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01.07.2007 | Therapy in Practice

Viral Respiratory Tract Infections in Transplant Patients

Epidemiology, Recognition and Management

verfasst von: Dr Ingi Lee, Todd D. Barton

Erschienen in: Drugs | Ausgabe 10/2007

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Abstract

Viral respiratory tract infections (RTIs) are common causes of mild illness in immunocompetent children and adults, with occasional significant morbidity or mortality in the very young, very old or infirm. However, recipients of solid organ transplants (SOT) or haematopoietic stem cell transplants (HSCT) are at markedly increased risk for significant morbidity or mortality from these infections. The infections are generally acquired by transmission of large respiratory droplets and can be nosocomial in origin with many documented outbreaks on specialised transplant units. Typically, the infections begin as upper RTIs, with cough or rhinorrhoea predominating. Many will resolve at this stage, but more immunocompromised patients, typically closer in time to their SOT or HSCT, may develop progressive infection to lower RTI or pneumonia. The most common RTI pathogens are influenza viruses, parainfluenza viruses and respiratory syncytial viruses. Newer polymerase chain reaction-based diagnostic strategies are more sensitive than previous assays, and allow rapid and accurate diagnoses of these infections. These newer assays may also detect emerging pathogens of significance, one of which is human metapneumovirus. While diagnostic techniques have advanced significantly in the past decade, well established and effective specific treatments for these infections remain elusive. The epidemiology, clinical presentation, diagnosis and treatment of the common viral RTIs in SOT or HSCT recipients are reviewed, and recommendations presented based on a thorough review of recent literature.

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Englund JA. Diagnosis and epidemiology of community-acquired respiratory virus infections in the immunocompromised host. Biol Blood Marrow Transplant 2001; 7: 25–45CrossRef

Couch RB, Englund JA, Whimbey E. Respiratory viral infections in immunocompetent and immunocompromised persons. Am J Med 1997; 102: 2–9PubMedCrossRef

Chakrabarti S, Avivi I, Mackinnon S, et al. Respiratory virus infections in transplant recipients after reduced-intensity conditioning with Campath-1H: high incidence but low mortality. Br J Haematol 2002; 119: 1125–32PubMedCrossRef

Lujan-Zilbermann J, Benaim E, Tong X, et al. Respiratory virus infections in pediatric hematopoietic stem cell transplantation. Clin Infect Dis 2001; 33: 962–8PubMedCrossRef

Roghmann M, Ball K, Erdman D, et al. Active surveillance for respiratory virus infections in adults who have undergone bone marrow and peripheral blood stem cell transplantation. Bone Marrow Transplant 2003; 32: 1085–8PubMedCrossRef

Van Kraajj MGJ, van Eiden LJR, van Loon AM, et al. Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis 2005; 40: 662–9CrossRef

Singhal S, Muir DA, Ratcliffe DA, et al. Respiratory viruses in adult liver transplant patients. Transplantation 1999; 68: 981–4PubMedCrossRef

Ljungman P. Respiratory virus infections in bone marrow recipients: the European perspective. Am J Med 1997; 102: 44–7PubMedCrossRef

Raboni SM, Noguerira MB, Tsuchiya LRV, et al. Respiratory tract viral infections in bone marrow transplant patients. Transplantation 2003; 76: 142–6PubMedCrossRef

10.

Hassan IA, Chopra R, Swindell R, et al. Respiratory viral infections after bone marrow/peripheral stem cell transplantation: the Christie hospital experience. Bone Marrow Transplant 2003; 32: 73–7PubMedCrossRef

11.

Whimbey E, Englund JA, Couch RB. Community respiratory virus infections in immunocompromised patients with cancer. Am J Med 1997; 102: 10–8PubMedCrossRef

12.

Chakrabarti S, Collingham KE, Holder K, et al. Parainfluenza virus 3 infection after stem cell transplant relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32: 413–8CrossRef

13.

Ohori NP, Michaels MG, Jaffe R, et al. Adenovirus pneumonia in lung transplant patients. Hum Pathol 1995; 26: 1073–9PubMedCrossRef

14.

Barton TD, Blumberg EA. Viral pneumonias other than cytome-galovirus in transplant recipients. Clin Chest Med 2005; 26(4): 707–20PubMedCrossRef

15.

Vilchez RA, Fung J, Kusne S. The pathogenesis and management of influenza virus infection in organ transplant recipients. Transpl Infect Dis 2002; 4: 177–82PubMedCrossRef

16.

Nichols WG, Corey L, Gooley T, et al. Parainfluenza viras infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood 2001; 98: 573–8PubMedCrossRef

17.

Elizaga J, Olavarria E, Apperley JF, et al. Parainfluenza viras 3 infection after stem cell transplant: relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32: 413–8PubMedCrossRef

18.

Centers for Disease Control and Prevention. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Morb Mortal Wkly Rep 2000; 49: 1–128

19.

Chan PWK, Chew FT, Tan TN, et al. Seasonal variation in respiratory syncytial virus chest infection in the tropics. Ped Pulmonol 2002; 34: 47–51CrossRef

20.

Hellman CA. Respiratory syncytial and parainfluenza viruses. J Infect Dis 1990; 161: 402–6CrossRef

21.

McCarthy AJ, Kingman HM, Kelly C, et al. The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation. Bone Marrow Transplant 1999; 24: 1315–22PubMedCrossRef

22.

Small TN, Casson A, Malak SF, et al. Respiratory syncytial virus infection following hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29: 321–7PubMedCrossRef

23.

Ljungman P, Ward KN, Crooks BNA, et al. Respiratory viras infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2001; 28: 479–84PubMedCrossRef

24.

Wendt CH. Community respiratory viruses: organ transplant recipients. Am J Med 1997; 102: 31–6PubMedCrossRef

25.

Vilchez RA, Dauber J, Kusne S. Infectious etiology of bronchiolitis obliterans: the respiratory viruses connection: myth or reality? Am J Transplant 2003; 3: 245–9PubMedCrossRef

26.

Taylor GS, Vipond IB, Caul EO. Molecular epidemiology of outbreak of respiratory syncytial virus within bone marrow transplant unit. J Clin Microbiol 2001; 39(2): 801–3PubMedCrossRef

27.

Singhal S, Muir DA, Ratcliffe DA, et al. Respiratory viruses in adult liver transplant recipients. Transplantation 1999; 68(7): 981–4PubMedCrossRef

28.

Hall CB. Nosocomial respiratory syncytial virus infections: the ‘cold war’ has not ended. Clin Infect Dis 2000; 31: 590–6PubMedCrossRef

29.

Abdallah A, Rowland KE, Schepetiuk SK, et al. An outbreak of respiratory syncytial virus infection in a bone marrow transplant unit: effect on engraftment and outcome of pneumonia without specific antiviral treatment. Bone Marrow Transplant 2003; 32: 195–203PubMedCrossRef

30.

Raad I, Abbas J, Whimbey E. Infection control of nosocomial respiratory viral disease in the immunocompromised host. Am J Med 1997; 102: 48–52PubMedCrossRef

31.

Ghosh S, Champlin RE, Ueno NT, et al. Respiratory syncytial viras infections in autologous blood and marrow transplant recipients with breast cancer: combination therapy with aerosolized ribavirin and parenteral immunoglobulins. Bone Marrow Transplant 2001; 28: 271–5PubMedCrossRef

32.

Lewinsohn DM, Bowden RA, Mattson D, et al. Phase I study of intravenous ribavirin treatment of respiratory syncytial viras pneumonia after marrow transplantation. Antimicrob Agents Chemother 1996; 40: 2555–7PubMed

33.

Machado CM, Boas LSV, Mendes AVA, et al. Low mortality rates related to respiratory virus infections after bone marrow transplantation. Bone Marrow Transplant 2003; 31: 695–700PubMedCrossRef

34.

Chemaly RF, Ghosh S, Bodey GP, et al. Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center. Medicine 2006; 85(5): 278–87PubMedCrossRef

35.

Champlin RE, Whimbey E. Community respiratory viras infections in bone marrow transplant recipients: the MD Anderson Cancer Center Experience. Biol Blood Marrow Transplant 2001; 7: 85–105

36.

Peck AJ, Corey L, Boeckh M. Pretransplantation respirator syncytial viras infection: impact of a strategy to delay transplantation. Clin Infect Dis 2004; 39: 673–80PubMedCrossRef

37.

Billings JL, Hertz MI, Wendt CH. Community respiratory viras infections following lung transplantation. Transpl Infect Dis 2001; 3: 138–48PubMedCrossRef

38.

van Elden LJR, van Loon AM, vander Beek A, et al. Applicability of a real-time quantitative PCR assay for diagnosis of respiratory syncytial viras infection in immunocompromised adults. J Clin Microbiol 2003; 41(9): 4378–81PubMedCrossRef

39.

Weinberg A, Zamora MR, Li S, et al. The value of polymerase chain reaction for the diagnosis of viral respiratory tract infections in lung transplant recipients. J Clin Virol 2002; 25(2): 171–5PubMedCrossRef

40.

Kochhar DM, Penner JD, Knudsen TB. Embryotoxic, teratogenic, and metabolic effects of ribavirin in mice. Toxicol Appl Pharmacol 1980; 52: 99–112PubMedCrossRef

41.

Ferm VH, Willhite C, Kilham L. Teratogenic effects of ribavirin on hamster and rat embryos. Teratology 1978; 17(1): 93–101PubMedCrossRef

42.

Atmar RL, Englund JA, Hammil H. Complications of measles during pregnancy. Clin Infect Dis 1992; 14: 217–26PubMedCrossRef

43.

Harrington RD, Hooton TM, Hackman RC, et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center. J Infect Dis 1992; 165: 987–93PubMedCrossRef

44.

Boeckh M, Englund J, Yufeng L, et al. Randomized controlled multicenter trial of aerosolized ribavirin for respiratory syncytial virus upper respiratory tract infection in hematopoietic cell transplant recipients. Clin Infect Dis 2007; 44: 245–9PubMedCrossRef

45.

Glanville AR, Scott AIR, Morton JM, et al. Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation. J Heart Lung Transplant 2005; 24(12): 2114–9PubMedCrossRef

46.

Ghosh S, Champlin RE, Englund J, et al. Respiratory syncytial virus upper respiratory tract illnesses in adult blood and bone marrow transplant recipients: combination therapy with aerosolized ribavirin and intravenous immunoglobulin. Bone Marrow Transplant 2000; 25: 751–5PubMedCrossRef

47.

Whimbey E, Champlin RE, Englund JA, et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. Bone Marrow Transplant 1995; 16: 393–9PubMed

48.

Boeckh M, Berrey MM, Bowden RA, et al. Phase 1 evaluation of the respiratory syncytial virus-specific monoclonal antibody palivizumab in recipients of hematopoietic stem cell transplants. J Infect Dis 2001; 184(3): 350–4PubMedCrossRef

49.

Zamora MR, Hodges T, Nicholls MR, et al. Impact of respiratory syncytial virus pneumonia following lung transplantation: a case-controlled study [abstract]. J Heart Lung Transplant 2004; 23 (2 Suppl.): S43–4CrossRef

50.

Swedish Consensus Group. Management of infections caused by respiratory syncytial virus. Scand J Infect Dis 2001; 33(5): 323–8CrossRef

51.

Community-acquired respiratory viruses. Am J Transplant 2004; 4 (Suppl 10): 105–9CrossRef

52.

Vilchez RA, Dauber J, McCurry K, et al. Parainfluenza virus infection in adult lung transplant recipients: an emergent clinical syndrome with implications on allograft function. Am J Transplant 2003; 3: 116–20PubMedCrossRef

53.

Vilchez RA, McCurry K, Dauber J, et al. The epidemiology of parainfluenza virus infection in lung transplant recipients. Clin Infect Dis 2001; 33: 2004–8PubMedCrossRef

54.

Nichols WG, Erdman DD, Han A, et al. Prolonged outbreak of human parainfluenza virus 3 infection in a stem cell transplant outpatient department: insights from molecular epidemiologic analysis. Biol Blood Marrow Transplant 2004; 10: 58–64PubMedCrossRef

55.

Bowden RA. Respiratory virus infections after marrow transplant: the Fred Hutchinson Cancer Research Center experience. Am J Med 1997; 102: 27–30PubMedCrossRef

56.

McCurdy LH, Milstone A, Dummer S. Clinical features and outcomes of paramyxoviral infection in lung transplant recipients treated with ribavirin. J Heart Lung Transplant 2003; 22: 745–53PubMedCrossRef

57.

Heilman CA. Respiratory syncytial and parainfluenza viruses. J Infect Dis 1990; 161: 402–6PubMedCrossRef

58.

Machado CM, Boas LSV, Mendes AVA, et al. Use of oseltamivir to control influenza complications after bone marrow transplantation. Bone Marrow Transplant 2004; 34: 111–4PubMedCrossRef

59.

Vilchez R, McCurry K, Dauber J, et al. Influenza and parainfluenza respiratory viral infection requiring admission in adult lung transplant recipients. Transplantation 2002; 73(7): 1075–8PubMedCrossRef

60.

Vilchez R, McCurry K, Dauber J, et al. Influenza virus infection in adult solid organ transplant recipients. Am J Transplant 2002; 2: 287–91PubMedCrossRef

61.

Nichols WG, Guthrie KA, Corey L, et al. Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis 2004; 39: 1300–6PubMedCrossRef

62.

Weinstock DM, Gubareva LV, Zuccotti G. Prolonged shedding of multidrug-resistant influenza A virus in an immunocompromised patient. N Engl J Med 2003; 348(9): 867–8PubMedCrossRef

63.

Whimbey E, Bodey GP. Viral pneumonia in the immunocompromised adult with neoplastic disease: the role of common community respiratory viruses. Semin Resp Infect 1992; 7: 122–31

64.

Ison MG, Hayden FG. Viral infections in immunocompromised patients: what’s new with respiratory viruses? Curr Opin Infect Dis 2002; 15: 355–67PubMedCrossRef

65.

Smith NM, Bresee JS, Shay DK, et al., on behalf of the Advisory Committee on Immunization Practices. Prevention and control of influenza [published erratum appears in MMWR Morb Mortal Wkly Rep 2006; 55 (29): 800]. Morb Mortal Wkly Rep 2006; 55(RR10): 1–42

66.

Duchini A, Gross JA, Karpen S, et al. Vaccinations for adult solid-organ transplant recipients: current recommendations and protocols. Clin Microbiol Rev 2003; 16(3): 357–64PubMedCrossRef

67.

Gandhi MK, Egner W, Sizer L, et al. Antibody responses to vaccinations given within the first two years after transplant are similar between autologous peripheral blood stem cell and bone marrow transplant recipients. Bone Marrow Transplant 2001; 28: 775–81PubMedCrossRef

68.

Duchini A, Hendry RM, Nyberg LM, et al. Immune response to influenza vaccine in adult liver transplant recipients. Liver Transplant 2001; 7: 311–3CrossRef

69.

Mazzone PJ, Mossad SB, Mawhorter SD, et al. The humoral response to influenza vaccination in lung transplant recipients. Euro Resp J 2001; 18: 971–6CrossRef

70.

Wyzgal J, Brydak LB, Zygier D, et al. Study on efficacy of influenza vaccination in renal allograft recipients. Transplant Proc 2002; 34: 572–5PubMedCrossRef

71.

Kumar D, Humar A. Pandemic influenza and its implications for transplantation. Am J Transplant 2006; 6: 1512–7PubMedCrossRef

72.

Yuen KY, Chan PK, Peiris M, et al. Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet 1998; 351: 467–71PubMedCrossRef

73.

World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO [online]. Available from URL: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2007_05_30/en/index.html [Accessed 2007 May 31]

74.

The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H 5. Avian influenza A (H5N1) infection in humans. N Engl J Med 2005; 353: 1374–85CrossRef

75.

Centers for Disease Control an Prevention. Severe acute respiratory syndrome. Morb Mortal Wkly Rep 2003; 52(18): 405–32

76.

De Jong MD, Tran TT, Truong HK, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005; 353: 2667–72PubMedCrossRef

77.

Adenovirus. Am J Transplant 2004; 4: 101–4

78.

Machado CM, Boas LSV, Mendes AVA, et al. Low mortality rates related to respiratory virus infections after bone marrow transplantation. Bone Marrow Transplant 2003; 31: 695–700PubMedCrossRef

79.

Khalifah AP, Hachem RR, Chakinala MM, et al. Respiratory viral infections are a distinct risk for bronchiolitis obliterans syndrome and death. Am J Resp Crit Care Med 2004; 170: 181–7PubMedCrossRef

80.

Howard DS, Phillips II GL, Reece DE, et al. Adenovirus infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 1999 Dec; 29(6): 1494–501PubMedCrossRef

81.

Bredius RGM, Templeton KE, Scheltinga SA, et al. Prospective study of respiratory viral infections in pediatric hemopoietic stem cell transplantation patients. Ped Infect Dis J 2004; 23: 518–22CrossRef

82.

McGrath D, Falagas ME, Freeman R, et al. Adenovirus infection in adult orthotopic liver transplant recipients: incidence and clinical significance. J Infect Dis 1998; 177: 459–62PubMedCrossRef

83.

Humar A, Kumar D, Mazzuli T, et al. A surveillance study of adenovirus infection in adult solid organ transplant recipients. Am J Transplant 2005; 5: 2555–9PubMedCrossRef

84.

Walls T, Hawrami K, Ushiro-Lumb I, et al. Adenovirus infection after pediatric bone marrow transplantation: is treatment always necessary? Clin Infect Dis 2005; 40: 1244–9PubMedCrossRef

85.

Holt ND, Gould FK, Taylor CE, et al. Incidence and significance of noncytomegalovirus viral respiratory infection after adult lung transplantation. J Heart Lung Transplant 1997; 16: 416–9PubMed

86.

Crooks BNA, Taylor CE, Turner AJL, et al. Respiratory viral infections in primary immune deficiencies: significance and relevance to clinical outcome in a single BMT unit. Bone Marrow Transplant 2000; 26: 1097–102PubMedCrossRef

87.

Kumar D, Tellier R, Draker R, et al. Severe acute respiratory syndrome (SARS) in a liver transplant recipient and guidelines for donor screening. Am J Transplant 2003; 3: 977–81PubMedCrossRef

88.

Taplitz RA, Jordan MC. Pneumonia caused by herpesviruses in recipients of hematopoietic cell transplants. Semin Resp Infect 2002; 17: 121–9CrossRef

89.

Yoshikawa T. Human herpesvirus-6 and -7 infections in transplantation. Ped Transplant 2003; 7: 11–7CrossRef

90.

Buchbinder S, Elmaagacli AH, Schaefer UW, et al. Human herpesvirus 6 is an important pathogen in infectious lung disease after allogeneic bone marrow transplantation. Bone Marrow Transplant 2000; 26: 639–44PubMedCrossRef

91.

Kadakia MP, Rybka WB, Stewart JA, et al. Human herpesvirus 6: infection and disease following autologous and allogeneic bone marrow transplantation. Blood 1996; 87: 5341–54PubMed

92.

Ross DJ, Chan RCK, Kubak B, et al. Bronchiolitis obliterans with organizing pneumonia: possible association with human herpesvirus-7 infection after lung transplantation. Transplant Proc 2001; 33: 2603–6PubMedCrossRef

93.

Larcher C, Geltner C, Fischer H, et al. Human metapneumovirus infection in lung transplant recipients: clinical presentation and epidemiology. J Heart Lung Transplant 2005; 24: 1891–901PubMedCrossRef

94.

Gerna G, Vitulo P, Rovida F, et al. Impact of human metapneumovirus and human cytomegalovirus versus other respiratory viruses on the lower respiratory tract infections of lung transplant patients. J Med Virol 2006; 78: 408–16PubMedCrossRef

95.

Williams JV, Martino R, Rabella N, et al. A prospective study comparing human metapneumovirus with other respiratory viruses in adults with hematologic malignancies and respiratory tract infections. Clin Infect Dis 2005; 192: 1061–5

96.

Englund JA, Boeckh M, Kuypers J, et al. Fatal human metapneumovirus infection in stem-cell transplant recipients. Ann Intern Med 2006; 144: 344–9PubMed

97.

Debiaggi M, Canducci F, Sampaolo M, et al. Persistent symptomless human metapneumovirus infection in hematopoietic stem cell transplant recipients. J Infect Dis 2006; 194: 474–8PubMedCrossRef

Titel: Viral Respiratory Tract Infections in Transplant Patients
Epidemiology, Recognition and Management
verfasst von: Dr Ingi Lee
Todd D. Barton
Publikationsdatum: 01.07.2007
Verlag: Springer International Publishing
Erschienen in: Drugs / Ausgabe 10/2007
Print ISSN: 0012-6667
Elektronische ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200767100-00004

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Viral Respiratory Tract Infections in Transplant Patients

Epidemiology, Recognition and Management

Abstract

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

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