 120 for mixed chimerism.

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Acknowledgements

We wish to thank Rosen Galit, Dana Salzberg, Dorothea Douglas, Kyrie Hospodar, Kristen Beebe, Erin Combs and Kristy Morgan for their valuable support in taking care of this patient. We also wish to thank Christopher Bradley and Spencer Hansen for helpful discussions and Wei-Ming Lee for providing pW10-containing HRV-C sequences and advice on the PCR assay.

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Authors and Affiliations

  1. Department of Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    A K Pathak & K E Gustin

  2. Mayo Clinic Arizona, Phoenix, AZ, USA

    R H Adams

  3. Phoenix Children’s Hospital, Phoenix, AZ, USA

    R H Adams & N C Shah

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  1. A K Pathak
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Correspondence to K E Gustin.

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Pathak, A., Adams, R., Shah, N. et al. Persistent human rhinovirus type C infection of the lower respiratory tract in a pediatric cord blood transplant recipient. Bone Marrow Transplant 48, 747–748 (2013). https://doi.org/10.1038/bmt.2012.226

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