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Hirsch HH. Spatiotemporal Virus Surveillance for Severe Acute Respiratory Infections in Resource-limited Settings: How Deep Need We Go? Clin Infect Dis 2020; 68:1126-1128. [PMID: 30099498 PMCID: PMC7108180 DOI: 10.1093/cid/ciy663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hans H Hirsch
- Division of Infection Diagnostics, Department of Biomedicine, University of Basel, Switzerland.,Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
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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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Spahr Y, Tschudin-Sutter S, Baettig V, Compagno F, Tamm M, Halter J, Gerull S, Passweg J, Hirsch HH, Khanna N. Community-Acquired Respiratory Paramyxovirus Infection After Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience. Open Forum Infect Dis 2018; 5:ofy077. [PMID: 29780847 PMCID: PMC5952916 DOI: 10.1093/ofid/ofy077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background Paramyxoviruses include respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (MPV), which may cause significant respiratory tract infectious disease (RTID) and mortality after allogeneic hematopoietic cell transplantation (HCT). However, clinical data regarding frequency and outcome are scarce. Methods We identified all paramyxovirus RTIDs in allogeneic HCT recipients diagnosed by multiplex polymerase chain reaction between 2010 and 2014. Baseline characteristics of patients, treatment, and outcome of each episode were analyzed; ie, moderate, severe, and very severe immunodeficiency (verySID) according to HCT ≤6 months, T- or B-cell depletion ≤3 months, graft-versus-host disease, neutropenia, lymphopenia, or hypo-gammaglobulinemia. Results One hundred three RTID episodes in 66 patients were identified (PIV 47% [48 of 103], RSV 32% [33 of 103], MPV 21% [22 of 103]). Episodes occurred in 85% (87 of 103) at >100 days post-HCT. Lower RTID accounted for 36% (37 of 103). Thirty-nine percent (40 of 103) of RTID episodes required hospitalization and more frequently affected patients with lower RTID. Six percent progressed from upper to lower RTID. Overall mortality was 6% and did not differ between paramyxoviruses. Sixty-one percent (63 of 103) of episodes occurred in patients with SID, and 20.2% (19 of 63) of episodes occurred in patients with verySID. Oral ribavirin plus intravenous immunoglobulin was administered in 38% (39 of 103) of RTIDs, preferably for RSV or MPV (P ≤ .001) and for SID patients (P = .001). Patients with verySID frequently progressed to lower RTID (P = .075), required intensive care unit transfer, and showed higher mortality. Conclusion Paramyxovirus RTID remains a major concern in allogeneic HCT patients fulfilling SID and verySID, emphasizing that efficacious and safe antiviral treatments are urgently needed.
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Affiliation(s)
- Yasmin Spahr
- Department of Anesthesiology, Cantonal Hospital St. Gallen, Switzerland
- Infectious Diseases and Hospital Epidemiology, Switzerland
| | | | | | - Francesca Compagno
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Switzerland
| | - Michael Tamm
- Clinic of Pulmonary Medicine and Respiratory Cell Research, Switzerland
| | - Jörg Halter
- Hematology, University of Basel, Switzerland
| | | | | | - Hans H Hirsch
- Infectious Diseases and Hospital Epidemiology, Switzerland
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Switzerland
| | - Nina Khanna
- Infectious Diseases and Hospital Epidemiology, Switzerland
- Infection Biology, Department Biomedicine, University and University Hospital of Basel, Switzerland
- Correspondence: N. Khanna, MD, Infection Biology Laboratory and Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland ()
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Beckmann C, Hirsch HH. Comparing Luminex NxTAG-Respiratory Pathogen Panel and RespiFinder-22 for multiplex detection of respiratory pathogens. J Med Virol 2016; 88:1319-24. [PMID: 26856438 PMCID: PMC7166946 DOI: 10.1002/jmv.24492] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 11/09/2022]
Abstract
Respiratory tract infection (RTI) involves a variety of viruses and bacteria, which can be conveniently detected by multiplex nucleic acid amplification testing (NAT). To compare the novel Luminex-based NxTAG-Respiratory Pathogen Panel (NxTAG-RPP) with the routine multiplex-ligation-NAT based RespiFinder-22® (RF-22), 282 respiratory specimens including nasopharyngeal swabs (71%), broncho-alveolar lavage (27%), throat swabs, tracheal secretions, and sputum (2%) from 116 children and 155 adults were extracted using a Corbett CAS1200 (Qiagen), and analyzed in parallel by the routine RF-22 and NxTAG-RPP. Concordant results were obtained in 263 (93.3%) cases consisting of concordant positives in 167 (59.2%) and concordant negatives in 96 (34%). Results were discordant in 19 (6.7%) consisting of 15 positive:negative, and 4 negative:positive results by NxTAG-RPP versus RF-22, respectively. Co-infections were observed in 10.3% with NxTAG-RPP and in 5.9% with RF-22. Most additional viral pathogens identified by the NxTAG-RPP involved dual infections with rhinovirus and RSV. Discordant samples were mainly due to low genome signals of Ct less than 36, when retested by QNAT suggesting a higher sensitivity of the NxTAG-RPP, also when detecting multiple infections. Hands-on time after extraction for 24 and 96 samples was 0.25 and <0.5 hr for the NxTAG-RPP, and 2 and 4 hr for the RF-22, respectively. The median turn-around time was 6 hr (range 5-7 hr) for NxTAG-RPP and 12 hr (range 8-16 hr) for RF-22. The NxTAG-RPP showed comparable detection rates for most respiratory pathogens, while hands-on and turn-around time were considerably shorter. The clinical significance of detecting multiple viruses needs further clinical evaluation. J. Med. Virol. 88:1319-1324, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christiane Beckmann
- Division of Infection Diagnostics, Department of Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infection Diagnostics, Department of Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department of Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.,Infectious Disease and Hospital Epidemiology, University of Hospital Basel, Basel, Switzerland
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Beckmann C, Hirsch HH. Diagnostic performance of near-patient testing for influenza. J Clin Virol 2015; 67:43-6. [PMID: 25959157 PMCID: PMC7106417 DOI: 10.1016/j.jcv.2015.03.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/10/2015] [Accepted: 03/28/2015] [Indexed: 01/28/2023]
Abstract
Rapid isothermal NAT for influenza reveals improved sensitivity and specificity compared to direct antigen testing. Simple sample processing and short turn-around time render isothermal NAT suitable for sequential near-patient testing. The turn-around time advantage is lost by the single-test format precluding sample cohorting and testing of larger series.
Background Rapid diagnosis of influenza is important for controlling outbreaks and starting antiviral therapy. Direct antigen detection (DAD) is rapid, but lacks sensitivity, whereas nucleic acid amplification testing (NAT) is more sensitive, but also more time-consuming. Objectives To evaluate the performance of a rapid isothermal NAT and two DADs. Study design During February–May 2014, we tested 211 consecutive patients with influenza-like illness using a commercial isothermal NAT (Alere™ Influenza A&B) as well as the DAD Sofia® Influenza A + B and BinaxNOW® Influenza A&B for detection of influenza-A and -B virus. RespiFinder-22® a commercial multiplex NAT served as reference test. Serial 10-fold dilutions of influenza-A and -B cell culture supernatants were examined. Another 225 patient samples were tested during December 2014–February 2015. Results Compared to RespiFinder-22®, the isothermal NAT Alere™ Influenza A&B, and the DAD Sofia® Influenza A + B and BinaxNOW® Influenza A&B had sensitivities of 77.8%, 59.3% and 29.6%, and specificities of 99.5%, 98.9% and 100%, respectively, for the first 211 patient samples. Alere™ Influenza A&B showed 85.7% sensitivity and 100% specificity in the second cohort. Isothermal NAT was 10-100-fold more sensitive compared to DAD for influenza virus culture supernatants with a lower limit of detection of 5000–50,000 copies/mL. The average turn-around time (TAT) of isothermal NAT and DADs was 15 min, but increased to 110 min for Alere™ Influenza A&B, 30 min for BinaxNOW® Influenza A&B, and 45 min for Sofia® Influenza A + B, when analyzing batches of 6 samples. Conclusion Simple sample processing and a TAT of 15 min render isothermal NAT Alere™ Influenza A&B suitable for sequential near-patient testing, but the TAT advantage is lost when testing of larger series.
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Affiliation(s)
- Christiane Beckmann
- Division of Infection Diagnostics, Department Biomedicine (Haus Petersplatz), University of Basel, Switzerland
| | - Hans H Hirsch
- Division of Infection Diagnostics, Department Biomedicine (Haus Petersplatz), University of Basel, Switzerland; Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Switzerland; Infectious Disease & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Human metapneumovirus infection after allogeneic hematopoietic stem cell transplantation. Infection 2012; 40:677-84. [PMID: 22802096 PMCID: PMC7099999 DOI: 10.1007/s15010-012-0279-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 05/25/2012] [Indexed: 11/30/2022]
Abstract
Background The clinical characteristics of human metapneumovirus (hMPV)-associated lower respiratory tract infection (LRTI) after allogeneic hematopoietic stem cell transplantation (HSCT) is not well described. We describe the clinical course in eight HSCT recipients suffering from hMPV infection. Methods We prospectively included all patients with hMPV-associated LRTI after allogeneic HSCT during a period of 1 year. hMPV was diagnosed by multiplex polymerase chain reaction (PCR) from bronchoalveolar lavage (BAL). Results Eight patients with hMPV-associated LRTI were identified from 93 BAL samples. Three of the eight patients had co-infections with other pathogens. The median age of the patients was 45 years [interquartile range (IQR) 36.8–53.5], the median time posttransplant was 473 days (IQR 251–1,165), 5/8 patients had chronic graft-versus-host disease (cGvHD), and 6/8 patients received immunosuppression. Chest computed tomography (CT) scanning showed a ground-glass pattern in 7/8 patients. Seven of eight patients required hospitalization due to severe symptoms and hypoxemia. All were treated with intravenous immunoglobulin (IVIG), which was combined with oral ribavirin in six patients. The mortality rate was 12.5 % (1/8). Conclusions hMPV-associated LRTI in allogeneic HSCT recipients are not uncommon and present with unspecific respiratory symptoms, ground-glass pattern in CT scanning, and co-infection.
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Schnepf N, Resche-Rigon M, Chaillon A, Scemla A, Gras G, Semoun O, Taboulet P, Molina JM, Simon F, Goudeau A, LeGoff J. High burden of non-influenza viruses in influenza-like illness in the early weeks of H1N1v epidemic in France. PLoS One 2011; 6:e23514. [PMID: 21858150 PMCID: PMC3157400 DOI: 10.1371/journal.pone.0023514] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/19/2011] [Indexed: 11/18/2022] Open
Abstract
Background Influenza-like illness (ILI) may be caused by a variety of pathogens. Clinical observations are of little help to recognise myxovirus infection and implement appropriate prevention measures. The limited use of molecular tools underestimates the role of other common pathogens. Objectives During the early weeks of the 2009–2010 flu pandemic, a clinical and virological survey was conducted in adult and paediatric patients with ILI referred to two French University hospitals in Paris and Tours. Aims were to investigate the different pathogens involved in ILI and describe the associated symptoms. Methods H1N1v pandemic influenza diagnosis was performed with real time RT-PCR assay. Other viral aetiologies were investigated by the molecular multiplex assay RespiFinder19®. Clinical data were collected prospectively by physicians using a standard questionnaire. Results From week 35 to 44, endonasal swabs were collected in 413 patients. Overall, 68 samples (16.5%) were positive for H1N1v. In 13 of them, other respiratory pathogens were also detected. Among H1N1v negative samples, 213 (61.9%) were positive for various respiratory agents, 190 in single infections and 23 in mixed infections. The most prevalent viruses in H1N1v negative single infections were rhinovirus (62.6%), followed by parainfluenza viruses (24.2%) and adenovirus (5.3%). 70.6% of H1N1v cases were identified in patients under 40 years and none after 65 years. There was no difference between clinical symptoms observed in patients infected with H1N1v or with other pathogens. Conclusion Our results highlight the high frequency of non-influenza viruses involved in ILI during the pre-epidemic period of a flu alert and the lack of specific clinical signs associated with influenza infections. Rapid diagnostic screening of a large panel of respiratory pathogens may be critical to define and survey the epidemic situation and to provide critical information for patient management.
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Affiliation(s)
- Nathalie Schnepf
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Matthieu Resche-Rigon
- Université Paris Diderot, Sorbonne Paris Cité, Biostatistics Department, Saint-Louis Hospital, APHP, Paris, France
| | - Antoine Chaillon
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Anne Scemla
- Université Paris Diderot, Sorbonne Paris Cité, Infectious Diseases Department, Saint-Louis Hospital, APHP, Paris, France
| | - Guillaume Gras
- Internal Medicine and Infectious Diseases Departement, Bretonneau Hospital, CHRU Tours, France
| | - Oren Semoun
- Université Paris Diderot, Sorbonne Paris Cité, Biostatistics Department, Saint-Louis Hospital, APHP, Paris, France
| | - Pierre Taboulet
- Emergency Department, Saint-Louis Hospital, APHP, Paris, France
| | - Jean-Michel Molina
- Université Paris Diderot, Sorbonne Paris Cité, Infectious Diseases Department, Saint-Louis Hospital, APHP, Paris, France
| | - François Simon
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- Inserm U941, Institut Universitaire d'Hématologie, Paris, France
| | - Alain Goudeau
- François Rabelais University, Microbiology Department, Bretonneau Hospital, CHRU Tours, France
| | - Jérôme LeGoff
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
- Inserm U941, Institut Universitaire d'Hématologie, Paris, France
- * E-mail:
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Piso RJ, Albrecht Y, Handschin P, Bassetti S. Low transmission rate of 2009 H1N1 Influenza during a long-distance bus trip. Infection 2011; 39:149-53. [PMID: 21340580 PMCID: PMC7099280 DOI: 10.1007/s15010-011-0084-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/20/2011] [Indexed: 11/27/2022]
Abstract
Background Current data on the risk of transmission of 2009 H1N1 Influenza in public transportation systems (e.g., public trains, busses, airplanes) are conflicting. The main transmission route of this virus is thought to be via droplets, but airborne transmission has not been completely ruled out. Methods This is a contact tracing investigation of a young woman subsequently diagnosed with the 2009 H1N1 Influenza virus who was symptomatic during a long-distance bus trip from Spain to Switzerland. Fever and cough had begun 24 h earlier, 2 h before she stepped onto a bus for a long-distance trip. After the 2009 H1N1 virus had been confirmed in the patient, the other bus travellers were contacted by telephone on day 7 and 10 after the bus trip. Results Of the 72 individuals travelling on the bus with the H1N1-infected young woman, 52 (72%) could be contacted. Only one of these 52 developed fever, with onset of symptoms 3 days after the bus trip, and rRT-PCR analysis of the nasopharyngeal swab showed the infection to be caused by the 2009 H1N1 virus. One other person complained of coughing 1 day after the bus trip, but without fever, and no further investigation was carried out. All other passengers remained without fever, coughing, or arthralgia. The risk of transmission was calculated as 1.96% (95% confidence interval 0–5.76%). Conclusion The transmission rate of 2009 H1N1 Influenza was low on a long-distance bus trip. Electronic supplementary material The online version of this article (doi:10.1007/s15010-011-0084-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R J Piso
- Medizinische Klinik, Kantonsspital, 4500, Olten, Switzerland.
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