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Vasiloudes KP, Greene JN. Rhinovirus, When Is It More Than Just a Cold? Rhinovirus as a Cause of Organizing Pneumonia in Two Patients With Hematological Cancer. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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2
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Kawang K, Naoudom U, Kowitdamrong E, Kerr SJ, Ruxrungtham K, Nilaratanakul V. Sensitivity and specificity of anti-double-stranded RNA immunofluorescence for universal detection of viral infection in respiratory specimens. Heliyon 2021; 7:e08471. [PMID: 34977399 PMCID: PMC8689082 DOI: 10.1016/j.heliyon.2021.e08471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
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Shinn K, Wetzel M, DeGroote NP, Keller F, Briones M, Felker J, Castellino S, Miller TP. Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia. Pediatr Blood Cancer 2020; 67:e28570. [PMID: 32881268 PMCID: PMC7721999 DOI: 10.1002/pbc.28570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Polymerase chain reaction (PCR) respiratory viral panel (RVP) testing is often used in evaluation of pediatric cancer patients with febrile neutropenia (FN), but correlation with adverse outcomes has not been well characterized. PROCEDURE A retrospective cohort of all children ages 0-21 years with cancer admitted to Children's Healthcare of Atlanta for FN from January 2013 to June 2016 was identified. Patient demographic and clinical variables such as age, RVP results, length of stay (LOS), and deaths were abstracted. Relationship between RVP testing and positivity and LOS, highest temperature (Tmax), hypotension and intensive care unit (ICU) admission were compared using Wilcoxon rank sums, chi-square, or Fisher's exact tests adjusting for age, sex, bacteremia, and diagnosis. RESULTS The 404 patients identified had 787 total FN admissions. RVPs were sent in 38% of admissions and were positive in 59%. Patients with RVPs sent were younger (median 5.5 vs 8.0 years, P < .0001) with higher Tmax (39.2° vs 39.1°, P = .016). The most common virus identified was rhinovirus/Enterovirus (61%). There were no significant differences in highest temperature or lowest blood pressure based on RVP positivity. Patients admitted to the ICU were more likely to have RVPs sent (odds ratio [OR] = 3.19, P < .002); however, neither having RVP testing nor RVP positivity were significantly associated with increased LOS or death. Coinfection with bacteremia and a respiratory virus was identified in 9.1% of patients. CONCLUSIONS These data raise the question of the utility of sending potentially costly RVP testing as RVP positivity during febrile neutropenia does not impact LOS, degree of hypotension, or ICU admission.
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Affiliation(s)
| | - Martha Wetzel
- Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Nicholas P. DeGroote
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Michael Briones
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - James Felker
- Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Sharon Castellino
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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4
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Abstract
PURPOSE OF REVIEW In hematopoietic cell transplant (HCT) recipients, paramyxovirus infections are major viral respiratory tract infections that, if they progress to lower respiratory tract infections, are associated with reduced survival rates in this population. There are important knowledge gaps regarding treatment decisions for HCT recipients with these infections and in the identification of risk factors that predict infection severity. Here, we review recent data on paramyxovirus infections in HCT recipients focusing on risk factors, new diagnostic and prognostic tools, and management including new drugs and vaccines under development. RECENT FINDINGS Multiplexed molecular assays associated with immunodeficiency scoring index for respiratory syncytial virus (RSV) have improved our understanding of the epidemiology of RSV and other paramyxovirus infections and the risk factors for worse outcomes. Novel antiviral drugs, monoclonal antibodies, and vaccines are under evaluation with mixed preliminary results. SUMMARY Advances in our knowledge of paramyxovirus infections in HCT recipients in the last two decades contributed to better strategies for management and prevention of these infections. A widespread understanding of how to stratify HCT recipients with paramyxovirus infections who would benefit most from antiviral therapy remains to be ascertained. Vaccines and new drugs under development may mitigate the burden of paramyxovirus infections.
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Meena JP, Brijwal M, Seth R, Gupta AK, Jethani J, Kapil A, Jat KR, Choudhary A, Kabra SK, Dwivedi SN, Dar L. Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia. Pediatr Hematol Oncol 2019; 36:330-343. [PMID: 31512959 DOI: 10.1080/08880018.2019.1631920] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The role of respiratory viruses (RV) in children with cancer having febrile neutropenic episodes has not been well studied. The objectives of our study were to investigate the prevalence and clinical outcomes of Respiratory viral infection (RVI). Methods: Children with cancer and febrile neutropenia (FN) having acute respiratory infections (ARI) were considered as cases and febrile neutropenic cancer patients without ARI were considered as controls. A throat swab sample was obtained for the detection of 21-respiratory pathogens. Results: A total of 81 episodes of FN in cases and 37 episodes of FN in controls were included. Prevalence of RVI (at least 1 RV) was seen in 76.5% of cases and 48.6% of controls (p = 0.005). The mixed-respiratory viruses (co-infections of ≥2 viruses) were seen only in cases (26%) (p = 0.00). Rhinovirus (36.8%) and respiratory syncytial virus (13.6%) were the most frequently detected viruses. Median duration of fever before presentation was more in cases with RVI compared to without RVI [2 (1-5) days vs 1 (1-5) day (p = 0.012)]. The median total duration of febrile period was 4 (IQR, 3-6) days in cases with RVI and 3 (IQR, 1-4) days in cases without RVI (p = 0.005). The median duration of antibiotic days were longer in cases with RVI as compared to patients without RVI [9 (IQR, 7-17) days vs 7 (IQR, 6-10) days (p = 0.046)] respectively. Conclusion: There was high prevalence of RVI in children with cancer and FN; more in association with ARI. The RVI were associated with prolonged febrile period and days of antibiotics therapy.
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Affiliation(s)
- Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences , New Delhi , India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences , New Delhi , India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences , New Delhi , India
| | - Aditya Kumar Gupta
- Department of Pediatrics, All India Institute of Medical Sciences , New Delhi , India
| | - Jyoti Jethani
- Department of Microbiology, All India Institute of Medical Sciences , New Delhi , India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences , New Delhi , India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences , New Delhi , India
| | - Aashish Choudhary
- Department of Microbiology, All India Institute of Medical Sciences , New Delhi , India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences , New Delhi , India
| | - S N Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences , New Delhi , India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences , New Delhi , India
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Impacts and Challenges of Advanced Diagnostic Assays for Transplant Infectious Diseases. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121269 DOI: 10.1007/978-1-4939-9034-4_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The advanced technologies described in this chapter should allow for full inventories to be made of bacterial genes, their time- and place-dependent expression, and the resulting proteins as well as their outcome metabolites. The evolution of these molecular technologies will continue, not only in the microbial pathogens but also in the context of host-pathogen interactions targeting human genomics and transcriptomics. Their performance characteristics and limitations must be clearly understood by both laboratory personnel and clinicians to ensure proper utilization and interpretation.
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7
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Respiratory Viral Infections in Children and Adolescents with Hematological Malignancies. Mediterr J Hematol Infect Dis 2019; 11:e2019006. [PMID: 30671212 PMCID: PMC6328038 DOI: 10.4084/mjhid.2019.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/03/2018] [Indexed: 11/08/2022] Open
Abstract
Background Despite the introduction of a polymerase chain reaction (PCR) test for the diagnosis of respiratory viral infection (RVI), guidance on the application of this test and the management of RVI in immunocompromised children is lacking. This study evaluated the clinical characteristics of RVI and established strategies for the PCR test in children and adolescents with hematological malignancies. Methods This study included children and adolescents with underlying hematological malignancies and respiratory symptoms, in whom a multiplex PCR test was performed. Patients in whom RVI was identified and not identified were categorized into Groups I and II, respectively. Group I was sub-divided into patients with upper and lower respiratory infections. The medical records of the enrolled patients were retrospectively reviewed. Results A total of 93 respiratory illnesses were included. Group I included 46 (49.5%) cases of RVI, including 31 (67.4%) upper and 15 (32.6%) lower respiratory infections. Rhinovirus (37.0%) was the most common viral pathogen. Significantly more patients in Group I had community-acquired respiratory illnesses (p=0.003) and complained of rhinorrhea (p<0.001) and sputum (p=0.008) than those in Group II. In Group I, significantly more patients with lower respiratory infections had uncontrolled underlying malignancies (p=0.038) and received re-induction or palliative chemotherapy (p=0.006) than those with upper respiratory infections. Conclusions A multiplex PCR test should be considered for RVI diagnosis in immunocompromised children and adolescents with respiratory symptoms, especially in those with rhinorrhea or sputum prominent over a cough. The early application of the PCR test in patients with uncontrolled underlying malignancies may improve outcomes.
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Abstract
Viral pneumonias in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation cause significant morbidity and mortality. Advances in diagnostic techniques have enabled rapid identification of respiratory viral pathogens from upper and lower respiratory tract samples. Lymphopenia, myeloablative and T-cell depleting chemotherapy, graft-versus-host disease, and other factors increase the risk of developing life-threatening viral pneumonia. Chest imaging is often nonspecific but may aid in diagnoses. Bronchoscopy with bronchoalveolar lavage is recommended in those at high risk for viral pneumonia who have new infiltrates on chest imaging.
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Gu Z, Zhu H, Rodriguez A, Mhaissen M, Schultz-Cherry S, Adderson E, Hayden RT. Comparative Evaluation of Broad-Panel PCR Assays for the Detection of Gastrointestinal Pathogens in Pediatric Oncology Patients. J Mol Diagn 2015; 17:715-21. [PMID: 26321042 DOI: 10.1016/j.jmoldx.2015.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 12/22/2022] Open
Abstract
Broadly multiplexed molecular amplification assays offer an unprecedented ability to diagnose gastrointestinal infection in immunocompromised patients. However, little data are available to compare the performance of such systems in this population. A total of 436 stool samples were collected from 199 predominantly immunocompromised pediatric oncology patients. Remnant samples were tested in parallel with the use of the premarket (investigational use only) versions of two broadly multiplexed PCR assays (BioFire and Luminex), and the results of samples corresponding to the first episode per patient were compared with those from laboratory-developed molecular assays, culture, and antigen detection. Overall performance of the multiplexed systems was comparable, with BioFire and Luminex detecting 94 and 99 positives (P = 0.34), respectively. Stratifying by analyte, BioFire assay detected 51 samples positive for Clostridium difficile, whereas Luminex assay detected 60 (P = 0.01). Biofire and Luminex detected 28 and 38 norovirus-positive samples (P = 0.002), respectively. Astrovirus- and adenovirus-positive samples were detected in higher numbers by in-house PCR than by BioFire; the same was observed for adenovirus with Luminex. Differences observed with other analytes were minimal, did not reach statistical significance, or lacked the numbers needed to detect a difference between systems. Broadly multiplexed PCR offers an effective means of detecting a variety of gastrointestinal pathogens in pediatric oncology patients, with assay performance comparable among the tests examined.
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Affiliation(s)
- Zhengming Gu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haiqing Zhu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alicia Rodriguez
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mohammad Mhaissen
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Elisabeth Adderson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Randall T Hayden
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
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Nucci M, Nouér SA, Anaissie E. Distinguishing the Causes of Pulmonary Infiltrates in Patients With Acute Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S98-103. [DOI: 10.1016/j.clml.2015.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 12/16/2022]
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11
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Loria C, Domm JA, Halasa NB, Heitman E, Miller EK, Xu M, Saville BR, Frangoul H, Williams JV. Human rhinovirus C infections in pediatric hematology and oncology patients. Pediatr Transplant 2015; 19:94-100. [PMID: 25377237 PMCID: PMC4280346 DOI: 10.1111/petr.12383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/31/2022]
Abstract
Children with cancer and HSCT recipients are at high risk for common viral infections. We sought to define the viral etiology of ARI and identify risk factors. Nasal wash samples were collected from pediatric hematology-oncology patients and HSCT recipients with ARI during the 2003-2005 winter seasons. Real-time RT-PCR was performed to detect Flu A, influenza B, RSV, PIV 1-3, human MPV, and HRV. HRV specimens were sequenced and genotyped. Seventy-eight samples from 62 children were included. Viruses were detected in 31 of 78 samples (40%). HRV were detected most frequently, in 16 (52%) including five HRVC; followed by seven (22%) RSV, five (16%) Flu A, four (13%) MPV, and two (6%) PIV2. There was a trend toward higher risk of viral infection for children in day care. Only 8% of the study children had received influenza vaccine. HRV, including the recently discovered HRVC, are an important cause of infection in pediatric oncology and HSCT patients. Molecular testing is superior to conventional methods and should be standard of care, as HRV are not detected by conventional methods.
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Affiliation(s)
- Carolina Loria
- Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine, Nashville, TN
| | - Jennifer A. Domm
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Elizabeth Heitman
- Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine, Nashville, TN
| | - E. Kathryn Miller
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Benjamin R. Saville
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Haydar Frangoul
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - John V. Williams
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN,Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
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12
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Babady NE. The FilmArray® respiratory panel: an automated, broadly multiplexed molecular test for the rapid and accurate detection of respiratory pathogens. Expert Rev Mol Diagn 2014; 13:779-88. [PMID: 24151847 PMCID: PMC7103684 DOI: 10.1586/14737159.2013.848794] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The FilmArray Respiratory Panel (RP) (BioFire(™) Diagnostics, Inc., Salt Lake City, UT, USA) is the first multiplex molecular panel cleared by the US FDA for the detection of both bacterial and viral respiratory pathogens in nasopharygeal swabs. The FilmArray RP targets 20 pathogens including 17 viruses and subtypes and three bacteria, and is performed with minimal sample manipulation. The FilmArray RP has a fully automated sample-to-answer workflow with a turn-around-time of approximately 1 h. The reported sensitivity and specificity of the assay ranges from 80 to 100 and 100%, respectively, with the sensitivity for the adenovirus as low as 46%. A new version of the FilmArray RP assay (version 1.7) with improved sensitivity for the adenovirus was released in 2013. The performance characteristics and simplified workflow have allowed its implementation in a wide range of laboratories. The FilmArray RP has changed the diagnostic landscape and will have a significant impact on the care of patients with respiratory tract infection.
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Affiliation(s)
- N Esther Babady
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, S428D, New York, NY, 10044, USA
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13
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Principi N, Daleno C, Esposito S. Human rhinoviruses and severe respiratory infections: is it possible to identify at-risk patients early? Expert Rev Anti Infect Ther 2014; 12:423-30. [PMID: 24559383 DOI: 10.1586/14787210.2014.890048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Molecular methods of viral screening have demonstrated that human rhinoviruses (HRVs) are associated with lower respiratory tract infections (LRTIs, including bronchiolitis and pneumonia), exacerbations of chronic pulmonary disease and the development of asthma. Patients with severe chronic diseases are at greater risk of developing major clinical problems when infected by HRVs, particularly if they are immunocompromised or have a chronic lung disease. Analysing the characteristics of HRVs does not provide any certainty concerning the risk of a poor prognosis and, although viremia seems to be associated with an increased risk of severe HRV infection, the available data are too scanty to be considered conclusive. However, a chest x-ray showing alveolar involvement suggests the potentially negative evolution of a bacterial superinfection. There is therefore an urgent need for more effective diagnostic, preventive and therapeutic measures in order to prevent HRV infection, and identify and treat the patients at highest risk.
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Affiliation(s)
- Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric High Intensity Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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14
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Kadmon G, Levy I, Mandelboim M, Nahum E, Stein J, Dovrat S, Schonfeld T. Polymerase-chain-reaction-based diagnosis of viral pulmonary infections in immunocompromised children. Acta Paediatr 2013; 102:e263-8. [PMID: 23421914 PMCID: PMC7159754 DOI: 10.1111/apa.12207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 12/01/2022]
Abstract
Aim Viral pneumonia is a serious complication in immunocompromised children. Its aetiology is difficult to identify owing to the limitations of conventional microbiological tests. The aim of this study was to determine whether polymerase chain reaction (PCR) assays for respiratory viruses increase the diagnostic yield of bronchoalveolar lavage (BAL) in immunocompromised children. Methods BAL samples obtained from immunocompromised children hospitalized with pneumonia were processed for respiratory viruses by viral culture, rapid antigen test and PCR (for CMV, adenovirus, influenza, parainfluenza, herpesvirus, RSV and hMPV). Results The study group included 42 patients (mean age 7.2 ± 5.1 years) with 50 episodes of clinical pneumonia (50 BAL samples). Forty viral pathogens were identified in 30 episodes (60%). PCR increased the diagnostic rate by fourfold (75% identified by PCR alone, p < 0.0001). When viral culture and rapid antigen test were used as the gold standard, PCR was found to have high sensitivity (86–100% when assessed) and specificity (80–96%). The PCR results prompted the initiation of specific antiviral therapy and the avoidance of unnecessary antibiotic treatment in 17 (34%) episodes. Conclusion PCR‐based diagnosis from BAL may increase the rate of pathogen detection in immunocompromised children, decrease the time to diagnosis and spare patients unnecessary antimicrobial treatment.
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Affiliation(s)
- Gili Kadmon
- Pediatric Intensive Care Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Itzhak Levy
- Infectious Diseases Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Michal Mandelboim
- Sackler Faculty of Medicine; Central Virology Laboratory; Ministry of Health; Chaim Sheba Medical Center; Tel Aviv University; Tel Hashomer Tel Aviv Israel
| | - Elhanan Nahum
- Pediatric Intensive Care Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Jerry Stein
- Department of Hematology-Oncology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Sara Dovrat
- Sackler Faculty of Medicine; Central Virology Laboratory; Ministry of Health; Chaim Sheba Medical Center; Tel Aviv University; Tel Hashomer Tel Aviv Israel
| | - Tommy Schonfeld
- Pediatric Intensive Care Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
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Abstract
Cancer patients are frequently immunosuppressed and at risk for a wide range of opportunistic and healthcare-associated infections. A good infection prevention program is extremely important to reduce risk of infection. This review focuses on infection prevention measures specific to patients, healthcare personnel, and visitors in the cancer center.
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Affiliation(s)
- Kerri A Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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16
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Vallières E, Renaud C. Clinical and economical impact of multiplex respiratory virus assays. Diagn Microbiol Infect Dis 2013; 76:255-61. [PMID: 23601453 PMCID: PMC7132665 DOI: 10.1016/j.diagmicrobio.2013.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 01/15/2023]
Abstract
During the last decade, a variety of molecular assays targeting respiratory viruses have been developed and commercialized. Therefore, multiplex PCR are increasingly used in everyday clinical practice. This improves our understanding of respiratory virus epidemiology and enhances our concerns about their clinical impact in specific patient populations. However, questions remain regarding cost-effectiveness of performing these diagnostic tests in routine and their real impact on patient care. This article will review available data and highlight unresolved questions about cost-effectiveness, infection control, clinical utility and public health impact of multiplex respiratory virus assays.
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Affiliation(s)
- Emilie Vallières
- Département de Microbiologie et Immunologie, CHU Sainte-Justine, Université de Montréal, Montréal, Québec H3T 1C5, Canada
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Bergeron A. The pulmonologist's point of view on lung infiltrates in haematological malignancies. Diagn Interv Imaging 2013; 94:216-20. [PMID: 23295045 DOI: 10.1016/j.diii.2012.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In haematological malignancies, the development of lung disease is a common source of significant morbidity and mortality for this population of patients. There is a wide range of infectious and non-infectious aetiologies that can be responsible for such complications. It is a major challenge to make an early diagnosis of aetiology in order to choose the most suitable treatment. Computed tomography (CT) of the chest has undeniably become a crucial tool in diagnosing these cases of lung disease. Although it is not possible to make a definitive diagnosis of aetiology based solely on analysing CT scan findings in these complex patients, there are some abnormalities that are highly suspicious for particular diagnoses. CT, therefore, allows the clinician to put forward and prioritise possible diagnoses that may then be considered in view of clinical information and laboratory study results. There must be multidisciplinary involvement in the management of lung disease patients and there must be an ongoing dialogue between the radiologist and the clinician.
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Affiliation(s)
- A Bergeron
- Paris Diderot University, Sorbonne Cité, Department of Respiratory Medicine, AP-HP, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10 Paris, France.
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18
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Srinivasan A, Flynn P, Gu Z, Hartford C, Lovins R, Sunkara A, Srivastava DK, Leung W, Hayden RT. Detection of respiratory viruses in asymptomatic children undergoing allogeneic hematopoietic cell transplantation. Pediatr Blood Cancer 2013; 60:149-51. [PMID: 22987475 PMCID: PMC3502722 DOI: 10.1002/pbc.24314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/14/2012] [Indexed: 02/04/2023]
Abstract
Detection of respiratory viruses by molecular methods, in children without respiratory symptoms undergoing hematopoietic cell transplantation (HCT), has not been well described. A prospective study of 33 asymptomatic children detected respiratory viruses in 8 of 33 (24%) patients before HCT. Human rhinovirus (HRV) was detected in five patients, and human adenovirus (hADV) in three patients. Two additional patients shed HRV, and one shed human coronavirus (hCoV), post-HCT. Two patients had co-infections. Of the 11 asymptomatic patients where respiratory virus was detected, 3 (27%) later developed an upper respiratory tract infection, from the same virus.
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Affiliation(s)
- Ashok Srinivasan
- Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT), St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | - Patricia Flynn
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhengming Gu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Christine Hartford
- Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT), St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Lovins
- BMTCT Clinical Research Office, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anusha Sunkara
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo K. Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wing Leung
- Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT), St. Jude Children's Research Hospital, Memphis, Tennessee,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Randall T. Hayden
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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19
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Abstract
Human rhinoviruses (HRVs), first discovered in the 1950s, are responsible for more than one-half of cold-like illnesses and cost billions of dollars annually in medical visits and missed days of work. Advances in molecular methods have enhanced our understanding of the genomic structure of HRV and have led to the characterization of three genetically distinct HRV groups, designated groups A, B, and C, within the genus Enterovirus and the family Picornaviridae. HRVs are traditionally associated with upper respiratory tract infection, otitis media, and sinusitis. In recent years, the increasing implementation of PCR assays for respiratory virus detection in clinical laboratories has facilitated the recognition of HRV as a lower respiratory tract pathogen, particularly in patients with asthma, infants, elderly patients, and immunocompromised hosts. Cultured isolates of HRV remain important for studies of viral characteristics and disease pathogenesis. Indeed, whether the clinical manifestations of HRV are related directly to viral pathogenicity or secondary to the host immune response is the subject of ongoing research. There are currently no approved antiviral therapies for HRVs, and treatment remains primarily supportive. This review provides a comprehensive, up-to-date assessment of the basic virology, pathogenesis, clinical epidemiology, and laboratory features of and treatment and prevention strategies for HRVs.
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Affiliation(s)
- Samantha E. Jacobs
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, USA
| | - Daryl M. Lamson
- Laboratory of Viral Diseases, Wadsworth Center, Albany, New York, USA
| | | | - Thomas J. Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, USA
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Utility of PCR amplification and DNA microarray hybridization of 16S rDNA for rapid diagnosis of bacteremia associated with hematological diseases. Int J Infect Dis 2012; 17:e271-6. [PMID: 23228627 DOI: 10.1016/j.ijid.2012.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/05/2012] [Accepted: 10/25/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The rapid diagnosis of bacteremia is crucial for patient management including the choice of antimicrobial therapy, especially in cases of hematological disease, because neutropenia occurs frequently during antineoplastic chemotherapy or disease progression. We describe a rapid detection and identification system that uses universal PCR primers to amplify a variable region of bacterial 16S ribosomal DNA (rDNA), followed by DNA microarray hybridization. METHODS Probes for 72 microorganisms including most causal clinical pathogens were spotted onto a microarray plate. The DNA microarray and conventional methods of identification were applied to 335 cultures from patients with hematological diseases. RESULTS Forty-one samples (12.2%) tested positive by conventional blood culture test in a few days, while 40 cases (11.9%) were identified by the new method within 24 h. The sensitivity and specificity of this new method were 93% and 99%, respectively, compared with conventional blood culture testing. CONCLUSIONS PCR combined with a DNA microarray is useful for the management of febrile patients with hematological diseases.
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Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J 2012; 31:889-93. [PMID: 22565292 DOI: 10.1097/inf.0b013e31825c4b7e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of respiratory viral infections (RVIs) as a cause of overall fever and neutropenia (FN) episodes in children with cancer has been less characterized than bacterial infections. We conducted a study aimed to determine the frequency of RVI in children with low compared with high risk for invasive bacterial infection (IBI) FN episodes and compare the clinical outcome of RVI and mixed RV-bacterial infections. METHODS Prospective, multicenter study in children with cancer and FN admitted to pediatric hospitals in Chile between May 2009 and January 2011. Children were evaluated by clinical examination and laboratory tests, including bacterial cultures and their risk for IBI. Nasopharyngeal sample was obtained for the detection of 17 respiratory viruses using polymerase chain reaction-DNA microarray platform. RESULTS A total of 331 episodes of FN in 193 children were enrolled of whom 55% were male, with the median age of 7 years and 61% had a hematological malignancy. A viral and/or bacterial pathogen was detected in 67% (224/331) episodes. Overall, RVIs were associated with 57% of FN of which one-third were mixed RV-bacterial infections. Bacterial infection was detected in 29% (97/331). Children classified at admission as high risk for IBI had a similar overall proportion of RVI compared with low-risk group. Respiratory syncytial virus (31%) and rhinovirus (23%) were the most frequently detected respiratory viruses, followed by parainfluenza (12%) and influenza A (11%). Children detected with any respiratory virus had fewer days of hospitalization and a significantly lower probability of hypotension and admission to pediatric intensive care unit irrespective of their risk classification status at admission when compared with children with mixed RV-bacterial or bacterial infections (P < 0.05). All children with a sole RVI had favorable outcome. CONCLUSIONS RVIs were the most frequently detected agents irrespective of their initial risk assessment for IBI. The clinical outcome of mixed RVI was similar to sole RVI episodes as well as for bacterial infections compared with mixed viral-bacterial infections. Systematic and early detection of RVI in children with cancer and FN might help to optimize their management by reducing hospitalization and antimicrobial use.
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22
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Respiratory virus detection in immunocompromised patients with FilmArray respiratory panel compared to conventional methods. J Clin Microbiol 2012; 50:3216-21. [PMID: 22814461 DOI: 10.1128/jcm.00538-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Respiratory virus infections cause significant morbidity and mortality in immunocompromised patients. Timely diagnosis is needed to provide optimal clinical care. Diagnostic tests routinely available at most institutions are limited by poor sensitivity and a slow turnaround time. We collected 90 respiratory samples from 87 immunocompromised patients (56 bronchoalveolar lavage and 34 nasopharyngeal aspirate samples) in order to compare the performance of routine respiratory virus testing available at our institution to the FilmArray respiratory panel assay, a novel diagnostic tool which utilizes multiplex PCR to test for 21 respiratory pathogens with a 1-h turnaround time. Samples with discordant results and 13 samples with concordant results underwent further verification testing by laboratory-developed real-time PCR. The FilmArray assay identified viral pathogens in more samples than did clinical testing (30/90 versus 16/90; McNemar P = 0.001). Most of the additional viral pathogens identified by the FilmArray respiratory panel assay that were confirmed by verification testing were pathogens not assessed by routine clinical tests, including rhinovirus/enterovirus, human metapneumovirus, and coronavirus. The FilmArray respiratory panel assay allowed for increased identification of respiratory viral pathogens in this cohort of immunocompromised patients.
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Severity of human rhinovirus infection in immunocompromised adults is similar to that of 2009 H1N1 influenza. J Clin Microbiol 2012; 50:1061-3. [PMID: 22205807 DOI: 10.1128/jcm.06579-11] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This retrospective chart review of patients at a tertiary referral center compares characteristics and clinical features of patients diagnosed with human rhinovirus (HRV) infection to those of patients with 2009 H1N1 influenza A (pH1N1) during the pandemic respiratory season of 2009 to 2010. Hospital admission rates, intensive care unit (ICU) admissions, and mortality were not statistically different between the HRV and pH1N1 groups; however, more patients in the HRV group were considered immunocompromised.
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Sanghavi SK, Bullotta A, Husain S, Rinaldo CR. Clinical evaluation of multiplex real-time PCR panels for rapid detection of respiratory viral infections. J Med Virol 2011; 84:162-9. [PMID: 22052551 PMCID: PMC7166524 DOI: 10.1002/jmv.22186] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 11/26/2022]
Abstract
Respiratory viral infections are one of the leading causes of morbidity and mortality, particularly in children, the elderly and immunocompromised persons. Rapid identification of viral etiology is critical in ruling out non‐viral infections, initiating antiviral treatment and limiting the spread of the infection. Multiplex assays of more than one viral gene target in a single tube have the advantage of rapid screening of a large number of potential viral pathogens in a short time. A multiplex real‐time PCR assay was used in this study for detection of respiratory RNA and DNA viral infections in 728 specimens received from 585 adult and pediatric patients comprised of symptomatic and asymptomatic organ transplant recipients and non‐recipients for diagnosis of respiratory illnesses and for routine clinical monitoring. Multiplex PCR was more sensitive than the multiplex immunofluoresence culture assay (R‐mix) and also detected additional respiratory viruses that were not covered by the R‐mix panel. The number of respiratory viruses detected in symptomatic patients was significantly higher than asymptomatic patients in both adult and pediatric patients. Herpesviral infections were the predominant cause of lower respiratory tract infection in the organ transplant recipients, whereas respiratory syncytial virus was the most common pathogen in non‐transplant patients particularly children. Multiplex real‐time PCR for detection of respiratory viruses has the potential for rapid identification of viral pathogens. In this era of emerging viral infections, addition of newer viral targets to the multiplex PCR panels will be beneficial in determining both patient management and public health epidemiology. J. Med. Virol. 84:162–169, 2011. © 2011 Wiley Periodicals, Inc.
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Affiliation(s)
- Sonali K Sanghavi
- Clinical Virology Laboratory, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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25
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Abstract
Bronchoscopy for paediatric respiratory disease is a routine procedure in paediatric pulmonology. Rigid bronchoscopy is now much less commonly used than flexible bronchoscopy. Technological advances have brought better picture quality and easier storage of video documentation. Indications with clear clinical benefit are congenital or acquired unexplained airway obstruction. In pulmonary infections or infiltrates in immunodeficient or immunosuppressed children not responding to empirical treatment a pathogen may be identified by bronchoscopy and bronchoalveolar lavage (BAL). Bronchoscopy and BAL can be indicated in children with unusual presentations of chronic cough or wheeze, and cystic fibrosis. The use of transbronchial biopsies (TBB) is established in paediatric lung transplantation. New applications and techniques are being developed, such as endobronchial ultrasound and transbronchial needle biopsy of lymph nodes and the role of airway stent placement have become better understood.
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Affiliation(s)
- T Nicolai
- University Kinderklinik München im Dr. von Haunerschen Kinderspital, München, Germany.
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26
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Olofsson S, Brittain-Long R, Andersson LM, Westin J, Lindh M. PCR for detection of respiratory viruses: seasonal variations of virus infections. Expert Rev Anti Infect Ther 2011; 9:615-26. [PMID: 21819328 PMCID: PMC7103711 DOI: 10.1586/eri.11.75] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Real-time PCR and related methods have revolutionized the laboratory diagnosis of viral respiratory infections because of their high detection sensitivity, rapidness and potential for simultaneous detection of 15 or more respiratory agents. Results from studies with this diagnostic modality have significantly expanded our knowledge about the seasonality of viral respiratory diseases, pinpointed the difficulties to make a reliable etiologic diagnosis without the aid of an unbiased multiplex molecular assay for respiratory viruses, and revealed previously unknown details as to possible infections with multiple agents as aggravating factors. The scope of this article is to review and discuss this new knowledge and its implications for diagnostic strategies and other measures essential for the clinical management of respiratory viral infections and for epidemiological surveillance of seasonal respiratory infections.
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Affiliation(s)
- Sigvard Olofsson
- Department of Clinical Virology, University of Gothenburg, Guldhedsgatan 10B, S-413 46 Gothenburg, Sweden.
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27
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An Unmet Medical Need: Rapid Molecular Diagnostics Tests for Respiratory Tract Infections. Clin Infect Dis 2011; 52 Suppl 4:S384-95. [DOI: 10.1093/cid/cir055] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Slupsky CM. Nuclear magnetic resonance-based analysis of urine for the rapid etiological diagnosis of pneumonia. ACTA ACUST UNITED AC 2010; 5:63-73. [DOI: 10.1517/17530059.2011.537653] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Shahda S, Carlos WG, Kiel PJ, Khan BA, Hage CA. The human metapneumovirus: a case series and review of the literature. Transpl Infect Dis 2010; 13:324-8. [PMID: 21631655 DOI: 10.1111/j.1399-3062.2010.00575.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Human metapneumovirus (hMPV) is an emerging human pulmonary pathogen that is genetically related to respiratory syncytial virus. It has been increasingly associated with respiratory illnesses over the last few decades. Immunocompromised patients are particularly susceptible with resultant morbidity and mortality. We describe our experience with 9 immunocompromised patients diagnosed with pneumonia secondary to hMPV, 2 of whom were successfully treated with aerosolized and oral ribavirin along with intravenous immunoglobulin (IVIG). We suggest that hMPV should be considered in the differential diagnosis of immunocompromised patients with acute respiratory illness. Ribavirin (oral and aerosolized) with IVIG is potentially an effective treatment option for those with severe disease.
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Affiliation(s)
- S Shahda
- Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA.
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Rogers GB, Stressmann FA, Walker AW, Carroll MP, Bruce KD. Lung infections in cystic fibrosis: deriving clinical insight from microbial complexity. Expert Rev Mol Diagn 2010; 10:187-96. [PMID: 20214537 DOI: 10.1586/erm.09.81] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lower respiratory tract bacterial infections, such as those associated with cystic fibrosis lung disease, represent a major healthcare burden. Treatment strategies are currently informed by culture-based routine diagnostics whose limitations, including an inability to isolate all potentially clinically significant bacterial species present in a sample, are well documented. Some advances have resulted from the introduction of culture-independent molecular assays for the detection of specific pathogens. However, the application of bacterial community profiling techniques to the characterization of these infections has revealed much higher levels of microbial diversity than previously recognized. These findings are leading to a fundamental shift in the way such infections are considered. Increasingly, polymicrobial infections are being viewed as complex communities of interacting organisms, with dynamic processes key to their pathogenicity. Such a model requires an analytical strategy that provides insight into the interactions of all members of the infective community. The rapid advance in sequencing technology, along with protocols that limit analysis to viable bacterial cells, are for the first time providing an opportunity to gain such insight.
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Affiliation(s)
- Geraint B Rogers
- Molecular Microbiology Research Laboratory, Pharmaceutical Science Division, 150 Stamford Street, Franklin-Wilkins Building, King's College London, London, SE1 9NH, UK.
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