scholarly journals Risk Factors for Parainfluenza Virus Lower Respiratory Tract Disease after Hematopoietic Cell Transplantation

2019 ◽  
Vol 25 (1) ◽  
pp. 163-171 ◽  
Author(s):  
Sachiko Seo ◽  
Hu Xie ◽  
Wendy M. Leisenring ◽  
Jane M. Kuypers ◽  
Farah T. Sahoo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Tract ◽  
Cell Transplantation ◽  
Lower Respiratory Tract ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Parainfluenza Virus ◽  
Respiratory Tract Disease ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease

scholarly journals How I treat respiratory viral infections in the setting of intensive chemotherapy or hematopoietic cell transplantation

Blood ◽  
2016 ◽  
Vol 127 (22) ◽  
pp. 2682-2692 ◽  
Author(s):  
Alpana Waghmare ◽  
Janet A. Englund ◽  
Michael Boeckh
Keyword(s):  
Respiratory Tract ◽  
Cell Transplantation ◽  
Lower Respiratory Tract ◽  
Hematopoietic Cell Transplantation ◽  
Respiratory Viruses ◽  
Hematopoietic Cell ◽  
Quality Data ◽  
Respiratory Tract Disease ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease

Abstract The widespread use of multiplex molecular diagnostics has led to a significant increase in the detection of respiratory viruses in patients undergoing cytotoxic chemotherapy and hematopoietic cell transplantation (HCT). Respiratory viruses initially infect the upper respiratory tract and then progress to lower respiratory tract disease in a subset of patients. Lower respiratory tract disease can manifest itself as airflow obstruction or viral pneumonia, which can be fatal. Infection in HCT candidates may require delay of transplantation. The risk of progression differs between viruses and immunosuppressive regimens. Risk factors for progression and severity scores have been described, which may allow targeting treatment to high-risk patients. Ribavirin is the only antiviral treatment option for noninfluenza respiratory viruses; however, high-quality data demonstrating its efficacy and relative advantages of the aerosolized versus oral form are lacking. There are significant unmet needs, including data defining the virologic characteristics and clinical significance of human rhinoviruses, human coronaviruses, human metapneumovirus, and human bocavirus, as well as the need for new treatment and preventative options.

Lower respiratory tract disease (LRTD) in patients with cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6563-6563
Author(s):  
Dimpy P Shah ◽  
Pankil Shah ◽  
Andrew Lachlan Schmidt ◽  
Ziad Bakouny ◽  
Dimitrios Farmakiotis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Mortality Rates ◽  
Smoking History ◽  
Respiratory Tract Disease ◽  
Factors Associated ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease ◽  
Overall Mortality

6563 Background: Immunodeficiency in patients (pts) with cancer can lead to the progression of common respiratory viral infections to lower respiratory tract disease (LRTD) with potentially high mortality. Understanding risk factors of SARS-CoV-2 related LRTD in pts with cancer is imperative for the development of preventive measures. Methods: We examined all patients aged 18 years or older with cancer and laboratory-confirmed SARS-CoV-2 infection reported between March 16, 2020 and February 6, 2021 in the international CCC19 registry. We examined frequency of LRTD (pneumonia, pneumonitis, acute respiratory distress syndrome, or respiratory failure), demographic and clinicopathologic factors associated with LRTD, and 30-day and overall mortality in pts with and without LRTD. Results: Of 7,289 pts with a median follow-up time of 42 (21-90) days, 2187 (30%) developed LRTD. Pts of older age (65 yrs or older), male sex, pre-existing comorbidities, baseline immunosuppressants, baseline corticosteroids, and ECOG performance status of 2 or more had substantially higher rates of LRTD compared to those without these risk factors (Table). We did not observe differences in LRTD rates between pts of different racial/ethnic groups, smoking history, hypertension, obesity, cancer status, timing or type of anti-cancer therapy. LRTD was more likely in pts with thoracic malignancy (39%), hematological malignancy (39%) compared to those with other solid tumors (27%). The majority of pts (86%) had symptomatic presentation; however, 8% of pts with asymptomatic presentation developed LRTD. 30-day and overall mortality rates were significantly higher in pts with LRTD than those without LRTD (31% vs. 4% and 38% vs. 6%, P < 0.05). Conclusions: COVID-19 related LRTD rate is high and associated with worse mortality rates in pts with cancer. The majority of risk factors associated with LRTD demonstrate underlying immunodeficiency or lung structural damage as a driving force in this population. Identifying pts at high-risk for developing LRTD can help guide clinical management, improve pt outcomes, increase the cost-effectiveness of antiviral therapy, and direct future clinical trial designs for vaccine or antiviral agents.[Table: see text]

scholarly journals Human Herpesvirus 6B and Lower Respiratory Tract Disease After Hematopoietic Cell Transplantation

2019 ◽  
Vol 37 (29) ◽  
pp. 2670-2681 ◽  
Author(s):  
Joshua A. Hill ◽  
Lisa K. Vande Vusse ◽  
Hu Xie ◽  
E. Lisa Chung ◽  
Cecilia C.S. Yeung ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Human Herpesvirus ◽  
Hematopoietic Cell ◽  
Respiratory Tract Disease ◽  
Lower Respiratory Tract Disease ◽  
Rna In Situ Hybridization ◽  
Tract Disease ◽  
Overall Mortality

PURPOSE Human herpesvirus 6B (HHV-6B) DNA is frequently detected in bronchoalveolar lavage fluid (BALF) from immunocompromised subjects with lower respiratory tract disease (LRTD). Whether HHV-6B is a pulmonary pathogen is unclear. METHODS We tested BALF for HHV-6B DNA using polymerase chain reaction in allogeneic hematopoietic cell transplantation (HCT) recipients who underwent a BAL for evaluation of LRTD from 1992 to 2015. We used multivariable proportional hazards models to evaluate the association of HHV-6B+ BALF with overall mortality, death from respiratory failure, and the effect of anti–HHV-6B antivirals on these outcomes. We used branched-chain RNA in situ hybridization to detect HHV-6 messenger RNA ( U41 and U57 transcripts) in lung tissue. RESULTS We detected HHV-6B+ BALF from 147 of 553 (27%) individuals. Subjects with HHV-6B+ BALF, with or without copathogens, had significantly increased risk of overall mortality (adjusted hazard ratio [aHR], 2.18; 95% CI, 1.41-3.39) and death from respiratory failure (aHR, 2.50; 95% CI, 1.56-4.01) compared with subjects with HHV-6B- BALF. Subjects with HHV-6B+ BALF who received antivirals within 3 days pre-BAL had an approximately 1 log10 lower median HHV-6B BALF viral load, as well as a lower risk of overall mortality (aHR, 0.42; 95% CI, 0.16-1.10), compared with subjects with HHV-6B+ BALF not receiving antivirals. We detected intraparenchymal HHV-6 gene expression by RNA in situ hybridization in lung tissue in all three tested subjects with HHV-6B+ BALF and sufficient tissue RNA preservation. CONCLUSION These data provide evidence that HHV-6B detection in BALF is associated with higher mortality in allogeneic hematopoietic cell transplantation recipients with LRTD. Definitive evidence of causation will require a randomized prevention or treatment trial.

scholarly journals Improved Survival of High Risk Patients with Parainfluenza Virus Following Hematopoietic Cell Transplantation: Role of Aerosolized Ribavirin

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5803-5803
Author(s):  
Isabelle T Nguyen ◽  
Sumana Shashidhar ◽  
Janice (Wes) M. Brown
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Respiratory Tract ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Parainfluenza Virus ◽  
High Risk Patients ◽  
Risk Patients ◽  
Tract Infections

Abstract Parainfluenza viruses (PIV) ARE associated with severe respiratory tract infections among immunocompromised patients. However, the most perplexing feature of PIV following hematopoietic cell transplantation (HCT) is the dichotomous nature of risk for life-threatening infection. Specifically, the vast majority of patients will not require treatment of any kind whereas a small subset appears to be at such high risk of death that it has been questioned if successful treatment is even possible. In 2007, we implemented a standardized approach to patients diagnosed with Parainfluenza virus (PIV) following HCT at Stanford University Medical Center (Fig 1) based on the need for supplemental oxygen and/or specific risk factors. We performed both a prospective analysis of cases of lower respiratory tract infection and a retrospective review of all 2495 patients transplanted during this period. The epidemiology, risk factors, clinical status, and outcome of the 115 PIV patients using this protocol from September 2007 through May 2015 shows that prudent, risk-stratified application of antiviral therapies in can result higher survival rates among patients with PIV post-HCT. Moreover, high risk patients who received aerosolized ribavirin had a lower mortality rate than those who were either not treated or received oral ribavirin. Disclosures No relevant conflicts of interest to declare.

Respiratory Synctial Virus (RSV) Infection in Hematopoietic Stem Cell Transplant (HCT) Recipients: Risk Factors for Acquisition and Lower Respiratory Tract Disease, and Impact on Mortality.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 187-187 ◽  
Author(s):  
Michael J. Boeckh ◽  
Ted Gooley ◽  
Janet Englund ◽  
Jason W. Chien ◽  
Stephen W. Crawford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Cell Transplant ◽  
Upper Respiratory Tract ◽  
Respiratory Tract Disease ◽  
Hematopoietic Stem ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease

Abstract RSV lower respiratory tract disease (LRTD) is a serious complication after HCT. Risk factors for virus acquisition and progression from RSV upper respiratory tract infection (URI) to RSV LRTD are poorly defined. A targeted surveillance system consisting of routine virologic evaluation for RSV (DFA, shell vial assay, culture) in HCT recipients with URI symptoms was instituted in 10/89. We retrospectively analyzed risk factors of RSV acquisition and the development of RSV-LRTD among patients with RSV-URI between 10/89 and 7/02. From 10/94 to 7/97, patients with RSV-URI received preemptive aerosolized ribavirin (2g/day) for 5–7 d; some patients received full-dose preemptive ribavirin (6g/day). All results are from multivariable models. One hundred forty-seven of 4717 (3.1%) patients were diagnosed with RSV URI and/or LRTD during the first 100 days after HCT. Risk factors for RSV acquisition included bone marrow vs. peripheral blood stem cell (PBSC) (1.7, P=0.01), winter season (P<0.0001), the years 1993 and 1997 when 2 outbreaks occurred (HR 1.7, P=0.01), male sex (HR 1.4, P=0.06). Laminar airflow rooms (HR 0.5, P=0.004) and the period after 1997 (HR 0.65, P=0.09) were protective against acquisition (after 1997, we started to restrict patient contact with staff and caretakers who had an URI with uncontrolled secretions). Risk factors for RSV-LRTD among infected patients included age > 20 year (OR 3.2, P=0.02) and lymphocytopenia < 100/mm3 (OR 4.7, P=0.0005). To assess risk factors for progression from RSV-URI to LRTD, patients who presented with RSV-URI were examined. Lymphocytopenia < 100/mm3 was the only statistically significant factor (OR 14, P<0.001) associated with progression; use of preemptive ribavirin (low- or high-dose) was not statistically significantly associated with a lower progression rate. The development of RSV LRTD as a time-dependent variable was associated with increased mortality after HCT (HR 2.2, p < 0.001), after controlling for age, underlying disease status, donor match and type, conditioning regimen, stem cell source, and CMV serostatus. Thus, RSV acquisition is less common with PBSC transplantation and in a strict isolation setting. Restricting recipients’ contact to people with uncontrolled respiratory secretions in the outpatient setting may be beneficial; further studies are needed to confirm this. Lymphocytopenia is an important risk factor for progression from URI to LRTD and RSV-LRTD is independently associated with mortality after HCT.

Clinical Characteristics of the Afebrile Pneumonia Associated With Chlamydia trachomatis Infection in Infants Less Than 6 Months of Age

PEDIATRICS ◽  
1979 ◽  
Vol 63 (2) ◽  
pp. 192-197
Author(s):  
Margaret A. Tipple ◽  
Marc O. Beem ◽  
Evelyn M. Saxon
Keyword(s):  
Chlamydia Trachomatis ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Characteristics ◽  
Respiratory Tract Disease ◽  
Chlamydia Trachomatis Infection ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease ◽  
Blood Eosinophils ◽  
Respiratory Tract Colonization

Respiratory tract colonization with Chlamydia trachomatis commonly occurs in natally acquired chlamydial infection and is sometimes associated with a chronic, afebrile pneumonia that has relatively distinctive clinical characteristics. To further define the frequency and clinical characteristics of lower respiratory tract disease associated with C trachomatis, we grouped 56 infants aged less than 6 months with afebrile pneumonia according to nasopharyngeal shedding of Chlamydia and viruses and compared their illnesses. Forty-one (73%) were positive for C trachomatis (23 had C trachomatis only, while 18 had C trachomatis plus a virus [cytomegalovirus, respiratory synctial virus, adenovirus, rhinovirus, or enterovirus]), and 15 were C trachomatis negative (nine had a virus only, and six had neither C trachomatis nor virus). The 41 infants with C trachomatis alone or C trachomatis plus a virus were similar clinically and differed significantly from other infants in several ways: (1) onset of symptoms before 8 weeks of age; (2) gradually worsening symptoms; (3) presentation for care at 4 to 11 weeks of age; (4) presence of conjunctivitis and ear abnormalities; (5) chest roentgenograms showing bilateral, symmetrical, interstitial infiltrates and hyperexpansion; (6) peripheral blood eosinophils ≥300/cu mm; and (7) elevated values for serum immunoglobulins M, G, and A.

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