title: Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders.
abstract: Respiratory viruses are a cause of upper respiratory tract infections (URTI), but can be associated with severe lower respiratory tract infections (LRTI) in immunocompromised patients. The objective of this study was to investigate the genetic variability of influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) and the duration of viral shedding in hematological patients. Nasopharyngeal swabs from hematological patients were screened for influenza, parainfluenza and RSV on admission as well as on development of respiratory symptoms. Consecutive swabs were collected until viral clearance. Out of 672 tested patients, a total of 111 patients (17%) were infected with one of the investigated viral agents: 40 with influenza, 13 with parainfluenza and 64 with RSV; six patients had influenza/RSV or parainfluenza/RSV co-infections. The majority of infected patients (n = 75/111) underwent stem cell transplantation (42 autologous, 48 allogeneic, 15 autologous and allogeneic). LRTI was observed in 48 patients, of whom 15 patients developed severe LRTI, and 13 patients with respiratory tract infection died. Phylogenetic analysis revealed a variety of influenza A(H1N1)pdm09, A(H3N2), influenza B, parainfluenza 3 and RSV A, B viruses. RSV A was detected in 54 patients, RSV B in ten patients. The newly emerging RSV A genotype ON1 predominated in the study cohort and was found in 48 (75%) of 64 RSV-infected patients. Furthermore, two distinct clusters were detected for RSV A genotype ON1, identical RSV G gene sequences in these patients are consistent with nosocomial transmission. Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation (p = 0.01) and was most pronounced in patients with RSV infection (n = 16) with a median duration of viral shedding for 80 days (range 35-334 days). Long-term shedding of respiratory viruses might be a catalyzer of nosocomial transmission and must be considered for efficient infection control in immunocompromised patients.
authors: Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
authors: Nicola
authors: N
authors: Lehners
authors: Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
authors: Julia
authors: J
authors: Tabatabai
authors: Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany.
authors: Christiane
authors: C
authors: Prifert
authors: National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.
authors: Marianne
authors: M
authors: Wedde
authors: Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
authors: Joe
authors: J
authors: Puthenparambil
authors: Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany.
authors: Benedikt
authors: B
authors: Weissbrich
authors: National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.
authors: Barbara
authors: B
authors: Biere
authors: National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany.
authors: Brunhilde
authors: B
authors: Schweiger
authors: Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
authors: Gerlinde
authors: G
authors: Egerer
authors: Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
authors: Paul
authors: P
authors: Schnitzler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003140:Communicable Disease Control; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology*; D005260:Female; D005838:Genotype; D006402:Hematologic Diseases / Q000821:virology*; D006801:Humans; D007251:Influenza, Human / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009666:Nose / Q000821:virology; D009975:Orthomyxoviridae / Q000378:metabolism; D010224:Parainfluenza Virus 3, Human / Q000378:metabolism; D018184:Paramyxoviridae Infections / Q000821:virology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000378:metabolism; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D013997:Time Factors; D014184:Transplantation, Homologous; D017201:Virus Shedding; D055815:Young Adult