A parainfluenza-3 outbreak in a SCT unit: sepsis with multi-organ failure and multiple co-pathogens are associated with increased mortality

Abstract

The estimated frequency of parainfluenza virus 3 (PIV-3) infections following haematopoietic SCT (HSCT) is 2-7%, whereas reported mortality ranges from 18 to 33%. We report a retrospective outcome analysis following an outbreak of PIV-3 infection in our transplant unit. A total of 16 HSCT patients developed PIV-3 infection. All patients had upper respiratory tract infection, whereas lower respiratory tract infection occurred in 8 patients. Overall, 13 patients were treated with aerosolised Ribavirin (2 g t.d.s. for 5 days) and i.v. Ig (0.5 g/kg) as per standard protocol. One patient refused treatment, whereas two patients with full immune reconstitution were not treated. Overall mortality was 62.5%. Sepsis with multi-organ failure and the presence of pulmonary co-pathogens were both significantly associated with PIV-3-related mortality. Our series confirms that high mortality is associated with PIV-3 infection in HSCT recipients. In patients who develop PIV-3 infection, despite strict enforcement of infection control policies, the best strategy might be careful risk assessment, with effective broad-spectrum anti-microbials in those who are at risk of secondary infection.

Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation

“…[1][2][3][4]8,12,[14][15][16][17][18][19][20][21] Furthermore, the development of LRTI has been consistently associated with significantly higher risk of death. 12,13,17,18 Early intervention with antiviral therapy has been demonstrated to reduce the risk of progression to pneumonia 7 and may lead to improved survival.…”

Circulating Clinical Strains of Human Parainfluenza Virus Reveal Viral Entry Requirements for In Vivo Infection

“…Paramyxoviruses, particularly respiratory syncytial virus (RSV), human metapneumovirus, and the human parainfluenza viruses (HPIVs), cause the majority of childhood croup, bronchiolitis, and pneumonia (1). In adults, these viruses cause about two-thirds of respiratory illnesses, with high mortality in immunocompromised persons (2); for example, HPIV3 accounts for 90% of the respiratory illnesses in hematopoietic stem cell transplant patients (3) and carries high mortality (3)(4)(5)(6)(7)(8). There are no effective vaccines or treatments for the HPIVs.…”

Epidemiology and clinical characteristics of parainfluenza virus 3 outbreak in a Haemato-oncology unit

“…29 The consequent greater susceptibility to pulmonary copathogens has been shown to substantially increase mortality in PIV3-infected patients with LRTI. 5,8,30 The early initiation of broad-spectrum antibiotic prophylaxis for bacterial infection on admission for all individuals with LRTI may have contributed substantially the reduced mortality in the study group.…”

“…Possible reasons include low numbers of pulmonary co-pathogens (6/32; 19%) in PIV3-infected subjects, prompt initiation of broadspectrum antibiotics (31/32; 97%) and only a small number of severely immunosuppressed HSCT recipients in our cohort (8/32; 25%), a group which in previous studies have shown the highest mortality (up to 60%) in those with LRTIs. 4,5,8,9,27,28 PIV3, in common with other respiratory viruses, may predispose to secondary bacterial infections by epithelial damage, impairment of ciliary function and triggering of host-inflammatory responses. In addition, bacterial infection may be promoted by increased expression of bacterial receptors on PIV3-infected cells.…”