scholarly journals Parainfluenza Virus Lower Respiratory Tract Disease After Hematopoietic Cell Transplant: Viral Detection in the Lung Predicts Outcome

2014 ◽  
Vol 58 (10) ◽  
pp. 1357-1368 ◽  
Author(s):  
Sachiko Seo ◽  
Hu Xie ◽  
Angela P. Campbell ◽  
Jane M. Kuypers ◽  
Wendy M. Leisenring ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Hematopoietic Cell ◽  
Parainfluenza Virus ◽  
Cell Transplant ◽  
Respiratory Tract Disease ◽  
Viral Detection ◽  
Hematopoietic Cell Transplant ◽  
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.

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.

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