Low mortality rates related to respiratory virus infections after bone marrow transplantation

Abstract

Summary:Respiratory viruses (RVs) frequently cause severe respiratory disease in bone marrrow transplant (BMT) recipients. To evaluate the frequency of RV, nasal washes were collected year-round from BMT recipients with symptoms of upper respiratory tract infection (URI). Direct immunofluorescence assay was performed for respiratory syncytial virus (RSV), influenza (Flu) A and B, adenovirus and parainfluenza (Paraflu) virus. Patients with RSV pneumonia or with upper RSV infection, but considered at high risk for developing RSV pneumonia received aerosolized ribavirin. Oseltamivir was given to patients with influenza. A total of 179 patients had 392 episodes of URI. In all, 68 (38%) tested positive: RSV was detected in 18 patients (26.4%), Flu B in 17 (25%), Flu A in 11 (16.2%) and Paraflu in 7 (10.3%). A total of 14 patients (20.6%) had multiple RV infections or coinfection. RSV pneumonia developed in 55.5% of the patients with RSV-URI. One of the 15 patients (6.6%) with RSV pneumonia died. Influenza pneumonia was diagnosed in three patients (7.3%). RSV and influenza infections peaked in fall-winter and winter-spring months, respectively. We observed decreased rates of influenza and parainfluenza pneumonia and low mortality because of RSV pneumonia. The role of antiviral interventions such as aerosolized ribavirin and new neuraminidase inhibitors remains to be defined in randomized trials.

Use of Oseltamivir to control influenza complications after bone marrow transplantation

“…Of the 18 patients (88.8%) infected with influenza A, 16 were allogeneic BMT recipients as were 16 of the 23 patients (69.5%) with influenza B. The seasonal distribution of influenza A and B viruses among BMT recipients has been published elsewhere 7 and is similar to that observed in the community, over the same period (unpublished data from the Adolfo Lutz Institute, State Health Department). Only five of the 41 episodes (12.2%) of influenza A or B infection occurred during the summer months.…”

“…Although influenza continues to cause annual, worldwide epidemics, and a higher risk of complication in BMT recipients, [1][2][3][4] surprisingly few studies have addressed the impact of influenza vaccination or of early, antiviral intervention with the new neuraminidase (NA) inhibitors, Zanamivir and Oseltamivir. [5][6][7] Oseltamivir is a potent and selective inhibitor of the NA glycoprotein, essential for replication of the influenza A and B viruses. This drug inhibits sialidase activity, and compared to Amantadine, provides clear advantages such as activity against both influenza A and B viruses, an improved safety profile, and a low potential for inducing resistance.…”

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

“…The results of RV infections in HSCT recipients from 2001 to 2003 have been published elsewhere. 14,15 Aliquots of the respiratory samples were stored in trizol at À80 1C until RNA extraction (trizol method; Invitrogen, Carlsbad, CA, USA).…”

“…In general, respiratory viruses (RVs) circulate year round with moderate activity except by respiratory syncytial virus and influenza A and B, which peak in fall and winter, respectively. 14,15 The present study was conducted to determine the frequency, seasonal distribution and genotypes of hMPV detected in HSCT recipients from Sa˜o Paulo, Brazil, during 3 consecutive years. …”

Successful prevention of respiratory syncytial virus nosocomial transmission following an enhanced seasonal infection control program

“…A more severe clinical course has been associated with early occurrence post-transplantation, chronic GVHD, persistant lymphopenia and allogeneic HSCT. [1][2][3][4][5][6][7][8] As preemptive therapy and treatment with aerosolized ribavirin and anti-RSV antibodies offer only modest benefits 1,[8][9][10][11][12][13][14] and no effective vaccine is currently available, recent strategies have focused on RSV infection prevention.…”