Abstract
Highly immunocompromised pediatric and adult hematopoietic cell transplant (HCT) recipients frequently experience respiratory infections caused by viruses that are less virulent in immunocompetent individuals. Most of these infections, with the exception of rhinovirus as well as adenovirus and parainfluenza virus in tropical areas, are seasonal variable and occur before and after HCT. Infectious disease management includes sampling of respiratory specimens from nasopharyngeal washes or swabs as well as sputum and tracheal or tracheobronchial lavages. These are subjected to improved diagnostic tools including multiplex PCR assays that are routinely used allowing for expedient detection of all respiratory viruses. Disease progression along with high mortality is frequently associated with respiratory syncytial virus, parainfluenza virus, influenza virus, and metapneumovirus infections. In this review, we discuss clinical findings and the appropriate use of diagnostic measures. Additionally, we also discuss treatment options and suggest new drug formulations that might prove useful in treating respiratory viral infections. Finally, we shed light on the role of the state of immune reconstitution and on the use of immunosuppressive drugs on the outcome of infection.
Highlights
Specialty section: This article was submitted to Infectious Diseases, a section of the journal Frontiers in Microbiology
Kmeid et al (2016) applied an immunodeficiency scoring index (ISI) that had been developed for respiratory syncytial virus (RSV) to identify patients with influenza virus (IFV) infection who might run at risk to develop progression to lower respiratory tract infection (LRI) (Shah et al, 2014)
A certain class of antibiotics that poses a particular risk could not be identified. Another recent study described significant lower overall survival for patients with respiratory virus infection accompanied by bacterial co-infection that contributed to increased mortality (Pinana et al, 2018)
Summary
Immunocompromised pediatric and adult hematopoietic cell transplant (HCT) recipients frequently experience respiratory infections caused by viruses that are less virulent in immunocompetent individuals. Human pathogenic viruses frequently causing respiratory infections in the allogeneic HCT setting include RSV, AdV, IFV, PIV, HMPV, RhV, HCoV, and HBoV (Renaud and Englund, 2012; Abbas et al, 2017). Such respiratory virus infections contribute to morbidity and mortality for a number of reasons. AdV is a pathogen associated with severe complications in immunosuppressed pediatric HCT recipients including increased mortality (Leen et al, 2006; Feuchtinger et al, 2007; Lion, 2014; Feucht et al, 2015; Hiwarkar et al, 2018). Gastrointestinal shedding pre-transplant has been demonstrated to reflect increased risk of viremia after HCT (Kosulin et al, 2018a)
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