A parainfluenza-3 outbreak in a SCT unit: sepsis with multi-organ failure and multiple co-pathogens are associated with increased mortality.
The estimated frequency of parainfluenza virus 3 (PIV-3) infections following haematopoietic SCT (HSCT) is 2-7%, whereas reported mortality ranges from 18 to 33%. We report a retrospective outcome analysis following an outbreak of PIV-3 infection in our transplant unit. A total of 16 HSCT patients developed PIV-3 infection. All patients had upper respiratory tract infection, whereas lower respiratory tract infection occurred in 8 patients. Overall, 13 patients were treated with aerosolised Ribavirin (2 g t.d.s. for 5 days) and i.v. Ig (0.5 g/kg) as per standard protocol. One patient refused treatment, whereas two patients with full immune reconstitution were not treated. Overall mortality was 62.5%. Sepsis with multi-organ failure and the presence of pulmonary co-pathogens were both significantly associated with PIV-3-related mortality. Our series confirms that high mortality is associated with PIV-3 infection in HSCT recipients. In patients who develop PIV-3 infection, despite strict enforcement of infection control policies, the best strategy might be careful risk assessment, with effective broad-spectrum anti-microbials in those who are at risk of secondary infection.
Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
A
A
Hodson
M
M
Kasliwal
M
M
Streetly
E
E
MacMahon
K
K
Raj
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D004196:Disease Outbreaks; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D010224:Parainfluenza Virus 3, Human; D010253:Respirovirus Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D012254:Ribavirin / Q000008:administration & dosage; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D012254:Ribavirin
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