Current management of parainfluenza pneumonitis in immunocompromised patients: a review

Abstract

Parainfluenza viruses (PIV) are common respiratory viruses that belong to the Paramyxoviridae family. PIV infection can lead to a wide variety of clinical syndromes ranging from mild upper respiratory illness to severe pneumonia. Severe disease can be seen in elderly or chronically ill persons and may be fatal in persons with compromised immune systems, particularly children with severe combined immunodeficiency disease syndrome and hematopathic stem cell transplant recipients. At present, there are no licensed antiviral agents for the treatment of PIV infection. Aerosolized or systemic ribavirin in combination with intravenous gamma globulin has been reported in small, uncontrolled series and case reports of immunocompromised patients. A number of agents show antiviral activity in vitro and in animals, but none are currently approved for human use.

Severe parainfluenza pneumonia in a case of transient hypogammalobulinemia of infancy

“…HPIV-3 infection is a common cause of pneumonia and bronchiolitis among children younger than 1-year-old,2 5 6 however, extremely severe manifestations such as giant cell pneumonia have been described only in immune compromised patients affected by SCID or in haematopoietic stem cell transplant recipients under immune suppressive therapy 1 7––9. Although HPIV-3 infects two-thirds of children within the first year of life, most of them do not show any symptom.…”

“…Treatment of uncommon viral pneumonia in childhood is debated and poor therapeutic tools are available,1 particularly for rapid progressive cases 2…”

Blood and Marrow Transplant Clinical Trials Network State of the Science Symposium 2014

“…PIVs are major respiratory tract pathogens, which can cause fatal viral LRTD and long-term airflow obstruction after HCT [120–123] and for which there are no effective therapy [124]. PIV URTI is a major risk factor for LRTD [120,121].…”

Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

“…The parainfluenza 3 viral infection was likely acquired in the community and may have also contributed to the severity of this patient’s respiratory failure. There is limited evidence to support the use of ribavirin and intravenous immunoglobulin in immunocompromised individuals with parainfluenza infections, and as this patient was immunocompetent, it was felt to have little benefit and therefore discontinued 3. The diagnosis of ARDS is made using the Berlin definition of ARDS.…”