scholarly journals Community-acquired respiratory virus lower respiratory tract disease in allogeneic stem cell transplantation recipient: Risk factors and mortality from pulmonary virus-bacterial mixed infections

2018 ◽  
Vol 20 (4) ◽  
pp. e12926 ◽  
Author(s):  
José Luis Piñana ◽  
María Dolores Gómez ◽  
Ariadna Pérez ◽  
Silvia Madrid ◽  
Aitana Balaguer-Roselló ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Lower Respiratory Tract ◽  
Respiratory Virus ◽  
Mixed Infections ◽  
Respiratory Tract Disease ◽  
Lower Respiratory Tract Disease ◽  
Tract Disease ◽  
Stem Cell Transplantation Recipient ◽  
Transplantation Recipient

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.

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]

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.

Weight Status and Risk of Inpatient Admission for Children With Lower Respiratory Tract Disease

2021 ◽  
Author(s):  
Elizabeth E. Halvorson ◽  
Amit Saha ◽  
Christopher B. Forrest ◽  
Hanieh Razzaghi ◽  
Suchitra Rao ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Hospital Admission ◽  
Lower Respiratory Tract ◽  
Normal Weight ◽  
Research Network ◽  
Respiratory Tract Disease ◽  
Weight Category ◽  
Lower Respiratory Tract Disease ◽  
Class 1 ◽  
Tract Disease

OBJECTIVES To identify associations between weight category and hospital admission for lower respiratory tract disease (LRTD), defined as asthma, community-acquired pneumonia, viral pneumonia, or bronchiolitis, among children evaluated in pediatric emergency departments (PEDs). METHODS We performed a retrospective cohort study of children 2 to &lt;18 years of age evaluated in the PED at 6 children’s hospitals within the PEDSnet clinical research network from 2009 to 2019. BMI percentile of children was classified as underweight, healthy weight, overweight, and class 1, 2, or 3 obesity. Children with complex chronic conditions were excluded. Mixed-effects multivariable logistic regression was used to assess associations between BMI categories and hospitalization or 7- and 30-day PED revisits, adjusted for covariates (age, sex, race and ethnicity, and payer). RESULTS Among 107 446 children with 218 180 PED evaluations for LRTD, 4.5% had underweight, 56.4% had healthy normal weight, 16.1% had overweight, 14.6% had class 1 obesity, 5.5% had class 2 obesity, and 3.0% had class 3 obesity. Underweight was associated with increased risk of hospital admission compared with normal weight (odds ratio [OR] 1.76; 95% confidence interval [CI] 1.69–1.84). Overweight (OR 0.87; 95% CI 0.85–0.90), class 1 obesity (OR 0.88; 95% CI 0.85–0.91), and class 2 obesity (OR 0.91; 95% CI 0.87–0.96) had negative associations with hospital admission. Class 1 and class 2, but not class 3, obesity had small positive associations with 7- and 30-day PED revisits. CONCLUSIONS We found an inverse relationship between patient weight category and risk for hospital admission in children evaluated in the PED for LRTD.

Ribavirin. Red Book Committee Recommendations Questioned

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 672-673
Author(s):  
Ellen R. Wald ◽  
Barry Dashefsky
Keyword(s):  
High Risk ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Disease ◽  
American Academy Of Pediatrics ◽  
Lower Respiratory Tract Disease ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Tract Disease ◽  
New Guidelines ◽  
Do So

The new guidelines provided by the Committee on Infectious Diseases of the American Academy of Pediatrics on the Use of Ribavirin in the Treatment of Respiratory Syncytial Virus Infection (RSV) are perplexing and prompt concern: "Ribavirin treatment is recommended for the following patients hospitalized with RSV lower respiratory tract disease: a. infants at high risk for severe or complicated RSV infection, including those with complicated congenital heart disease (including pulmonary hypertension); those with bronchopulmonary dysplasia, . . ."1,pp502-503 The accompanying qualifier that "the recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed"1,p501 is important but insufficient to dampen the effect of the Committee's decision to change its former stance of merely urging consideration of the use of ribavirin for patients at high risk for complications2 to an unequivocal recommendation to do so.

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