SARS-CoV-2 viral clearance during bone marrow aplasia after allogeneic hematopoietic stem cell transplantation-A case report.
Tomasz JarmolińskiAgnieszka Matkowska-KocjanMonika RosaIgor OlejnikEwa GorczyńskaKrzyzstof KalwakMarek UssowiczPublished in: Pediatric transplantation (2020)
Respiratory viral infections are known causes of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a unique case of a child with viral pneumonia caused by coinfection with human metapneumovirus (MPV), respiratory syncytial virus (RSV), and SARS-CoV-2 after HSCT. A 9-year-old girl with acute lymphoblastic leukemia underwent allogeneic HSCT from a matched, unrelated donor. During the post-transplant period, in profound leukopenia (below 10 leukocytes/µL), she was diagnosed with SARS-CoV-2, MPV, and RSV pneumonia and was treated with ribavirin and chloroquine. Before leukocyte recovery, the girl became asymptomatic, and SARS-CoV-2 and RSV clearance was achieved. The shedding of SARS-CoV-2 stopped before immune system recovery, and one may hypothesize that the lack of an inflammatory response might have been a contributing factor to the mild clinical course. Post-transplant care in HSCT recipients with COVID-19 infection is feasible in regular transplant units, provided the patient does not present with respiratory failure. Early and repeated testing for SARS-CoV-2 in post-transplant patients with concomitant infection mitigation strategies should be considered in children after HSCT who develop fever, respiratory symptoms, and perhaps gastrointestinal symptoms to control the spread of COVID-19 both in patients and in healthcare workers in hospital environments. Training of staff and the availability of personal protective equipment are crucial for containing SARS-CoV-2 infection.
Keyphrases
- sars cov
- allogeneic hematopoietic stem cell transplantation
- respiratory syncytial virus
- acute lymphoblastic leukemia
- respiratory syndrome coronavirus
- hematopoietic stem cell
- bone marrow
- respiratory failure
- acute myeloid leukemia
- inflammatory response
- healthcare
- respiratory tract
- mesenchymal stem cells
- newly diagnosed
- climate change
- endothelial cells
- stem cell transplantation
- extracorporeal membrane oxygenation
- end stage renal disease
- emergency department
- peripheral blood
- mental health
- autism spectrum disorder
- ejection fraction
- intensive care unit
- young adults
- health insurance
- acute care
- acute respiratory distress syndrome