Kumar, D., Ferreira, V. H., Blumberg, E., Silveira, F., Cordero, E., Perez-Romero, P., … Humar, A. (2018). A 5-Year Prospective Multicenter Evaluation of Influenza Infection in Transplant Recipients. Clinical Infectious Diseases.
Método
multicenter prospective observational study. A total of 20 sites from United
States, Canada, and Spain
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Nasopharyngeal (NP) swabs were taken from microbiologically confirmed influenza A virus infected transplant recipients at presentation (day 0), and days 3, 6, 11, 18 and 28. All NP swabs were stored at -80o C until batch testing as follows. RNA was extracted from NP swabs using the QIAamp Viral RNA Mini Kit (Qiagen)
Resultados
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Viral load at disease onset was also higher in HSCT vs. SOT patients (median VL 1.04 x 105 copies/ml vs 8.04 x 103 copies/ml; p=0.001)
early initiation of antiviral therapy (within 48 hours of symptom onset) was associated with a lower risk of pneumonia development (OR 0.51 (95%CI 0.31-0.86), p=0.011). In addition, patients who had received influenza vaccine in the current season were also less likely to have pneumonia at presentation (OR 0.34 (95% CI 0.21-0.55), p<0.001). O
both immunization in the current influenza season and initiation of early antiviral therapy were independently associated with a lower incidence of requirement for admission to the intensive care unit (OR 0.49 (95% CI 0.26-0.90), p=0.023 and OR 0.42 (95% CI 0.20-0.87), p=0.019).
With treatment viral load declined in the majority of patients (Figure 2A). By day 3, 24% were undetectable and by day 6, 55% were undetectable. Persistent viral detection occurred in 25% at day 11 and 7.1% at day 18. No patient had viral detection by day 28. Viral kinetics analysis demonstrated a median viral load half-life of 0.63 days (range 0.16 to 5.63 days) reflecting a rapid logarithmic decline with therapy (Figure 2B) in most patients.