title: The natural history of influenza infection in the severely immunocompromised vs nonimmunocompromised hosts.
abstract: BACKGROUND
  Medical advances have led to an increase in the world's population of immunosuppressed individuals. The most severely immunocompromised patients are those who have been diagnosed with a hematologic malignancy, solid organ tumor, or who have other conditions that require immunosuppressive therapies and/or solid organ or stem cell transplants.
  
  
  METHODS
  Medically attended patients with a positive clinical diagnosis of influenza were recruited prospectively and clinically evaluated. Nasal washes and serum were collected. Evaluation of viral shedding, nasal and serum cytokines, clinical illness, and clinical outcomes were performed to compare severely immunocompromised individuals to nonimmunocompromised individuals with influenza infection.
  
  
  RESULTS
  Immunocompromised patients with influenza had more severe disease/complications, longer viral shedding, and more antiviral resistance while demonstrating less clinical symptoms and signs on clinical assessment.
  
  
  CONCLUSIONS
  Immunocompromised patients are at risk for more severe or complicated influenza induced disease, which may be difficult to prevent with existing vaccines and antiviral treatments. Specific issues to consider when managing a severely immunocompromised host include the development of asymptomatic shedding, multi-drug resistance during prolonged antiviral therapy, and the potential high risk of pulmonary involvement.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT00533182.
authors.affiliation: Laboratory of Infectious Diseases, Viral Pathogenesis and Evolution Section.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Memoli
authors.forename: Rani
authors.initials: R
authors.lastname: Athota
authors.forename: Susan
authors.initials: S
authors.lastname: Reed
authors.forename: Lindsay
authors.initials: L
authors.lastname: Czajkowski
authors.forename: Tyler
authors.initials: T
authors.lastname: Bristol
authors.forename: Kathleen
authors.initials: K
authors.lastname: Proudfoot
authors.forename: Rachel
authors.initials: R
authors.lastname: Hagey
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Voell
authors.forename: Charles
authors.initials: C
authors.lastname: Fiorentino
authors.forename: Angela
authors.initials: A
authors.lastname: Ademposi
authors.forename: Shmuel
authors.initials: S
authors.lastname: Shoham
authors.forename: Jeffery K
authors.initials: JK
authors.lastname: Taubenberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016207:Cytokines / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007251:Influenza, Human / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000276:immunology; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D044967:Serum / Q000276:immunology; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D016207:Cytokines
keywords: immunocompromised host; influenza; influenza A; stem cell transplant