Community acquired respiratory virus infections in cancer patients-Guideline on diagnosis and management by the Infectious Diseases Working Party of the German Society for haematology and Medical Oncology.
Community acquired viruses (CRVs) may cause severe disease in cancer patients. Thus, efforts should be made to diagnose CRV rapidly and manage CRV infections accordingly.



A panel of 18 clinicians from the Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology have convened to assess the available literature and provide recommendations on the management of CRV infections including influenza, respiratory syncytial virus, parainfluenza virus, human metapneumovirus and adenovirus.



CRV infections in cancer patients may lead to pneumonia in approximately 30% of the cases, with an associated mortality of around 25%. For diagnosis of a CRV infection, combined nasal/throat swabs or washes/aspirates give the best results and nucleic acid amplification based-techniques (NAT) should be used to detect the pathogen. Hand hygiene, contact isolation and face masks have been shown to be of benefit as general infection management. Causal treatment can be given for influenza, using a neuraminidase inhibitor, and respiratory syncytial virus, using ribavirin in addition to intravenous immunoglobulins. Ribavirin has also been used to treat parainfluenza virus and human metapneumovirus, but data are inconclusive in this setting. Cidofovir is used to treat adenovirus pneumonitis.



CRV infections may pose a vital threat to patients with underlying malignancy. This guideline provides information on diagnosis and treatment to improve the outcome.
Department of Haematology and Medical Oncology, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care (CSCC), University Hospital Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institut, Jena, Germany. Electronic address: Marie.von_Lilienfeld-Toal@med.uni-jena.de.
Marie
M
von Lilienfeld-Toal
Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Germany.
Annemarie
A
Berger
Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Maximilian
M
Christopeit
Department of Haematology and Oncology, Red Cross Hospital, Munich, Germany.
Marcus
M
Hentrich
Department of Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
Claus Peter
CP
Heussel
Department of Haematology and Medical Oncology, Jena University Hospital, Jena, Germany.
Jana
J
Kalkreuth
Department I of Internal Medicine, Prosper-Hospital, Recklinghausen, Germany.
Michael
M
Klein
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
Matthias
M
Kochanek
Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany.
Olaf
O
Penack
Department III of Internal Medicine, The University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Elke
E
Hauf
Lehrpraxis der Ludwig-Maximilians-Universität München, Germering, Germany.
Christina
C
Rieger
Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
Gerda
G
Silling
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
Maria
M
Vehreschild
Department of Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Thomas
T
Weber
Department of Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Hans-Heinrich
HH
Wolf
Department of Haematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
Nicola
N
Lehners
Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Enrico
E
Schalk
Department of Haematology and Oncology, University Hospital Bonn, Bonn, Germany.
Karin
K
Mayer
D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005858:Germany; D063373:Hand Hygiene; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008168:Lung / Q000000981:diagnostic imaging; D008397:Masks; D008495:Medical Oncology; D029121:Metapneumovirus; D009369:Neoplasms / Q000453:epidemiology*; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D021141:Nucleic Acid Amplification Techniques; D063065:Organophosphonates / Q000627:therapeutic use; D053139:Oseltamivir / Q000627:therapeutic use; D018184:Paramyxoviridae Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010356:Patient Isolation; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012254:Ribavirin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D063065:Organophosphonates; D053139:Oseltamivir; D012254:Ribavirin; D003596:Cytosine; D009439:Neuraminidase; D000077404:Cidofovir
Influenza; Parainfluenza; Pneumonia; Respiratory syncytial virus; Superinfection; Upper respiratory tract infection
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