Respiratory Syncytial Virus Infection in Immunocompromised Adults

Abstract

Respiratory syncytial virus disease was documented in 11 immunocompromised adults, aged 21 to 50. Underlying conditions included bone marrow transplant (6 patients), renal transplant (3 patients), renal and pancreas transplants (1 patient), and T-cell lymphoma (1 patient). Diagnosis of infection was based on specimens from bronchoalveolar lavage, sputum, throat, sinus aspirate, and lung biopsy. The virus was detected simultaneously by antibody in either an immunofluorescence or enzyme-linked immunosorbent assay in 3 of 4 patients whose culture results were positive for respiratory syncytial virus. The virus was an unexpected finding, despite widespread infection in the community. Clinical symptoms included low-grade fever, nonproductive cough, rhinorrhea or nasal congestion, and radiographic evidence of interstitial infiltrates and sinusitis. Aerosolized ribavirin therapy was used in the 6 recipients of bone marrow transplants, 3 of whom required assisted ventilation but died. Death caused by virus infection was documented in 4 of 11 patients. Respiratory syncytial virus disease must be considered in the differential diagnosis of fever and pulmonary infiltrates in immunocompromised adults.

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

“…In adult patients, this procedure does not give an adequate cell yield to make a sensitive diagnosis and in these patients bronchoalveolar lavage is more appropriate. 18 Radiological changes are non-specific in the setting of BMT where a number of other opportunistic infections may give rise to similar findings. CT scans of the chest might be more sensitive, but we are not aware of any data concerning their use in BMT patients with RSV infections.…”

Frequency of human metapneumovirus infection in hematopoietic SCT recipients during 3 consecutive years

“…(2) NW collected from all symptomatic patients to test for RVs using direct immunofluorescent assay and the patients kept under contact precautions until specific diagnosis. NW sampling and storage Clinical specimens were collected by instilling 3-6 ml of normal saline with a needleless syringe in the nostril of the patient as described by Englund et al, 16 kept on ice and processed within 3 h from sampling. Direct fluorescence assay (Imagen, Dako, Cambridgeshire, UK) was used to diagnose respiratory syncytial virus (RSV), influenza A and B, parainfluenza and adenovirus.…”

Comparison of direct immunofluorescence, conventional cell culture and polymerase chain reaction techniques for detecting respiratory syncytial virus in nasopharyngeal aspirates from infants

“…Two milliliters of Ringer´s lactate were introduced into each nostril with a silicon tube and vacuum aspirated in a sterile collector 8 . The samples, kept at 4 o C, were promptly sent to the laboratory and processed within two hours for direct immunofluorescence (IF) and viral isolation.…”

“…Several studies underline the impact of the use of rapid techniques on the clinical evolution of patients compared with conventional techniques 2 . In immunocompromised patients, especially bone marrow transplant recipients and premature neonates, this is particularly important since these patients require prompt therapeutic intervention 8 . In addition, rapid diagnosis allows early implementation of RSV-infection control policies, thus reducing nosocomial infections.…”