Long‐term therapy with aerosolized ribavirin for parainfluenza 3 virus respiratory tract infection in an infant with severe combined immunodeficiency

Abstract

We report the case of an infant with severe combined immunodeficiency who was presented with PIV3 infection. Aerosolized ribavirin was administered for 10 months until the child gained a functional immune system through an allogeneic hematopoietic stem cell transplant and cleared PIV3 infection. No adverse effect was observed in the child and in healthcare personnel, with a follow-up of three years. Despite the burden of aerosolized administration, early and prolonged administration of aerosolized ribavirin was feasible, well tolerated, and safe for the patient and the caregivers. This is a case report and no definite conclusions can be drawn. However, our experience suggests that prolonged aerosolized ribavirin administration should be considered for the treatment of PIV3 infection in the context of primary immunodeficiency, where there is no currently available alternative treatment, until a functional immune system is gained.

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.…”

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

“…In the absence of robust clinical efficacy data from large randomised controlled studies and with no licensed treatment available, some centres offer Ribavirin on the basis of evidence of in vitro and in vivo activity against parainfluenza viruses in case reports and small series. 8,12,20 Sialic acid analogues, such as 4-GuanidinoNeu5Ac2en (Zanamivir), designed to interfere with the binding of the viral HA-NA to host sialic acid residues, were originally designed to inhibit influenza infections but are only partially active in blocking PIV-3 HN in vitro 21 and there is no evidence of in vivo activity. Analogous compounds that block the haemagglutinin and neuraminidase of PIVs 1-3, such as BCX 2798 and BCX 2855, show great promise, although trials in humans are yet to begin.…”

Current management of parainfluenza pneumonitis in immunocompromised patients: a review

“…This rare genetic disorder is characterized by primary deficiency of T, B, and NK cell-mediated immunity that predispose afflicted patients to serious infections, including respiratory viruses. Persistent respiratory tract infection and shedding has been observed in SCID and HIV patients 1,4. The natural history of PIV infection in HIV patients is not well defined, but severe illness appears uncommon unless significant T cell dysfunction has occurred.…”

“…Among heart and lung transplant patients with PIV infection, 82% developed acute allograft refection and 32% developed bronchiolitis obliterans. 20 Using culture direct immunofluorescence testing, PIV infection rates range from 2.2% to 14% among pediatric and adult HSCT transplant patients 4,17,22,25–28. More recently, higher rates of infection and asymptomatic shedding have been observed using new sensitive molecular diagnostic tests 29.…”

“…Severe disease can be seen in elderly or chronically ill persons and can be fatal in persons with compromised immune systems 1. Severe giant cell pneumonia has been reported in children with severe combined immunodeficiency disease syndrome (SCIDS), solid organ, and hematopathic stem cell transplant (HSCT) recipients 4–6. This review will focus on PIV infection in immunocompromised patients, the antiviral therapy in development, and current management of PIV in this patient population.…”