Community Respiratory Virus Infections Among Hospitalized Adult Bone Marrow Transplant Recipients

104

Summary:Respiratory syncytial virus (RSV) is known to cause acute lung injury in the immunocompromised host, especially recipients of bone marrow allografts. Specific prognostic factors for the development of severe lifethreatening disease remain to be identified as does the optimum treatment of established disease. Over a 5-year period the incidence and outcome of RSV in BMT recipients was analysed retrospectively. Prognostic factors assessed included type of transplant, engraftment status at the time of infection, the presence of lower respiratory tract disease, viral genotype and treatment received. During the study period, 26 of 336 (6.3%) allogeneic stem-cell recipients were identified as having RSV. Five patients (19.2%) died as a direct result of RSV. One patient died secondary to an intracranial bleed with concomitant RSV. There were four patients with graft failure (two primary and two secondary) attributable to the presence of RSV, two of whom subsequently died of infections related to prolonged myelosuppression. The presence of lower respiratory tract infection and a poor overall outcome was the only statistically significant association. Unrelated donor transplants and AML as the underlying disease appeared to be associated with a poorer outcome. Engraftment status, viral genotype and RSV treatment received did not correlate with outcome. We conclude that future studies are required to identify early sensitive and reproducible prognostic factors of RSV in the immunocompromised host. The roles of intravenous and nebulised ribavirin need to be clarified by prospective controlled trials.

Section: Discussionmentioning

confidence: 73%

“…[13][14][15][16] In one review, 13 RSV was found to be the responsible agent in 49% of cases, with just over half of these affecting the lower respiratory tract. Treatment options are either anti-viral, primarily using the virustatic agent, ribavirin or immunological, with the use of pooled or RSV specific immunoglobulin.…”

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confidence: 99%

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

McCarthy

Kingman

Kelly

et al. 1999

104

“…1,2 Although the majority are upper respiratory tract infections, [1][2][3][4][5] pneumonia historically occurs in 16-45% of all RV episodes, [1][2][3] and up to 80% of influenza. 6 Early treatment with oseltamavir has been shown to reduce the incidence of pneumonia in cases of influenza to o30% with an associated mortality o10%. 7,8 The widespread emergence of antiviral resistance 9 raises concern that these improvements may, however, not be sustained.…”

Section: Introductionmentioning

confidence: 99%

Patient and family education in HSCT: improving awareness of respiratory virus infection and influenza vaccination. A descriptive study and brief intervention

Ferguson

Jordens

Gilroy

2009

To prevent respiratory virus (RV) infection after hematopoietic SCT (HSCT), patient and household members are advised to have annual influenza vaccinations and avoid symptomatic contacts. The object of this study was to measure and increase patient/household awareness of RV infection and preventive measures. We used a selfadministered questionnaire before/after a 5-min educational module (2006)(2007) and interviews with HSCT patients (2005with HSCT patients ( -2007. The subjects were patients and their households attending pre-HSCT education in an Australian HSCT Unit. Outcome measures were awareness of RV infection post-HSCT and effective prevention strategies; household influenza vaccination on admission for HSCT. In all, 139 out of 205 (68%) participants completed both questionnaires. Baseline knowledge of RV infection risk was high; knowledge of prevention was low. Intervention increased awareness that influenza post-HSCT could be fatal or require intensive care (68-87%, P ¼ 0.003), knowledge of effective prevention strategies (41-78%, Po0.0001) including vaccination (11-58%, Po0.0001), and belief among family/friends (but not patients) that household vaccination reduces influenza risk post-HSCT (57-97%, Po0.0001 and 76-81%, P ¼ 0.2, respectively). Household vaccination at HSCT admission was 71% for attenders and 30% for non-participants (RR 2.38, 95% confidence interval (CI) 1.49-3.80, Po0.0001). We concluded that patient and family pre-HSCT education increases awareness of RV prevention strategies and household influenza vaccination.

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confidence: 99%

“…[1][2][3][4][5] RSV and PIV have been reported to account for most of the respiratory viral infections after transplant. [2][3][4] Progression to pneumonia occurs in about 50% of infected patients. [2][3][4][5] Depending on the clinical setting, the mortality from pneumonia due to RSV and PIV varies between 30 and 100%.…”

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confidence: 99%

Pre-emptive oral ribavirin therapy of paramyxovirus infections after haematopoietic stem cell transplantation: a pilot study

Chakrabarti

Collingham

Holder

et al. 2001

Summary:Infections with the paramyxoviruses, respiratory syncytial virus (RSV) and parainfluenza virus (PIV) can result in serious morbidity and mortality after haemopoietic stem cell transplant (HSCT). Once pneumonia develops, the outcome of these infections is often poor despite anti-viral therapy. Aerosolised ribavirin has been evaluated as pre-emptive therapy for post-transplant RSV infections with some success. Due to the financial and logistic burden involved with the use of aerosolised ribavirin, we explored the efficacy and toxicity of oral ribavirin for pre-emptive therapy of post-transplant RSV and PIV infections in a dose escalating schedule (15-60 mg/kg/day). Five episodes each of RSV and PIV were treated in seven patients. Five patients were receiving treatment for GVHD and two acquired the infection in the pre-engraftment period. All the episodes of RSV infection improved with oral ribavirin with dose escalation to 30-45 mg/kg in three of them. On the other hand, only two of the five PIV infections improved with oral ribavirin. Of the three non-responders, two infections were acquired in the pre-engraftment period with one death from PIV pneumonia. Reversible anaemia was the only side-effect noted in patients treated for over 2 weeks. Thus, the use of oral ribavirin was well tolerated in the post-transplant period with no untoward toxicities. There was a trend towards better response in RSV infections, which needs to be further explored in controlled studies. Bone Marrow Transplantation (2001) 28, 759-763.