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Harada N, Sonoda M, Ishimura M, Eguchi K, Kinoshita K, Matsuoka W, Motomura Y, Kaku N, Kawaguchi N, Takeuchi T, Ohga S. Pretransplant ribavirin and interferon-α therapy for rhinovirus interstitial pneumonia in a RAG1-deficient infant. J Infect Chemother 2024; 30:362-365. [PMID: 37944696 DOI: 10.1016/j.jiac.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Severe combined immunodeficiency (SCID) is one of the most serious inborn errors of immunity leading to a fatal infection in early infancy. Allogeneic hematopoietic cell transplantation (HCT) or elective gene therapy prior to infection or live-attenuated vaccination is the current standard of curative treatment. Even in the era of newborn screening for SCID, pretransplant control of severe infection is challenging for SCID. Multiple pathogens are often isolated from immunocompromised patients, and limited information is available regarding antiviral strategies to facilitate curative HCT. We herein present a case of successfully controlled pretransplant pneumonia after ribavirin and interferon-α therapy in an infant with RAG1-deficiency. A four-month-old infant presented with severe interstitial pneumonia due to a co-infection of rhinovirus and Pneumocystis jirovecii. The tentative diagnosis of SCID prompted to start antibiotics and trimethoprim-sulfamethoxazole on ventilatory support. Because of the progressive respiratory failure four days after treatment, ribavirin and then pegylated interferon-α were started. He showed a drastic response to the treatment that led to a curative HCT 32 days after admission. This patient received the genetic diagnosis of RAG1-deficiency. Currently, he is an active 3-year-old boy with normal growth and development. The review of literature indicated that rhinovirus had a comparable or rather greater impact on the mortality of pediatric patients than respiratory syncytial virus. Considered the turn-around time to the genetic diagnosis of SCID, prompt ribavirin plus interferon-α therapy may help to control severe rhinovirus pneumonia and led to the early curative HCT for the affected infants.
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Affiliation(s)
- Nobutaka Harada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Katsuhide Eguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keishiro Kinoshita
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshitomo Motomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Kawaguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | | | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Riccò M, Parisi S, Corrado S, Marchesi F, Bottazzoli M, Gori D. Respiratory Syncytial Virus Infections in Recipients of Bone Marrow Transplants: A Systematic Review and Meta-Analysis. Infect Dis Rep 2024; 16:317-355. [PMID: 38667752 PMCID: PMC11050314 DOI: 10.3390/idr16020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infections. Usually associated with infants and children, an increasing amount of evidence suggests that RSV can cause substantial morbidity and mortality in immunocompromised individuals, including recipients of bone marrow transplantation (BMT). The present systematic review was therefore designed in accordance with the PRISMA guidelines to collect available evidence about RSV infections in BMT recipients. Three medical databases (PubMed, Embase, and MedRxiv) were therefore searched for eligible observational studies published up to 30 September 2023 and collected cases were pooled in a random-effects model. Heterogeneity was assessed using I2 statistics. Reporting bias was assessed by means of funnel plots and regression analysis. Overall, 30 studies were retrieved, including 20,067 BMT cases and 821 RSV infection episodes. Of them, 351 were lower respiratory tract infections, and a total of 78 RSV-related deaths were collected. A pooled attack rate of 5.40% (95% confidence interval [95%CI] 3.81 to 7.60) was identified, with a corresponding incidence rate of 14.77 cases per 1000 person-years (95%CI 9.43 to 20.11), and a case fatality ratio (CFR) of 7.28% (95%CI 4.94 to 10.60). Attack rates were higher in adults (8.49%, 95%CI 5.16 to 13.67) than in children (4.79%, 95%CI 3.05 to 7.45), with similar CFR (5.99%, 95%CI 2.31 to 14.63 vs. 5.85%, 95%CI 3.35 to 10.02). By assuming RSV attack rates as a reference group, influenza (RR 0.518; 95%CI 0.446 to 0.601), adenovirus (RR 0.679, 95%CI 0.553 to 0.830), and human metapneumovirus (RR 0.536, 95%CI 0.438 to 0.655) were associated with a substantially reduced risk for developing corresponding respiratory infection. Despite the heterogeneous settings and the uneven proportion of adult and pediatric cases, our study has identified high attack rates and a substantial CFR of RSV in recipients of BMT, stressing the importance of specifically tailored preventive strategies and the need for effective treatment options.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
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Bahakel H, Waghmare A, Madan RP. Impact of Respiratory Viral Infections in Transplant Recipients. J Pediatric Infect Dis Soc 2024; 13:S39-S48. [PMID: 38417082 DOI: 10.1093/jpids/piad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 03/01/2024]
Abstract
Respiratory viral infections (RVIs) are among the leading cause of morbidity and mortality in pediatric hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) recipients. Transplant recipients remain at high risk for super imposed bacterial and fungal pneumonia, chronic graft dysfunction, and graft failure as a result of RVIs. Recent multicenter retrospective studies and prospective studies utilizing contemporary molecular diagnostic techniques have better delineated the epidemiology and outcomes of RVIs in pediatric transplant recipients and have advanced the development of preventative vaccines and treatment interventions in this population. In this review, we will define the epidemiology and outcomes of RVIs in SOT and HSCT recipients, describe the available assays for diagnosing a suspected RVI, highlight evolving management and vaccination strategies, review the risk of donor derived RVI in SOT recipients, and discuss considerations for delaying transplantation in the presence of an RVI.
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Affiliation(s)
- Hannah Bahakel
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alpana Waghmare
- Department of Pediatrics, University of Washington, Fred Hutchinson Cancer Research Center; Department of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Rebecca Pellet Madan
- New York University Grossman School of Medicine; Department of Infectious Diseases, Hassenfeld Children's Hospital, New York, NY, USA
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Heald-Sargent T, Michaels MG, Ardura MI. Pre-Transplantation Strategies for Infectious Disease Mitigation and Prevention. J Pediatric Infect Dis Soc 2024; 13:S3-S13. [PMID: 38417081 DOI: 10.1093/jpids/piad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/22/2023] [Indexed: 03/01/2024]
Abstract
Pediatric Infectious Disease (ID) clinicians play a critical role in helping prevent and mitigate infectious risks in children peri- and post-transplantation. Prevention starts during the pre-transplant evaluation and persists throughout the solid organ transplant and hematopoietic cell transplant continuum. The pre-transplant evaluation is an opportunity to screen for latent infections, plan preventative strategies, optimize immunizations, and discuss risk mitigation practices. An ideal pre-transplant evaluation establishes a relationship with the family that further promotes post-transplant infectious risk reduction. This manuscript builds on shared pediatric ID prevention strategies, introduces updated ID testing recommendations for transplant donors/candidates, highlights emerging data, and identifies ongoing knowledge gaps that are potential areas of research.
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Affiliation(s)
- Taylor Heald-Sargent
- Department of Pediatrics, Division of Infectious Diseases, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Marian G Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica I Ardura
- Division of Pediatric Infectious Diseases & Host Defense Program, Nationwide Children's Hospital and Department of Pediatrics, The Ohio University College of Medicine, Columbus, Ohio, USA
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Kumar M, Hanisch BR. How I approach: the transplant recipient with fever and pulmonary infiltrates. Front Pediatr 2024; 12:1273590. [PMID: 38440184 PMCID: PMC10909924 DOI: 10.3389/fped.2024.1273590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Recipients of hematopoietic stem cell transplants and solid organ transplants frequently develop pulmonary infiltrates from both infectious and non-infectious etiologies. Differentiation and further characterization of microbiologic etiologies-viral, bacterial, and fungal-can be exceedingly challenging. Pediatric patients face unique challenges as confirmatory evaluations with bronchoscopy or lung biopsy may be limited. A generalizable approach to diagnosing and managing these conditions has not been well established. This paper aims to summarize our initial clinical approach while discussing the relative evidence informing our practices. A pediatric patient with characteristic infiltrates who has undergone HSCT is presented to facilitate the discussion. Generalizable approaches to similar patients are highlighted as appropriate while highlighting considerations based on clinical course and key risk factors.
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Affiliation(s)
- Madan Kumar
- Section of Pediatric Infectious Diseases, University of Chicago, Chicago, IL, United States
| | - Benjamin R. Hanisch
- Department of Pediatrics, School of Medicine and Health Sciences, Division of Infectious Diseases, Children’s National Hospital, The George Washington University, Washington, DC, United States
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Castejon-Ramirez S, Chaisavaneeyakorn S, Ferrolino JA, Allison KJ, Peterson M, Dallas RH, Suliman A, Hayden RT, Maron G, Hijano DR. Clinical Outcomes of Human Rhinovirus/Enterovirus Infection in Pediatric Hemopoietic Cell Transplant Patients. J Pediatric Infect Dis Soc 2024; 13:75-83. [PMID: 38019957 PMCID: PMC10824257 DOI: 10.1093/jpids/piad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Respiratory viral infections are common among pediatric transplant patients, with human rhinovirus (HRV) being the most frequent. In pediatric patients undergoing hemopoietic cell transplant (HCT), infection with HRV has been associated with progression to lower respiratory tract infection (LRTI) and adverse outcomes. We describe the clinical presentation and outcomes of HRV infection in children undergoing HCT. METHODS Single-center retrospective study. HCT recipients who were positive for HRV/EV (HRV+) or negative for any respiratory virus (VN) by BioFire® FilmArray® panel between October 2014 and December 2017, were included. Primary outcomes were progression to LRTI, ICU admission, all-cause mortality at 3 and 6 months, and respiratory event-related mortality at 6 months. RESULTS 227 patients (160 allogeneic HCT) were included. Of all patients, 108/227 (47.6%) were HRV+. From all HRV+, 95/108 (88%) were symptomatic and 68/107 (63.6%) of the diagnosis were made pretransplant. The median age of HRV+ was significantly lower than VN patients (5 vs 10 years). Cough and rhinorrhea were more frequently observed in HRV+ (53.7 and 60% vs 19.8 and 22.8%, respectively). No differences were found between both groups pretransplant and overall in rates progression to LRTI, ICU admission, mechanical ventilation, all-cause within 3 and 6 months, and mortality related with respiratory failure. No significant association was found between the severity of respiratory disease and the type of conditioning, type of transplant, or absolute lymphocyte count. CONCLUSIONS HRV infection is frequently detected in HCT recipients but is not associated with severity of respiratory disease, need for intensive care unit or mortality, including those diagnosed before transplant, suggesting that delaying HCT in this scenario may not be needed. Multicenter larger studies are required to confirm these findings.
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Affiliation(s)
- Sandra Castejon-Ramirez
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, USA
| | | | - Jose A Ferrolino
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kim J Allison
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Megan Peterson
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ronald H Dallas
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ali Suliman
- Department of Transplant Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Randall T Hayden
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, USA
| | - Diego R Hijano
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, USA
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Schuster JE, Hamdan L, Dulek DE, Kitko CL, Batarseh E, Haddadin Z, Stewart LS, Stahl A, Potter M, Rahman H, Kalams SA, Bocchini CE, Moulton EA, Coffin SE, Ardura MI, Wattier RL, Maron G, Grimley M, Paulsen G, Harrison CJ, Freedman JL, Carpenter PA, Englund JA, Munoz FM, Danziger-Isakov L, Spieker AJ, Halasa NB. The Durability of Antibody Responses of Two Doses of High-Dose Relative to Two Doses of Standard-Dose Inactivated Influenza Vaccine in Pediatric Hematopoietic Cell Transplant Recipients: A Multi-Center Randomized Controlled Trial. Clin Infect Dis 2024; 78:217-226. [PMID: 37800415 PMCID: PMC10810702 DOI: 10.1093/cid/ciad534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Our previous study established a 2-dose regimen of high-dose trivalent influenza vaccine (HD-TIV) to be immunogenically superior compared to a 2-dose regimen of standard-dose quadrivalent influenza vaccine (SD-QIV) in pediatric allogeneic hematopoietic cell transplant (HCT) recipients. However, the durability of immunogenicity and the role of time post-HCT at immunization as an effect modifier are unknown. METHODS This phase II, multi-center, double-blinded, randomized controlled trial compared HD-TIV to SD-QIV in children 3-17 years old who were 3-35 months post-allogeneic HCT, with each formulation administered twice, 28-42 days apart. Hemagglutination inhibition (HAI) titers were measured at baseline, 28-42 days following each dose, and 138-222 days after the second dose. Using linear mixed effects models, we estimated adjusted geometric mean HAI titer ratios (aGMR: HD-TIV/SD-QIV) to influenza antigens. Early and late periods were defined as 3-5 and 6-35 months post-HCT, respectively. RESULTS During 3 influenza seasons (2016-2019), 170 participants were randomized to receive HD-TIV (n = 85) or SD-QIV (n = 85). HAI titers maintained significant elevations above baseline for both vaccine formulations, although the relative immunogenic benefit of HD-TIV to SD-QIV waned during the study. A 2-dose series of HD-TIV administered late post-HCT was associated with higher GMTs compared to the early post-HCT period (late group: A/H1N1 aGMR = 2.16, 95% confidence interval [CI] = [1.14-4.08]; A/H3N2 aGMR = 3.20, 95% CI = [1.60-6.39]; B/Victoria aGMR = 1.91, 95% CI = [1.01-3.60]; early group: A/H1N1 aGMR = 1.03, 95% CI = [0.59-1.80]; A/H3N2 aGMR = 1.23, 95% CI = [0.68-2.25]; B/Victoria aGMR = 1.06, 95% CI = [0.56-2.03]). CONCLUSIONS Two doses of HD-TIV were more immunogenic than SD-QIV, especially when administered ≥6 months post-HCT. Both groups maintained higher titers compared to baseline throughout the season. CLINICAL TRIALS REGISTRATION NCT02860039.
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Affiliation(s)
- Jennifer E Schuster
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Lubna Hamdan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie L Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Einas Batarseh
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Molly Potter
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spyros A Kalams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire E Bocchini
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Moulton
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
| | - Susan E Coffin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases & Host Defense, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Rachel L Wattier
- Department of Pediatrics, University of California San Francisco and Benioff Children's Hospital – San Francisco, San Francisco, California, USA
| | - Gabriela Maron
- Department of Infectious Diseases, Children's, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael Grimley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Grant Paulsen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher J Harrison
- Department of Infectious Diseases, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Jason L Freedman
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Carpenter
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lara Danziger-Isakov
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Matsui T, Ogimi C. Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients. Curr Opin Infect Dis 2023; 36:529-536. [PMID: 37729657 DOI: 10.1097/qco.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management. RECENT FINDINGS The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs. SUMMARY Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.
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Affiliation(s)
- Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Kitt E, Brennan L, Harrison C, Hei H, Paul E, Satchell L, Wilson KB, Smathers S, Handy L, Coffin SE. Dodging the bundle-Persistent healthcare-associated rhinovirus infection throughout the pandemic. Am J Infect Control 2022; 50:1140-1144. [PMID: 35588914 DOI: 10.1016/j.ajic.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Healthcare-associated viral infections (HAVI) are a common cause of patient harm in the pediatric population. We implemented a HAVI prevention bundle in 2015, which included 6 core elements: caregiver screening, symptom-based isolation, personal protective equipment (PPE), hand hygiene, staff illness procedures, and monitoring of environmental cleanliness. Enhanced bundle elements were introduced at the start of the COVID-19 pandemic, which provided an opportunity to observe the effectiveness of the bundle with optimal adherence to prevention practices, and to measure the impact on respiratory HAVI epidemiology. METHODS Respiratory HAVIs were confirmed through review of medical records and application of the National Health Safety Network (NHSN) surveillance criteria for upper respiratory infections (URIs) with predetermined incubation periods for unit attribution. Descriptive statistics of the study population were examined, and comparative analyses were performed on demographic and process metrics. Data analysis was conducted using R statistical software. RESULTS We observed an overall decrease in respiratory HAVI of 68%, with prepandemic rates of 0.19 infections per 1,000 patient significantly decreased to a rate of 0.06 per 1,000 patient days in the pandemic period (P < .01). Rhinovirus made up proportionally more of our respiratory HAVI in the pandemic period (64% vs 53%), with respiratory HAVI secondary only to rhinovirus identified during 8 of 16 months in the pandemic period. Compliance with our HAVI prevention bundle significantly improved during pandemic period. CONCLUSIONS Enhancement of our HAVI bundle during the COVID-19 pandemic contributed toward significant reduction in nosocomial transmission of respiratory HAVI. Even with prevention practices optimized, respiratory HAVIs secondary to rhinovirus continued to be reported, likely due to the capacity of rhinovirus to evade bundle elements in hospital, and infection prevention efforts at large in the community, leaving vulnerable patients at continued risk.
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Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Lauren Brennan
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Cecelia Harrison
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hillary Hei
- Department of Infection Prevention and Control, ECRI, Plymouth Meeting, PA
| | - Elina Paul
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren Satchell
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kimberly B Wilson
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Smathers
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lori Handy
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan E Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
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10
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Early pulmonary complications related to cancer treatment in children. Pediatr Radiol 2022; 52:2017-2028. [PMID: 35778572 DOI: 10.1007/s00247-022-05403-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/01/2022] [Accepted: 05/14/2022] [Indexed: 10/17/2022]
Abstract
In this review, we summarize early pulmonary complications related to cancer therapy in children and highlight characteristic findings on imaging that should be familiar to a radiologist reviewing imaging from pediatric cancer patients.
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Arjarquah AK, Obodai E, Anie HA, Osei MA, Odoom JK, Bonney JHK, Behene E, Kotey EN, Aboagye J, Nyarko SO, Bentum J, Yeboah C, Kumordjie S, Agbodzi B, Attiku K, Mawuli G, Letizia A, Ampofo WK, Quaye O. Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana. PLoS One 2022; 17:e0271877. [PMID: 35881575 PMCID: PMC9321433 DOI: 10.1371/journal.pone.0271877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza co-infection with bacteria is a leading cause of influenza-related deaths and severe respiratory infections, especially among high-risk groups like cancer patients undergoing treatment. However, acute respiratory infection (ARI)-like symptoms developed by upper-torso cancer (UTC) patients receiving radiotherapy are considered as side-effects of the radiation. Hence influenza and bacterial pathogens implicated in ARI are not investigated. Methods This prospective cohort study examined 85 in-patients with upper-torso cancers undergoing radiotherapy at the National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC) of Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Eligible patients who consented were recruited into the study from September 2018 to April 2019. Influenza viruses A and B in addition to the following bacteria species Streptococcus pneumonia, Haemophilus influenzae, Neisseria meningitidis and Staphylococcus aureus were detected from oropharyngeal and nasopharyngeal swab specimens collected at three different time points. Presence of respiratory pathogens were investigated by influenza virus isolation in cell culture, bacterial culture, polymerase chain reaction (PCR) and next generation sequencing (NGS) assays. Results Of the 85 eligible participants enrolled into the study, 87% were females. Participants were 17 to 77 years old, with a median age of 49 years. Most of the participants (88%) enrolled had at least one pathogen present. The most prevalent pathogen was N. meningitidis (63.4%), followed by H. influenzae (48.8%), Influenza viruses A and B (32.9%), S. pneumoniae (32.9%) and S. aureus (12.2%). Approximately, 65% of these participants developed ARI-like symptoms. Participants with previous episodes of ARI, did not live alone, HNC and total radiation less than 50 Gy were significantly associated with ARI. All treatment forms were also significantly associated with ARI. Conclusion Data generated from the study suggests that ARI-like symptoms observed among UTC patients receiving radiotherapy in Ghana, could be due to influenza and bacterial single and co-infections in addition to risk factors and not solely the side-effects of radiation as perceived. These findings will be prime importance for diagnosis, prevention, treatment and control for cancer patients who present with such episodes during treatment.
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Affiliation(s)
- Augustina K. Arjarquah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology (DBCMB), University of Ghana, Legon, Ghana
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- Cocoa Research Institute of Ghana (CRIG), New Tafo—Akim, Ghana
- * E-mail: (EO); (AKA)
| | - Evangeline Obodai
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- * E-mail: (EO); (AKA)
| | - Hannah Ayettey Anie
- National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC), Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael Aning Osei
- National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC), Korle-Bu Teaching Hospital, Accra, Ghana
| | - John Kofi Odoom
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Joseph H. K. Bonney
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Eric Behene
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Erasmus N. Kotey
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - James Aboagye
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Stephen O. Nyarko
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Jeannette Bentum
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Selassie Kumordjie
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Bright Agbodzi
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - Keren Attiku
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Gifty Mawuli
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Andrew Letizia
- United States Naval Medical Research Unit No. 3 (US-NAMRU 3), Ghana Detachment, Accra, Ghana
| | - William K. Ampofo
- College of Health Sciences, University of Ghana-Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology (DBCMB), University of Ghana, Legon, Ghana
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12
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Busca A, Marchesi F, Cattaneo C, Trecarichi EM, Delia M, Del Principe MI, Candoni A, Pagano L. When Viruses Meet Fungi: Tackling the Enemies in Hematology. J Fungi (Basel) 2022; 8:jof8020184. [PMID: 35205938 PMCID: PMC8875273 DOI: 10.3390/jof8020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Unit, AOU Citta’ della Salute e della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, University “Magna Graecia”—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy;
| | | | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University of Udine-ASUFC, 33100 Udine, Italy;
| | - Livio Pagano
- Unità di Ematologia Geriatrica ed Emopatie Rare, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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13
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Mukkada S, Bhakta N, Chantada GL, Chen Y, Vedaraju Y, Faughnan L, Homsi MR, Muniz-Talavera H, Ranadive R, Metzger M, Friedrich P, Agulnik A, Jeha S, Lam C, Dalvi R, Hessissen L, Moreira DC, Santana VM, Sullivan M, Bouffet E, Caniza MA, Devidas M, Pritchard-Jones K, Rodriguez-Galindo C. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol 2021; 22:1416-1426. [PMID: 34454651 PMCID: PMC8389979 DOI: 10.1016/s1470-2045(21)00454-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have shown that children and adolescents with COVID-19 generally have mild disease. Children and adolescents with cancer, however, can have severe disease when infected with respiratory viruses. In this study, we aimed to understand the clinical course and outcomes of SARS-CoV-2 infection in children and adolescents with cancer. METHODS We did a cohort study with data from 131 institutions in 45 countries. We created the Global Registry of COVID-19 in Childhood Cancer to capture de-identified data pertaining to laboratory-confirmed SARS-CoV-2 infections in children and adolescents (<19 years) with cancer or having received a haematopoietic stem-cell transplantation. There were no centre-specific exclusion criteria. The registry was disseminated through professional networks through email and conferences and health-care providers were invited to submit all qualifying cases. Data for demographics, oncological diagnosis, clinical course, and cancer therapy details were collected. Primary outcomes were disease severity and modification to cancer-directed therapy. The registry remains open to data collection. FINDINGS Of 1520 submitted episodes, 1500 patients were included in the study between April 15, 2020, and Feb 1, 2021. 1319 patients had complete 30-day follow-up. 259 (19·9%) of 1301 patients had a severe or critical infection, and 50 (3·8%) of 1319 died with the cause attributed to COVID-19 infection. Modifications to cancer-directed therapy occurred in 609 (55·8%) of 1092 patients receiving active oncological treatment. Multivariable analysis revealed several factors associated with severe or critical illness, including World Bank low-income or lower-middle-income (odds ratio [OR] 5·8 [95% CI 3·8-8·8]; p<0·0001) and upper-middle-income (1·6 [1·2-2·2]; p=0·0024) country status; age 15-18 years (1·6 [1·1-2·2]; p=0·013); absolute lymphocyte count of 300 or less cells per mm3 (2·5 [1·8-3·4]; p<0·0001), absolute neutrophil count of 500 or less cells per mm3 (1·8 [1·3-2·4]; p=0·0001), and intensive treatment (1·8 [1·3-2·3]; p=0·0005). Factors associated with treatment modification included upper-middle-income country status (OR 0·5 [95% CI 0·3-0·7]; p=0·0004), primary diagnosis of other haematological malignancies (0·5 [0·3-0·8]; p=0·0088), the presence of one of more COVID-19 symptoms at the time of presentation (1·8 [1·3-2·4]; p=0·0002), and the presence of one or more comorbidities (1·6 [1·1-2·3]; p=0·020). INTERPRETATION In this global cohort of children and adolescents with cancer and COVID-19, severe and critical illness occurred in one fifth of patients and deaths occurred in a higher proportion than is reported in the literature in the general paediatric population. Additionally, we found that variables associated with treatment modification were not the same as those associated with greater disease severity. These data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness. FUNDING American Lebanese Syrian Associated Charities and the National Cancer Institute.
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Affiliation(s)
- Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Guillermo L Chantada
- Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yuvanesh Vedaraju
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lane Faughnan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Maysam R Homsi
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Hilmarie Muniz-Talavera
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Radhikesh Ranadive
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Monika Metzger
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Catherine Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rashmi Dalvi
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Laila Hessissen
- Department of Pediatric Hematology and Oncology, Mohammed V University, Rabat, Morocco
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Victor M Santana
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Miguela A Caniza
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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14
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Houist AL, Bondeelle L, Salmona M, LeGoff J, de Latour RP, Rivière F, Soler C, Houdouin V, Dalle JH, Robin C, Fourati S, Griscelli F, Coman T, Chevret S, Bergeron A. Evaluation of prognostic scores for respiratory syncytial virus infection in a French multicentre cohort of allogeneic haematopoietic stem cell transplantation recipients. Bone Marrow Transplant 2021; 56:3032-3041. [PMID: 34548625 PMCID: PMC8454013 DOI: 10.1038/s41409-021-01462-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Abstract
Haematopoietic stem cell transplantation (HSCT) recipients are at risk for severe respiratory syncytial virus (RSV) infection. Two prognostic scores have been proposed to predict the risk of progression from upper respiratory tract infection (URTI) to lower respiratory tract infection (LRTI) and death. This was a multicentre study of allogeneic HSCT recipients diagnosed with an RSV infection between 2010 and 2019 who were retrospectively stratified by the immunodeficiency scoring index (ISI) and the severe immunodeficiency (SID) score. Endpoints were overall survival, RSV-attributable mortality and progression to LRTI after URTI. Prognostic analyses were performed using Cox regression models. We included 147 consecutive patients, including 94 (63.9%) initially diagnosed with URTI and 53 (36.1%) with LRTI. At 90 days, 14 patients had died (survival rate, 90.5%; 95% CI: 85.9-95.3), and nine deaths were attributable to RSV (attributable mortality rate, 5.4%; 95% CI: 2.5-10.0). The cumulative 90-day incidence of LRTI after URTI was 13.8% (95% CI: 7.8-21.6). Neither score showed prognostic value for mortality, while the ISI allowed the prediction of progression to LRTI (p = 0.0008). Our results do not fully replicate the results previously reported in cohorts of HSCT recipients. This may reflect the recent epidemiology of RSV infections in this HSCT cohort.
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Affiliation(s)
| | - Louise Bondeelle
- Université de Paris, Service de Pneumologie, Hôpital Saint-Louis, AP-HP -, Paris, France
| | - Maud Salmona
- Université de Paris, Service de Virologie, Hôpital Saint-Louis, AP-HP -, Paris, France
| | - Jérôme LeGoff
- Université de Paris, Service de Virologie, Hôpital Saint-Louis, AP-HP -, Paris, France
| | | | - Frédéric Rivière
- Service de Pneumologie, Hôpital d'instruction des armées Percy -, Clamart, France
| | - Charles Soler
- Service de Microbiologie, Hôpital d'instruction des armées Percy -, Clamart, France
| | - Véronique Houdouin
- Université de Paris, Service de Pneumologie-Pédiatrie, Hôpital Robert Debré, AP-HP -, Paris, France
| | - Jean-Hugues Dalle
- Université de Paris, Service d'Hématologie pédiatrique, Hôpital Robert Debré, AP-HP -, Paris, France
| | - Christine Robin
- Service d'Hématologie, Hôpital Henri Mondor, Université Paris-Est, AP-HP -, Créteil, France
| | - Slim Fourati
- Département de Bactériologie-Virologie, Hôpital Henri Mondor, Université Paris-Est, AP-HP -, Créteil, France
| | - Franck Griscelli
- Département de Biologie et de Pathologies médicales, Institut Gustave-Roussy -, Villejuif, France
| | - Tereza Coman
- Service d'Hématologie, Institut Gustave-Roussy -, Villejuif, France
| | - Sylvie Chevret
- Université de Paris, Département de Biostatistique et Informatique Médicale, Hôpital Saint Louis, AP-HP -, Paris, France.,Université de Paris, ECSTRRA Team, Inserm, UMR 1153 CRESS, F-75010, Paris, France
| | - Anne Bergeron
- Université de Paris, Service de Pneumologie, Hôpital Saint-Louis, AP-HP -, Paris, France. .,Université de Paris, ECSTRRA Team, Inserm, UMR 1153 CRESS, F-75010, Paris, France.
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15
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Jarmoliński T, Matkowska‐Kocjan A, Rosa M, Olejnik I, Gorczyńska E, Kałwak K, Ussowicz M. SARS-CoV-2 viral clearance during bone marrow aplasia after allogeneic hematopoietic stem cell transplantation-A case report. Pediatr Transplant 2021; 25:e13875. [PMID: 32949079 PMCID: PMC7537051 DOI: 10.1111/petr.13875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/30/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
Respiratory viral infections are known causes of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a unique case of a child with viral pneumonia caused by coinfection with human metapneumovirus (MPV), respiratory syncytial virus (RSV), and SARS-CoV-2 after HSCT. A 9-year-old girl with acute lymphoblastic leukemia underwent allogeneic HSCT from a matched, unrelated donor. During the post-transplant period, in profound leukopenia (below 10 leukocytes/µL), she was diagnosed with SARS-CoV-2, MPV, and RSV pneumonia and was treated with ribavirin and chloroquine. Before leukocyte recovery, the girl became asymptomatic, and SARS-CoV-2 and RSV clearance was achieved. The shedding of SARS-CoV-2 stopped before immune system recovery, and one may hypothesize that the lack of an inflammatory response might have been a contributing factor to the mild clinical course. Post-transplant care in HSCT recipients with COVID-19 infection is feasible in regular transplant units, provided the patient does not present with respiratory failure. Early and repeated testing for SARS-CoV-2 in post-transplant patients with concomitant infection mitigation strategies should be considered in children after HSCT who develop fever, respiratory symptoms, and perhaps gastrointestinal symptoms to control the spread of COVID-19 both in patients and in healthcare workers in hospital environments. Training of staff and the availability of personal protective equipment are crucial for containing SARS-CoV-2 infection.
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Affiliation(s)
- Tomasz Jarmoliński
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | | | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Igor Olejnik
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Ewa Gorczyńska
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and HematologyWroclaw Medical UniversityWroclawPoland
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16
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Hospitalizations for vaccine-preventable infections among pediatric hematopoietic cell transplantation recipients in the first 5 years after transplantation. Bone Marrow Transplant 2021; 56:2656-2663. [PMID: 34155358 DOI: 10.1038/s41409-021-01373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
Despite recommendations for vaccination after hematopoietic cell transplantation (HCT), immunization rates remain low leaving children at high risk for vaccine preventable infections (VPIs). However, the burden from VPIs in pediatric HCT recipients is not well known. We describe the prevalence, risk factors, and outcomes of VPI-associated hospitalizations at centers participating in the Pediatric Health Information System database. Children <18 years who underwent allogeneic or autologous-HCT between 1/1/2010-31/12/2018, were identified and prevalence of overall VPI and of each infection were determined at five time-points within 5 years post-HCT. In total, 684 of 9591 pediatric HCT recipients had a VPI-associated hospitalization, most frequently in the first 6-12 months, for an overall prevalence of 7.1% (95% CI: 6.6-7.7%). Influenza, varicella, and invasive pneumococcal infections were the most frequent. Multivariable analyses identified younger age (OR = 0.96 [95% CI: 0.93-0.99]; p = 0.013), primary immune deficiency (PID) (OR = 1.78 [95% CI: 1.11-2.84]; p = 0.016), and GVHD (OR = 1.62 [95% CI: 1.05-2.48]; p = 0.028) as independent risk factors during the initial HCT-hospitalization. Children with VPI had longer duration of hospitalization (55[51] vs 36[24] days, p < 0.001), higher rates of ICU admission (42 vs 26%, p < 0.001), and mortality (11% [n = 17) vs 6% [n = 519]; p = 0.003). Continued efforts to improve vaccination early post-HCT are warranted.
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17
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Saleh G, Ahmed A, Hassanain O, Emad A, Essameldin S, Ragai M, Saad Y. Nutrition in Cancer Patients Positive for COVID-19; Case Series and a Systematic Review of Literature. Nutr Cancer 2021; 74:450-462. [PMID: 34080508 DOI: 10.1080/01635581.2021.1931363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer is making patients vulnerable to diseases by impairing immunity directly or by anticancer therapy. In COVID-19 era, it is mandatory to face cancer with more organized & prompter response. Nutrition plays an important role in prevention & management of cancer patients. The objective of this study is to understand the role of nutrition in cancer patients during Corvid 19 era. We conducted literature searches till May 2020, electronic databases, evidence-based collections, relevant websites and trial registries about SARS-CoV2/COVID-19 and nutrition in cancer patients. Search generated 836 sources; 83/836 sources were relevant. This review summarized role of nutrition in predisposition, prevention and management of COVID-19 in cancer patient and role of vitamins, mineral supplements and microbiota in era of COVID-19. In this review, implementing appropriate nutritional care with vitamins or mineral supplementation & their effect on outcome remain largely unknown. COVID co-infection with cancer whether under chemotherapy or not have worse outcome especially in male adults. Findings may help in creating recommendations on nutritional protocol of management & prevention of complications during ongoing COVID-19 pandemic for all cancer patients.
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Affiliation(s)
- Gulsen Saleh
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt.,Public Health Department, National Nutrition Institute (NNI), Cairo, Egypt
| | - Aliaa Ahmed
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Tanta, Egypt
| | - Omneya Hassanain
- Epidemiology and Biostatistics Unit, Research Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Aya Emad
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Samer Essameldin
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Marianne Ragai
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt
| | - Yasmin Saad
- Clinical Nutrition Department, 57357 Cancer Children Hospital of Egypt (CCHE), Cairo, Egypt.,Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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18
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COVID-19 in Patients with Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:315-331. [PMID: 33973186 DOI: 10.1007/978-3-030-63761-3_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With more than 5 million cases and 333,212 deaths, COVID-19 (or SARS-CoV-2) continues to spread. General symptoms of this disease are similar to that of many other viral respiratory diseases, including fever, cough, dyspnea, and fatigue, with a chance of progression to more severe complications. However, the virus does not affect all people equally, and cases with comorbidities such as malignancies, cardiovascular diseases, respiratory diseases, and kidney diseases are at higher risk of developing severe events, including requiring intensive ventilation, intensive care unit (ICU) admission, and death. Patients with cancer are more likely to be infected with COVID-19, which is possibly due to their immunological dysfunction or frequent clinic visits. Also, there is a higher chance that these patients experience severe events because of the medication they receive. In this chapter, we will review the main clinical manifestations of COVID-19 in patients with cancer. Recommendations and challenges for managing resources, organizing cancer centers, treatment of COVID-19-infected cancer patients, and performing cancer research during this pandemic will also be discussed.
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19
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Risk factors for seasonal human coronavirus lower respiratory tract infection after hematopoietic cell transplantation. Blood Adv 2021; 5:1903-1914. [PMID: 33792629 PMCID: PMC8015796 DOI: 10.1182/bloodadvances.2020003865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 12/25/2022] Open
Abstract
We demonstrate risk factors for HCoV LRTI in allogeneic HCT recipients and significance of virologic documentation by BAL on mortality. Hyperglycemia associated with steroid use appears to be a strong predictor of HCoV disease progression.
Data are limited regarding risk factors for lower respiratory tract infection (LRTI) caused by seasonal human coronaviruses (HCoVs) and the significance of virologic documentation by bronchoalveolar lavage (BAL) on outcomes in hematopoietic cell transplant (HCT) recipients. We retrospectively analyzed patients undergoing allogeneic HCT (4/2008-9/2018) with HCoV (OC43/NL63/HKU1/229E) detected by polymerase chain reaction during conditioning or post-HCT. Risk factors for all manifestations of LRTI and progression to LRTI among those presenting with HCoV upper respiratory tract infection (URTI) were analyzed by logistic regression and Cox proportional hazard models, respectively. Mortality rates following HCoV LRTI were compared according to virologic documentation by BAL. A total of 297 patients (61 children and 236 adults) developed HCoV infection as follows: 254 had URTI alone, 18 presented with LRTI, and 25 progressed from URTI to LRTI (median, 16 days; range, 2-62 days). Multivariable logistic regression analyses showed that male sex, higher immunodeficiency scoring index, albumin <3 g/dL, glucose >150 mg/dL, and presence of respiratory copathogens were associated with occurrence of LRTI. Hyperglycemia with steroid use was associated with progression to LRTI (P < .01) in Cox models. LRTI with HCoV detected in BAL was associated with higher mortality than LRTI without documented detection in BAL (P < .01). In conclusion, we identified factors associated with HCoV LRTI, some of which are less commonly appreciated to be risk factors for LRTI with other respiratory viruses in HCT recipients. The association of hyperglycemia with LRTI might provide an intervention opportunity to reduce the risk of LRTI.
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Atalla E, Kalligeros M, Mylona EK, Tsikala-Vafea M, Shehadeh F, Georgakas J, Mylonakis E. Impact of Influenza Infection Among Adult and Pediatric Populations With Hematologic Malignancy and Hematopoietic Stem Cell Transplant: A Systematic Review and Meta-Analysis. Clin Ther 2021; 43:e66-e85. [PMID: 33812700 DOI: 10.1016/j.clinthera.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Influenza is increasingly recognized as a leading cause of morbidity and mortality in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation (HSCT). However, the impact of influenza on this population has not been previously evaluated in a systematic review. This study systematically reviewed and summarized the outcomes of influenza infection as to in-hospital influenza-related mortality, development of lower respiratory tract infection and acute respiratory distress syndrome, need for hospitalization, intensive care unit admission, and mechanical ventilation. METHODS We conducted a systematic search of literature using the PubMed and EMBASE databases for articles published from January 1989 through January 19, 2020, reporting laboratory-confirmed influenza in patients of any age with hematologic malignancies and HSCT. Time from transplantation was not included in the search criteria. The impact of antiviral therapy on influenza outcomes was not assessed due to heterogeneity in antiviral treatment provision across the studies. Patients with influenza-like illness, solid-tumor cancers, or nonmalignant hematologic diseases were excluded from the study. A random-effects meta-analysis was performed to estimate the prevalences and 95% CIs of each outcome of interest. A subgroup analysis was carried out to assess possible sources of heterogeneity and to evaluate the potential impact of age on the influenza infection outcomes. Heterogeneity was assessed using the I2 statistic. FINDINGS Data from 52 studies providing data on 1787 patients were included in this analysis. During seasonal epidemics, influenza-related in-hospital mortality was 16.60% (95% CI, 7.49%-27.7%), with a significantly higher death rate in adults compared to pediatric patients (19.55% [95% CI, 10.59%-29.97%] vs 0.96% [95% CI, 0%-6.77%]; P < 0.001). Complications from influenza, such as lower respiratory tract infection, developed in 35.44% of patients with hematologic malignancies and HSCT recipients, with a statistically significant difference between adults and children (46.14% vs 19.92%; P < 0.001). However, infection resulted in a higher hospital admission rate in pediatric patients compared to adults (61.62% vs 22.48%; P < 0.001). For the 2009 H1N1 pandemic, no statistically significant differences were found between adult and pediatric patients when comparing the rates of influenza-related in-hospital mortality, lower respiratory tract infection, and hospital admission. Similarly, no significant differences were noted in any of the outcomes of interest when comparing H1N1 pandemic with seasonal epidemics. IMPLICATIONS Regardless of influenza season, patients, and especially adults, with underlying hematologic malignancies and HSCT recipients with influenza are at risk for severe outcomes including lower respiratory tract infection and in-hospital mortality.
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Affiliation(s)
- Eleftheria Atalla
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Markos Kalligeros
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Evangelia K Mylona
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Maria Tsikala-Vafea
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Fadi Shehadeh
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joanna Georgakas
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
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21
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Hanisch BR, Cohen W, Jacobsohn D, Song X. Impact of hospital acquired infections on post-transplant one year mortality in pediatric bone marrow transplant patients. Am J Infect Control 2021; 49:179-183. [PMID: 32682014 DOI: 10.1016/j.ajic.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Children undergoing hematopoietic stem cell transplant (HSCT) are prone to infections, especially when hospitalized for the transplant or additional medical care. These infections are perceived to increase patient's mortality risk, but data are lacking. We conducted this study to assess the burden and the impact of hospital acquired infections (HAI) on mortality risk among pediatric HSCT patients. METHODS This retrospective study included 169 patients that received allogeneic HSCT between January 1 2011 and July 6 2017 at Children's National Hospital, a tertiary referral center. Clinical and laboratory data were reviewed for 1 year after transplant to determine HAI and survival status. The HAI incident rates stratified by bloodstream, respiratory, and gastrointestinal infections were then compared between deceased patients and survivors. RESULTS Including transplant, 169 patients sustained 499 hospital admissions for total of 10,523 patient days and 112 HAI episodes, resulting in a HAI rate of 10.6 per 1,000 patient-days. Within 1-year after transplant, 38 (22%) patient died, 30 (17.5%) with nonrelapse-related causes. Unadjusted univariate analysis revealed mortality correlated with cell source (p=0.035), donor type (p = 0.002), respiratory viral infections (P = .015), and central line associated blood stream infection (CLABSIs; P < .001). Adjusted analysis revealed CLABSI and respiratory adenovirus infection independently increased mortality risk by 3-fold (hazard ratio: 3.22, 95% confidence interval:1.30-8.00) and (hazard ratio: 3.32, 95% confidence interval: 1.22-9.06), respectively. CONCLUSIONS In light of the high frequency of multiple factors contributing to mortality we are unable to determine the degree HAI contributed mortality. However, our findings suggest preventing CLABSIs and respiratory adenovirus infections are crucial to improve the 1-year survival among pediatric HSCT patients.
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Abstract
Respiratory viruses are commonly detected in both healthy and immunocompromised children. In most healthy children, respiratory viruses are associated with self-limited upper respiratory tract infections and are not accompanied by significant morbidity. In immunocompromised hosts, including hematopoietic cell transplant recipients, solid organ transplant recipients, and oncology patients, respiratory viruses can be associated with significant clinical manifestations, including prolonged viral shedding, lower respiratory tract disease, the need for supplemental oxygen, late airflow obstruction, and even death. This chapter reviews the major respiratory viruses, including respiratory syncytial virus, human metapneumovirus, influenza, parainfluenza viruses, human rhinoviruses, and human coronaviruses. Other viruses can manifest as pulmonary infection; however, these viruses are discussed elsewhere (see Chapter 17 for discussion of cytomegalovirus and Chapter 22 for discussion of adenoviruses).
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Perret C, Le Corre N, Castro-Rodriguez JA. Emergent Pneumonia in Children. Front Pediatr 2021; 9:676296. [PMID: 34222146 PMCID: PMC8247473 DOI: 10.3389/fped.2021.676296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
In recent decades there have been multiple pathogens, viruses and bacteria, which have emerged as causal agents of pneumonia affecting adults, albeit less frequently, to children. For the purposes of this article we have classified emerging pathogens as follows: True emerging, to pathogens identified for the very first time affecting human population (SARS-CoV-1, SARS-CoV-2, MERS-CoV, avian influenza, and hantavirus); Re-emerging, to known pathogens which circulation was controlled once, but they have reappeared (measles, tuberculosis, antimicrobial resistant bacteria such as CA-MRSA, Mycoplasma pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and new serotypes of post-vaccine pneumococcal); and finally, those that we have called old known with new presentations, including common pathogens that, in particular condition, have changed their form of presentation (rhinovirus, and non-SARS coronavirus). We will review for each of them their epidemiology, forms of presentation, therapy, and prognosis in children compared to the adult with the aim of being able to recognize them to establish appropriate therapy, prognostics, and effective control measures.
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Affiliation(s)
- Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Chiotos K, Hayes M, Kimberlin DW, Jones SB, James SH, Pinninti SG, Yarbrough A, Abzug MJ, MacBrayne CE, Soma VL, Dulek DE, Vora SB, Waghmare A, Wolf J, Olivero R, Grapentine S, Wattier RL, Bio L, Cross SJ, Dillman NO, Downes KJ, Timberlake K, Young J, Orscheln RC, Tamma PD, Schwenk HT, Zachariah P, Aldrich M, Goldman DL, Groves HE, Lamb GS, Tribble AC, Hersh AL, Thorell EA, Denison MR, Ratner AJ, Newland JG, Nakamura MM. Multicenter Initial Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2. J Pediatric Infect Dis Soc 2020; 9:701-715. [PMID: 32318706 PMCID: PMC7188128 DOI: 10.1093/jpids/piaa045] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics. METHODS A panel of pediatric infectious diseases physicians and pharmacists from 18 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of best available evidence and expert opinion. RESULTS Given the typically mild course of pediatric COVID-19, supportive care alone is suggested for the overwhelming majority of cases. The panel suggests a decision-making framework for antiviral therapy that weighs risks and benefits based on disease severity as indicated by respiratory support needs, with consideration on a case-by-case basis of potential pediatric risk factors for disease progression. If an antiviral is used, the panel suggests remdesivir as the preferred agent. Hydroxychloroquine could be considered for patients who are not candidates for remdesivir or when remdesivir is not available. Antivirals should preferably be used as part of a clinical trial if available. CONCLUSIONS Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare cases of severe or critical disease, this guidance offers an approach for decision-making regarding antivirals, informed by available data. As evidence continues to evolve rapidly, the need for updates to the guidance is anticipated.
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Affiliation(s)
- Kathleen Chiotos
- Department of Anesthesia and Critical Care Medicine, Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, United States
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, United States
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, United States
| | - Molly Hayes
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, United States
| | - David W Kimberlin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, United States
| | - Sarah B Jones
- Department of Pharmacy, Boston Children’s Hospital, Boston, United States
- Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, United States
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, United States
| | - Swetha G Pinninti
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, United States
| | - April Yarbrough
- Department of Pharmacy, Children’s of Alabama, Birmingham, United States
| | - Mark J Abzug
- Department of Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, United States
| | | | - Vijaya L Soma
- Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital, New York, United States
| | - Daniel E Dulek
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University and Monroe Carell Jr. Children’s Hospital, Nashville, United States
| | - Surabhi B Vora
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle Children’s Hospital, Seattle, United States
| | - Alpana Waghmare
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle Children’s Hospital, Seattle, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, United States
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, United States
| | - Rosemary Olivero
- Department of Pediatrics and Human Development, Section of Infectious Diseases, Helen DeVos Children's Hospital of Spectrum Health, Michigan State College of Human Medicine, Grand Rapids, United States
| | - Steven Grapentine
- Department of Pharmacy, UCSF Benioff Children’s Hospital, San Francisco, United States
| | - Rachel L Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California, San Francisco, San Francisco, United States
| | - Laura Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital Stanford, Stanford, United States
| | - Shane J Cross
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, United States
| | - Nicholas O Dillman
- Department of Pharmacy, CS Mott Children’s Hospital, Ann Arbor, United States
| | - Kevin J Downes
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, United States
| | | | - Jennifer Young
- Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, United States
| | - Rachel C Orscheln
- Department of Pediatrics, Division of Infectious Diseases, Washington University and St. Louis Children’s Hospital, St. Louis, United States
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Hayden T Schwenk
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine and Lucile Packard Children’s Hospital Stanford, Stanford, United States
| | - Philip Zachariah
- Department of Pediatrics, Division of Infectious Diseases, Columbia University, New York, United States
| | - Margaret Aldrich
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital at Montefiore, New York, United States
| | - David L Goldman
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital at Montefiore, New York, United States
| | - Helen E Groves
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
| | - Gabriella S Lamb
- Department of Pediatrics, Division of Infectious Diseases, Boston Children’s Hospital, Boston, United States
| | - Alison C Tribble
- Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children’s Hospital, Ann Arbor, United States
| | - Adam L Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah and Primary Children’s Hospital, Salt Lake City, United States
| | - Emily A Thorell
- Department of Pediatrics, Division of Infectious Diseases, University of Utah and Primary Children’s Hospital, Salt Lake City, United States
| | - Mark R Denison
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University and Monroe Carell Jr. Children’s Hospital, Nashville, United States
| | - Adam J Ratner
- Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital, New York, United States
- Department of Microbiology, New York University Grossman School of Medicine, New York, United States
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University and St. Louis Children’s Hospital, St. Louis, United States
| | - Mari M Nakamura
- Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, United States
- Department of Pediatrics, Division of Infectious Diseases, Boston Children’s Hospital, Boston, United States
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Cimolai N. Complicating Infections Associated with Common Endemic Human Respiratory Coronaviruses. Health Secur 2020; 19:195-208. [PMID: 33186086 DOI: 10.1089/hs.2020.0067] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronaviruses OC43, 229E, NL63, and HKU1 are endemic human respiratory coronaviruses that typically cause mild to moderate upper respiratory infections, similar to the common cold. They also may cause simple and complicated lower respiratory infections, otitis media, asthma exacerbations, gastroenteritis, and a few systemic complications. These viruses are usually seasonal (with winter dominance) and affect nearly all age groups. The seasonal and annual variation in virus prevalence has implications for understanding the concept of acquired immunity and its persistence or diminution. Coronaviruses generally have outbreak potential in susceptible populations of any age, particularly in patients with comorbidities, who tend to have increased clinical disease. These 4 coronaviruses are often found in the context of what appears to be coinfection with other pathogens, but especially other viruses. If coronaviruses are not specifically tested for, the sole detection of a viral copathogen would suggest the pathogen is the causative agent, when a coronavirus may be culpable, or both. The detection of these viruses in circumstances where respiratory viruses are generally sought in clinical samples is, therefore, justified. These pathogens can be chronically shed from the respiratory tract, which is more likely to occur among immunocompromised and complicated patients. These viruses share the potential for genetic drift. The genome is among the largest of RNA viruses, and the capability of these viruses to further change is likely underestimated. Given the potential disease among humans, it is justified to search for effective antiviral chemotherapy for these viruses and to consider uses in niche situations should effective therapy be defined. Whereas SARS-CoV-2 may follow the epidemiological pattern of SARS-CoV and extinguish slowly over time, there is yet concern that SARS-CoV-2 may establish itself as an endemic human respiratory coronavirus similar to OC43, 2299E, NL63, and HKU1. Until sufficient data are acquired to better understand the potential of SARS-CoV-2, continued work on antiviral therapy and vaccination is imperative.
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Affiliation(s)
- Nevio Cimolai
- Nevio Cimolai, MD, FRCPC, is a Professor, Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia; he is also Medical Staff, Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia; both in Vancouver, Canada
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26
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Chiotos K, Hayes M, Kimberlin DW, Jones SB, James SH, Pinninti SG, Yarbrough A, Abzug MJ, MacBrayne CE, Soma VL, Dulek DE, Vora SB, Waghmare A, Wolf J, Olivero R, Grapentine S, Wattier RL, Bio L, Cross SJ, Dillman NO, Downes KJ, Oliveira CR, Timberlake K, Young J, Orscheln RC, Tamma PD, Schwenk HT, Zachariah P, Aldrich ML, Goldman DL, Groves HE, Rajapakse NS, Lamb GS, Tribble AC, Hersh AL, Thorell EA, Denison MR, Ratner AJ, Newland JG, Nakamura MM. Multicenter Interim Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2. J Pediatric Infect Dis Soc 2020; 10:34-48. [PMID: 32918548 PMCID: PMC7543452 DOI: 10.1093/jpids/piaa115] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance is needed regarding use of these agents in children. METHODS A panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of the best available evidence and expert opinion. RESULTS Given the typically mild course of COVID-19 in children, supportive care alone is suggested for most cases. For children with severe illness, defined as a supplemental oxygen requirement without need for noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically ill children requiring invasive or noninvasive mechanical ventilation or ECMO. A duration of 5 days is appropriate for most patients. The panel recommends against the use of hydroxychloroquine or lopinavir-ritonavir (or other protease inhibitors) for COVID-19 in children. CONCLUSIONS Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.
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Affiliation(s)
- Kathleen Chiotos
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, United States,Corresponding Author: Kathleen Chiotos, MD, Roberts Center for Pediatric Research, 2716 South Street, Room 10292, Philadelphia, PA 19146,
| | - Molly Hayes
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, United States
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sarah B Jones
- Department of Pharmacy, Boston Children’s Hospital, Boston, MA, United States,Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, MA, United States
| | - Scott H James
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Swetha G Pinninti
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - April Yarbrough
- Department of Pharmacy, Children’s of Alabama, Birmingham, AL, United States
| | - Mark J Abzug
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
| | | | - Vijaya L Soma
- Division of Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital, New York, NY, United States
| | - Daniel E Dulek
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University and Monroe Carell Jr. Children’s Hospital, Nashville, TN, United States
| | - Surabhi B Vora
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, United States
| | - Alpana Waghmare
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, United States,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Rosemary Olivero
- Section of Infectious Diseases, Department of Pediatrics and Human Development, Helen DeVos Children's Hospital of Spectrum Health, Michigan State College of Human Medicine, Grand Rapids, MI, United States
| | - Steven Grapentine
- Department of Pharmacy, UCSF Benioff Children’s Hospital, San Francisco, CA, United States
| | - Rachel L Wattier
- Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital Stanford, Stanford, United States
| | - Shane J Cross
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Nicholas O Dillman
- Department of Pharmacy, CS Mott Children’s Hospital, Ann Arbor, MI, United States
| | - Kevin J Downes
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Carlos R Oliveira
- Yale University School of Medicine, Yale University, New Haven, CT, United States
| | | | - Jennifer Young
- Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, MO, United States
| | - Rachel C Orscheln
- Division of Infectious Diseases, Department of Pediatrics, Washington University and St. Louis Children’s Hospital, St. Louis, MO, United States
| | - Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hayden T Schwenk
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine & Lucile Packard Children’s Hospital Stanford, Stanford, CA, United States
| | - Philip Zachariah
- Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, NY, United States
| | - Margaret L Aldrich
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital at Montefiore, New York, NY, United States
| | - David L Goldman
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital at Montefiore, New York, NY, United States
| | - Helen E Groves
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Nipunie S Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Gabriella S Lamb
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Alison C Tribble
- Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children’s Hospital, Ann Arbor, MI, United States
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, United States
| | - Emily A Thorell
- Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, United States
| | - Mark R Denison
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University and Monroe Carell Jr. Children’s Hospital, Nashville, TN, United States
| | - Adam J Ratner
- Division of Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital, New York, NY, United States,Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University and St. Louis Children’s Hospital, St. Louis, MO, United States
| | - Mari M Nakamura
- Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, MA, United States,Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States,Alternate Corresponding Author: Mari M. Nakamura, MD, MPH, Antimicrobial Stewardship Program, Boston Children’s Hospital, 300 Longwood Avenue, Mailstop BCH 3052, Boston, MA 02115, 617-355-1561,
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Gabutti G, De Motoli F, Sandri F, Toffoletto MV, Stefanati A. Viral Respiratory Infections in Hematological Patients. Infect Dis Ther 2020; 9:495-510. [PMID: 32638228 PMCID: PMC7339094 DOI: 10.1007/s40121-020-00313-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Viral infections of the respiratory system represent one of the most important complications in hematological patients in terms of both the severity of the clinical picture and its related impact on the duration of hospitalization, and of mortality. The most implicated viruses are those that commonly cause community-based respiratory diseases: respiratory syncytial virus, Influenza virus and rhinovirus. However, in some cases the clinical picture may be triggered by first infection with or reactivation of pathogens normally not responsible for clinically relevant diseases in immunocompetent subjects. This issue is currently being taken into greater consideration within the scientific community. However, the strong heterogeneity in the epidemiology and clinical expression of these infections and the lack of adequate therapeutic options imply that there is currently no uniform consensus on the best management of these patients. The main purpose of this review is to highlight which viruses are currently most implicated in the onset of these infections, what is their incidence in so heterogeneous and fragile patients and the factors that lead to disease's onset and evolution. Possible or available clinical management options, diagnostic and therapeutic tools, and preventive and prophylaxis measures are also discussed.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Francesco De Motoli
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | | | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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28
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Schuster JE, Banerjee D, Ahmed I, Selvarangan R. Frequency of asymptomatic and symptomatic respiratory virus detection in pediatric hematopoietic cell transplant patients. Pediatr Transplant 2020; 24:e13732. [PMID: 32418305 DOI: 10.1111/petr.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/04/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
Respiratory viral infections are common and can cause significant morbidity and mortality in pediatric patients undergoing hematopoietic cell transplantation (HCT). The prevalence of disease has been primarily identified from retrospective studies using standard-of-care specimens. The incidence of both asymptomatic respiratory viral detection and symptomatic respiratory viral detection in this high-risk population is not well described. We performed longitudinal, active, prospective surveillance in pediatric HCT patients. Subjects underwent weekly midturbinate swabs (MTSs) for the detection of 18 respiratory viruses and subtypes peri-HCT and 100 days post-HCT. Clinical data were obtained from the medical record. From September 2015 to February 2017, 24 children underwent 29 HCT, and 284 MTSs were collected. Forty-two (15%) specimens were virus-positive from 10 (42%) subjects. Specimens from children undergoing allogeneic HCT were more likely to have a virus detected (17% vs 8%, P = .04) compared with specimens from children undergoing autologous HCT. Sixteen (38%) detections were not associated with symptoms. Almost half (8/17) of the unique viral infections occurred during the HCT hospitalization after a negative specimen, suggesting nosocomial acquisition, and preceded detection from a clinical specimen. Rhinovirus, the most common virus detected, was the only virus detected in 33 (81%) virus-positive specimens; only 11 (33%) rhinovirus detections were asymptomatic. Asymptomatic detection of coronavirus and bocavirus occurred. Asymptomatic respiratory virus detection occurred in more than one-third of the children undergoing HCT. The acquisition of respiratory viruses during HCT hospitalization suggests nosocomial acquisition. Early detection of respiratory viruses during asymptomatic periods could have infection prevention and treatment implications.
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Affiliation(s)
- Jennifer E Schuster
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy, Kansas City, MO, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA
| | - Ibrahim Ahmed
- Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, Children's Mercy, Kansas City, MO, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA
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29
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Lassandro G, Palladino V, Amoruso A, Palmieri VV, Russo G, Giordano P. Children in Coronaviruses' Wonderland: What Clinicians Need to Know. Mediterr J Hematol Infect Dis 2020; 12:e2020042. [PMID: 32670520 PMCID: PMC7340228 DOI: 10.4084/mjhid.2020.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023] Open
Abstract
Human coronaviruses (HCoVs) commonly cause mild upper-respiratory tract illnesses but can lead to more severe and diffusive diseases. A variety of signs and symptoms may be present, and infections can range in severity from the common cold and sore throat to more serious laryngeal or tracheal infections, bronchitis, and pneumonia. Among the seven coronaviruses that affect humans (SARS)-CoV, the Middle East respiratory syndrome (MERS)-CoV, and the most recent coronavirus disease 2019 (COVID-19) represent potential life-threatening diseases worldwide. In adults, they may cause severe pneumonia that evolves in respiratory distress syndrome and multiorgan failure with a high mortality rate. Children appear to be less susceptible to develop severe clinical disease and present usually with mild and aspecific symptoms similar to other respiratory infections typical of childhood. However, some children, such as infants, adolescents, or those with underlying diseases may be more at-risk categories and require greater caution from clinicians. Available data on pediatric coronavirus infections are rare and scattered in the literature. The purpose of this review is to provide to clinicians a complete and updated panel useful to recognize and characterize the broad spectrum of clinical manifestations of coronavirus infections in the pediatric age.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Anna Amoruso
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Viviana Valeria Palmieri
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
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30
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Yeoh CB, Lee KJ, Rieth EF, Mapes R, Tchoudovskaia AV, Fischer GW, Tollinche LE. COVID-19 in the Cancer Patient. Anesth Analg 2020; 131:16-23. [PMID: 32543802 PMCID: PMC7179051 DOI: 10.1213/ane.0000000000004884] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) was first reported in China in December 2019. Since then, it has spread across the world to become one of the most serious life-threatening pandemics since the influenza pandemic of 1918. This review article will focus on the specific risks and nuanced considerations of COVID-19 in the cancer patient. Important perioperative management recommendations during this outbreak are emphasized, in addition to discussion of current treatment techniques and strategies available in the battle against COVID-19.
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Affiliation(s)
- Cindy B. Yeoh
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathleen J. Lee
- Department of Anesthesiology and Pain Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elizabeth F. Rieth
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Renee Mapes
- Department of Anesthesiology and Pain Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anna V. Tchoudovskaia
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory W. Fischer
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luis E. Tollinche
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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31
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Vora SB, Waghmare A, Englund JA, Qu P, Gardner RA, Hill JA. Infectious Complications Following CD19 Chimeric Antigen Receptor T-cell Therapy for Children, Adolescents, and Young Adults. Open Forum Infect Dis 2020; 7:ofaa121. [PMID: 32432149 PMCID: PMC7221263 DOI: 10.1093/ofid/ofaa121] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/07/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Infectious complications of chimeric antigen receptor (CAR) T-cell immunotherapy in children and young adults have not been well described. METHODS Medical records of patients ≤26 years old receiving CD19 CAR T-cell infusion (CTI) at a single institution between 2014 and 2017 were reviewed. The number of infections per 100 days-at-risk (infection density) in the 90 days preceding and 0-28 and 29-90 days after CTI was calculated. Poisson regression and Cox analyses were utilized to identify risk factors for infections. RESULTS Eighty-three patients received CTI during the study period. Most patients (98%) had refractory or relapsed acute lymphoblastic leukemia (ALL). Infections occurred in 54% of patients in the 90 days before CTI (infection density, 1.23) and in 40% of patients in the first 28 days following CTI (infection density, 2.89). Infection density decreased to 0.55 in the 29-90 days post-CTI. Most infections were bacteremias (39%) or respiratory viral infections (43%). Pre-CTI risk factors associated with infection included prior hematopoietic cell transplantation (HCT), immunoglobulin G (IgG) level <400 mg/dL, and lymphodepletion other than cyclophosphamide plus fludarabine; post-CTI risk factors included higher-severity CRS and IgG <400 mg/dL. CONCLUSIONS Infection rates in children and young adults receiving CD19 CAR T-cell therapy increase in the first month and then decline. Understanding types and timing of infections and contributing risk factors may help inform prophylactic and monitoring strategies. Specific attention should be given to patients with prior HCT, severe hypogammaglobulinemia, and severe CRS.
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Affiliation(s)
- Surabhi B Vora
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Alpana Waghmare
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Pingping Qu
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Rebecca A Gardner
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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32
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Mårtensson T, Mellgren K, Toporski J, Arvidson J, Szakos A, Casswall TH, Gustafsson B. Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft-versus-host disease. Clin Transplant 2020; 34:e13867. [PMID: 32248590 DOI: 10.1111/ctr.13867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/22/2022]
Abstract
Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft-versus-host disease (GI-GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI-GVHD (2000-2013) after receiving hematopoietic stem cell transplantation. Sixty-eight children with ninety-one endoscopic occasions were enrolled. At the time of endoscopy, anti-GI-GVHD treatment was ongoing in 71% (65/91). In 18% (12/65) with ongoing treatment, no histopathological evidence of GI-GVHD or another cause to justify anti-GI-GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re-endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (P = .007). Histopathological findings generating treatment changes were as follows: GI-GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI-GVHD.
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Affiliation(s)
- Thomas Mårtensson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Mellgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Johan Arvidson
- Department of Women´s and Children´s Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Attila Szakos
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas H Casswall
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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33
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Ogimi C, Kim YJ, Martin ET, Huh HJ, Chiu CH, Englund JA. What's New With the Old Coronaviruses? J Pediatric Infect Dis Soc 2020; 9:210-217. [PMID: 32314790 PMCID: PMC7188130 DOI: 10.1093/jpids/piaa037] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Coronaviruses contribute to the burden of respiratory diseases in children, frequently manifesting in upper respiratory symptoms considered to be part of the "common cold." Recent epidemics of novel coronaviruses recognized in the 21st century have highlighted issues of zoonotic origins of transmissible respiratory viruses and potential transmission, disease, and mortality related to these viruses. In this review, we discuss what is known about the virology, epidemiology, and disease associated with pediatric infection with the common community-acquired human coronaviruses, including species 229E, OC43, NL63, and HKU1, and the coronaviruses responsible for past world-wide epidemics due to severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus.
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Affiliation(s)
- Chikara Ogimi
- Department of Pediatrics, Seattle Children’s Hospital Research Institute, University of Washington, Seattle, Washington, USA
| | - Yae Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung Universit,y College of Medicine, Taoyuan, Taiwan
| | - Janet A Englund
- Department of Pediatrics, Seattle Children’s Hospital Research Institute, University of Washington, Seattle, Washington, USA
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34
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Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit. Pediatr Qual Saf 2019; 4:e242. [PMID: 32010868 PMCID: PMC6946222 DOI: 10.1097/pq9.0000000000000242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/01/2019] [Indexed: 01/11/2023] Open
Abstract
Supplemental Digital Content is available in the text. Healthcare-associated respiratory viral infections (HARVIs) result in significant harm to infants in the neonatal intensive care unit (NICU). Healthcare workers and visitors can serve as transmission vectors to patients. We hypothesized that improved family and visitor hand hygiene (FVHH) and visitor screening would reduce HARVIs by at least 25%.
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35
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Immunogenicity of the inactivated influenza vaccine in children who have undergone allogeneic haematopoietic stem cell transplant. Bone Marrow Transplant 2019; 55:773-779. [PMID: 31659236 PMCID: PMC7223911 DOI: 10.1038/s41409-019-0728-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
Influenza vaccination is recommended for children following allogeneic haematopoietic stem cell transplant (HSCT), however there is limited evidence regarding its benefit. A prospective multicentre study was conducted to evaluate the immunogenicity of the inactivated influenza vaccine in children who have undergone HSCT compared with healthy age-matched controls. Participants were vaccinated between 2013 and 2016 according to Australian guidelines. Influenza-specific hemagglutinin inhibition antibody titres were performed prior to each vaccination and 4 weeks following the final vaccination. A nasopharyngeal aspirate for influenza was performed on participants that developed influenza-like illness. There were 86 children recruited; 43 who had undergone HSCT and 43 controls. For the HSCT group, seroprotection and seroconversion rates were 81.4% and 60.5% for H3N2, 41.9% and 32.6% for H1N1, and 44.2% and 39.5% for B strain respectively. There was a significant geometric mean fold increase to the H3N2 (GMFI 5.80, 95% CI 3.68–9.14, p < 0.001) and B (GMFI 3.44, 95% CI 2.36–5.00, p = 0.048) strains. Serological response was superior in age-matched controls to all vaccine strains. There were no serious adverse events following vaccination. For children who underwent HSCT, incidence of laboratory-proven influenza infection was 2.3%. Overall, this study provides evidence to support annual inactivated influenza vaccine administration to children following HSCT.
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36
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Ottaviano G, Lucchini G, Breuer J, Furtado-Silva JM, Lazareva A, Ciocarlie O, Elfeky R, Rao K, Amrolia PJ, Veys P, Chiesa R. Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality. Br J Haematol 2019; 188:560-569. [PMID: 31566733 PMCID: PMC7161889 DOI: 10.1111/bjh.16216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
Viral respiratory infections (VRIs) contribute to the morbidity and transplant‐related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre‐HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.
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Affiliation(s)
- Giorgio Ottaviano
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Paediatrics, University of Milano-Bicocca, San Gerardo Hospital/Fondazione MBBM, Monza, Italy
| | - Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Judith Breuer
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Division of Infection and Immunity, University College London, London, UK
| | - Juliana M Furtado-Silva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Arina Lazareva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Oana Ciocarlie
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Reem Elfeky
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kanchan Rao
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Persis J Amrolia
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Robert Chiesa
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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37
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Ison MG, Hirsch HH. Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs. Clin Microbiol Rev 2019; 32:e00042-19. [PMID: 31511250 PMCID: PMC7399564 DOI: 10.1128/cmr.00042-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.
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Affiliation(s)
- Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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38
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Fontana L, Strasfeld L. Respiratory Virus Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:523-544. [PMID: 30940462 PMCID: PMC7126949 DOI: 10.1016/j.idc.2019.02.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Respiratory virus infections in hematologic stem cell transplant recipients and patients with hematologic malignancies are increasingly recognized as a cause of significant morbidity and mortality. The often overlapping clinical presentation makes molecular diagnostic strategies imperative for rapid diagnosis and to inform understanding of the changing epidemiology of each of the respiratory viruses. Most respiratory virus infections are managed with supportive therapy, although there is effective antiviral therapy for influenza. The primary focus should remain on primary prevention infection control procedures and isolation precautions, avoidance of ill contacts, and vaccination for influenza.
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Affiliation(s)
- Lauren Fontana
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA.
| | - Lynne Strasfeld
- Division of Infectious Disease, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L457, Portland, OR 97239, USA
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39
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Forkpa H, Rupp AH, Shulman ST, Patel SJ, Gray EL, Zheng X, Bovee M, Kociolek LK. Association Between Children's Hospital Visitor Restrictions and Healthcare-Associated Viral Respiratory Infections: A Quasi-Experimental Study. J Pediatric Infect Dis Soc 2019; 9:240-243. [PMID: 30989226 PMCID: PMC7107505 DOI: 10.1093/jpids/piz023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/21/2019] [Indexed: 12/29/2022]
Abstract
We investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions.
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Affiliation(s)
- Hawa Forkpa
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela H Rupp
- Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Stanford T Shulman
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Sameer J Patel
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth L Gray
- Departments of Preventive Medicine-Biostatistics, and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaotian Zheng
- Departments of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maria Bovee
- Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Larry K Kociolek
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois,Correspondence: L. K. Kociolek, MD, MSCI, 320 E. Superior St, Searle 15–560, Chicago, IL 60611 ()
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40
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Vliora C, Papadakis V, Doganis D, Tourkantoni N, Paisiou A, Kottaridi C, Kourlamba G, Zaoutis T, Kosmidis H, Kattamis A, Polychronopoulou S, Goussetis E, Giannouli G, Syridou G, Priftis K, Papaevangelou V. A prospective study on the epidemiology and clinical significance of viral respiratory infections among pediatric oncology patients. Pediatr Hematol Oncol 2019; 36:173-186. [PMID: 31215284 DOI: 10.1080/08880018.2019.1613462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Respiratory infections in oncology are both common and potentially severe. However, there is still a gap in the literature, regarding the epidemiology of viral respiratory infections in children with cancer. We prospectively enrolled 224 patients, from September 2012 to August 2015. The cohort included children with hematologic or solid malignancies receiving chemotherapy, or undergoing hemopoietic stem cell transplantation, outpatients/inpatients exhibiting signs/symptoms of febrile/afebrile upper/lower respiratory infection. Viral infection was diagnosed by detection of ≥1 viruses from a sample at time of enrollment, using the CLART® PneumoVir kit (GENOMICA, Spain). Α detailed questionnaire including demographics and medical history was also completed. Samples were processed in batches, results were communicated as soon as they became available. Children recruited in whom no virus was detected composed the no virus detected group. Viral prevalence was 38.4% in children presenting with respiratory illness. A single virus was found in 30.4%, with RSV being the most frequent. Viral coinfections were detected in 8%. Children with viral infection were more likely to be febrile upon enrollment and to present with lower respiratory signs/symptoms. They had longer duration of illness and they were more likely to receive antibiotics/antifungals. Only 22% of children with influenza received oseltamivir. Mortality was low (2.7%), however, pediatric intensive care unit (PICU) admission and death were correlated with virus detection. In our study mortality was low and PICU admission was related to virus identification. Further research is needed to clarify whether antibiotics in virus-proven infection are of value and underline the importance of oseltamivir's timely administration in influenza.
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Affiliation(s)
- Christianna Vliora
- a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece
| | - Vassilios Papadakis
- b Department of Pediatric Hematology-Oncology , Athens , Greece , "Aghia Sofia" Children's Hospital
| | - Dimitrios Doganis
- c Oncology Department , " P&A Kyriakou" Children's Hospital , Athens , Greece
| | - Natalia Tourkantoni
- d Hematology-Oncology Unit, First Department of Pediatrics , National and Kapodistrian University of Athens, "Aghia Sofia" Children's Hospital , Athens , Greece
| | - Anna Paisiou
- e Stem Cell Transplant Unit , Aghia Sofia Children's Hospital , Athens , Greece
| | | | - Georgia Kourlamba
- g The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), First and Second Departments of Pediatrics, National and Kapodistrian University of Athens , Athens , Greece
| | - Theoklis Zaoutis
- g The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), First and Second Departments of Pediatrics, National and Kapodistrian University of Athens , Athens , Greece
| | - Helen Kosmidis
- c Oncology Department , " P&A Kyriakou" Children's Hospital , Athens , Greece
| | - Antonis Kattamis
- d Hematology-Oncology Unit, First Department of Pediatrics , National and Kapodistrian University of Athens, "Aghia Sofia" Children's Hospital , Athens , Greece
| | - Sophia Polychronopoulou
- b Department of Pediatric Hematology-Oncology , Athens , Greece , "Aghia Sofia" Children's Hospital
| | - Evgenios Goussetis
- e Stem Cell Transplant Unit , Aghia Sofia Children's Hospital , Athens , Greece
| | - Georgia Giannouli
- a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece
| | - Garyfallia Syridou
- a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece
| | - Kostas Priftis
- a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece
| | - Vassiliki Papaevangelou
- a Third Department of Pediatrics , National and Kapodistrian University of Athens, "ATTIKON" University Hospital , Athens , Greece
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Hijano DR, Maron G, Hayden RT. Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant. Front Microbiol 2018; 9:3097. [PMID: 30619176 PMCID: PMC6299032 DOI: 10.3389/fmicb.2018.03097] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/29/2018] [Indexed: 12/25/2022] Open
Abstract
Survival rates for pediatric cancer have steadily improved over time but it remains a significant cause of morbidity and mortality among children. Infections are a major complication of cancer and its treatment. Community acquired respiratory viral infections (CRV) in these patients increase morbidity, mortality and can lead to delay in chemotherapy. These are the result of infections with a heterogeneous group of viruses including RNA viruses, such as respiratory syncytial virus (RSV), influenza virus (IV), parainfluenza virus (PIV), metapneumovirus (HMPV), rhinovirus (RhV), and coronavirus (CoV). These infections maintain a similar seasonal pattern to those of immunocompetent patients. Clinical manifestations vary significantly depending on the type of virus and the type and degree of immunosuppression, ranging from asymptomatic or mild disease to rapidly progressive fatal pneumonia Infections in this population are characterized by a high rate of progression from upper to lower respiratory tract infection and prolonged viral shedding. Use of corticosteroids and immunosuppressive therapy are risk factors for severe disease. The clinical course is often difficult to predict, and clinical signs are unreliable. Accurate prognostic viral and immune markers, which have become part of the standard of care for systemic viral infections, are currently lacking; and management of CRV infections remains controversial. Defining effective prophylactic and therapeutic strategies is challenging, especially considering, the spectrum of immunocompromised patients, the variety of respiratory viruses, and the presence of other opportunistic infections and medical problems. Prevention remains one of the most important strategies against these viruses. Early diagnosis, supportive care and antivirals at an early stage, when available and indicated, have proven beneficial. However, with the exception of neuraminidase inhibitors for influenza infection, there are no accepted treatments. In high-risk patients, pre-emptive treatment with antivirals for upper respiratory tract infection (URTI) to decrease progression to LRTI is a common strategy. In the future, viral load and immune markers may prove beneficial in predicting severe disease, supporting decision making and monitor treatment in this population.
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Affiliation(s)
- Diego R. Hijano
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Randall T. Hayden
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, United States
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42
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Waghmare A, Xie H, Kuypers J, Sorror ML, Jerome KR, Englund JA, Boeckh M, Leisenring WM. Human Rhinovirus Infections in Hematopoietic Cell Transplant Recipients: Risk Score for Progression to Lower Respiratory Tract Infection. Biol Blood Marrow Transplant 2018; 25:1011-1021. [PMID: 30537551 PMCID: PMC6511300 DOI: 10.1016/j.bbmt.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022]
Abstract
Risk factors for rhinovirus lower respiratory tract infection are not well characterized. Several risk factors in hematopoietic cell transplant recipients were identified. A risk score for progression to lower respiratory tract infection was developed.
Human rhinovirus lower respiratory tract infection (LRTI) is associated with mortality after hematopoietic cell transplantation (HCT); however, risk factors for LRTI are not well characterized. We sought to develop a risk score for progression to LRTI from upper respiratory tract infection (URTI) in HCT recipients. Risk factors for LRTI within 90 days were analyzed using Cox regression among HCT recipients with rhinovirus URTI between January 2009 and March 2016. The final multivariable model included factors with a meaningful effect on the bootstrapped optimism corrected concordance statistic. Weighted score contributions based on hazard ratios were determined. Cumulative incidence curves estimated the probability of LRTI at various score cut-offs. Of 588 rhinovirus URTI events, 100 (17%) progressed to LRTI. In a final multivariable model allogeneic grafts, prior rhinovirus URTI, low lymphocyte count, low albumin, positive cytomegalovirus serostatus, recipient statin use, and steroid use ≥2 mg/kg/day were associated with progression to LRTI. A weighted risk score cut-off with the highest sensitivity and specificity was determined. Risk scores above this cut-off were associated with progression to LRTI (cumulative incidence 28% versus 11% below cut-off; P < .001). The weighted risk score for progression to rhinovirus LRTI can help identify and stratify patients for clinical management and for future clinical trials of therapeutics in HCT recipients.
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Affiliation(s)
- Alpana Waghmare
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, Seattle, WA.
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Mohamed L Sorror
- Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith R Jerome
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Michael Boeckh
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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43
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Versluys AB, Boelens JJ. Morbidity and Mortality Associated With Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplant: Too Little Defense or Harmful Immunity? Front Microbiol 2018; 9:2795. [PMID: 30519222 PMCID: PMC6258814 DOI: 10.3389/fmicb.2018.02795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022] Open
Abstract
The impact on morbidity and mortality of Community Acquired Respiratory Virus (CARV) infections in patients undergoing Allogeneic Hematopoietic Cell Transplant (HCT) is widely studied. Here we give an overview of the current literature on the incidence and chance of progression to severe disease in this highly immune compromised population. We discuss the issue whether it is predominantly direct viral damage that causes clinical deterioration, or that it is in fact the allogeneic immuneresponse to the virus that is most important. This is an important question as it will guide therapeutic decision making. It asks for further collaborative studies focusing on sensitive surveillance with PCR techniques and relating clinical data with parameters of immune reconstitution.
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Affiliation(s)
- Anne Birgitta Versluys
- Blood and Marrow Transplantation Program, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jaap Jan Boelens
- Stem Cell Transplant and Cellular Therapies Program, Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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44
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Mirra V, Ullmann N, Cherchi C, Onofri A, Paglietti MG, Cutrera R. Respiratory syncytial virus prophylaxis and the "special population". Minerva Pediatr 2018; 70:589-599. [PMID: 30334623 DOI: 10.23736/s0026-4946.18.05316-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bronchiolitis is the most frequent airway infection in the first 2 years of life, and the respiratory syncytial virus (RSV) is the most frequently responsible virus. In selected high-risk groups, RSV may cause severe respiratory disease leading to hospitalization, need for mechanical ventilation, and even death. These high-risk groups include children with congenital heart disease, infants with neuromuscular impairment, cystic fibrosis, Down Syndrome, immunodeficiency syndromes and others specific conditions. In these high-risk populations defined in literature as "special population", a 3- to 10-fold increase in the rate of RSV hospitalization has been observed, justifying RSV specific prophylaxis with palivizumab, a monoclonal antibody that binds a viral glycoprotein epitope and blocks the link between RSV and target cell. Evidence of safety and efficacy of RSV prophylaxis in these populations is lacking. Given the low incidence of these conditions, randomized clinical trials are not feasible. The purpose of this paper is to give an update from the literature of various conditions at higher risk to develop severe RSV infection, and to offer an overview of the efficacy of palivizumab in preventing RSV infection in these specific populations.
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Affiliation(s)
- Virginia Mirra
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Nicola Ullmann
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy - .,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Claudio Cherchi
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Alessandro Onofri
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Maria G Paglietti
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Renato Cutrera
- Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy.,Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
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45
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Danziger-Isakov L, Steinbach WJ, Paulsen G, Munoz FM, Sweet LR, Green M, Michaels MG, Englund JA, Murray A, Halasa N, Dulek DE, Madan RP, Herold BC, Fisher BT. A Multicenter Consortium to Define the Epidemiology and Outcomes of Pediatric Solid Organ Transplant Recipients With Inpatient Respiratory Virus Infection. J Pediatric Infect Dis Soc 2018. [PMID: 29538674 PMCID: PMC7107524 DOI: 10.1093/jpids/piy024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear. METHODS A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant. An RVI diagnosis required respiratory symptoms and detection of a virus (ie, human rhinovirus/enterovirus, human metapneumovirus, influenza virus, parainfluenza virus, coronavirus, and/or respiratory syncytial virus). The incidence of RVI was calculated, and the association of baseline SOT factors with subsequent pulmonary complications and death was assessed. RESULTS Of 1096 pediatric SOT recipients (448 liver, 289 kidney, 251 heart, 66 lung, 42 intestine/multivisceral), 159 (14.5%) developed RVI associated with hospitalization within 12 months after their transplant. RVI occurred at the highest rates in intestine/abdominal multivisceral (38%), thoracic (heart/lung) (18.6%), and liver (15.6%) transplant recipients and a lower rate in kidney (5.5%) transplant recipients. RVI was associated with younger median age at transplant (1.72 vs 7.89 years; P < .001) and among liver or kidney transplant recipients with the receipt of a deceased-donor graft compared to a living donor (P = .01). The all-cause and attributable case-fatality rates within 3 months of RVI onset were 4% and 0%, respectively. Multivariable logistic regression models revealed that age was independently associated with increased risk for a pulmonary complication (odds ratio, 1.24 [95% confidence interval, 1.02-1.51]) and that receipt of an intestine/multivisceral transplant was associated with increased risk of all-cause death (odds ratio, 24.54 [95% confidence interval, 1.69-327.96]). CONCLUSIONS In this study, hospital-associated RVI was common in the first year after pediatric SOT and associated with younger age at transplant. All-cause death after RVI was rare, and no definitive attributable death occurred.
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Affiliation(s)
- Lara Danziger-Isakov
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Ohio,Correspondence: L. Danziger-Isakov, MD, MPH, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7017, Cincinnati, OH 45236 ()
| | - William J Steinbach
- Departments of Pediatrics and Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
| | - Grant Paulsen
- Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Ohio
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Leigh R Sweet
- Department of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Michael Green
- Division of Infectious Diseases, Children’s Hospital of Pittsburgh of UPMC, and Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pennsylvania
| | - Marian G Michaels
- Division of Infectious Diseases, Children’s Hospital of Pittsburgh of UPMC, and Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pennsylvania
| | - Janet A Englund
- Seattle Children’s Research Institute, Seattle Children’s Hospital, and University of Washington
| | - Alastair Murray
- Seattle Children’s Research Institute, Seattle Children’s Hospital, and University of Washington
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel E Dulek
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Pellett Madan
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, New York
| | - Betsy C Herold
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, New York
| | - Brian T Fisher
- Division of Infectious Diseases, Department of Pediatrics, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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