Clinical Outcomes in Outpatient Respiratory Syncytial Virus Infection in Immunocompromised Children

Overview

Journal Influenza Other Respir Viruses

Publisher Wiley

Specialty Microbiology

Date 2016 Feb 10

PMID 26859306

Citations 14

Authors

Helen Y Chu

Jennifer Chin

Jessica Pollard

Danielle M Zerr

Janet A Englund

Affiliations

Soon will be listed here.

Abstract

Background: Immunocompromised patients are at high risk for morbidity and mortality due to respiratory syncytial virus (RSV) infection. Increasingly, pediatric patients with malignancy or undergoing transplantation are managed primarily as outpatients. Data regarding the clinical presentation and outcomes of RSV in the outpatient pediatric immunocompromised population are limited.

Methods: We performed a retrospective cohort study of children with hematologic malignancy or hematopoietic or solid organ transplant with laboratory-confirmed RSV infection diagnosed as outpatients at an academic medical center between 2008 and 2013.

Results: Of 54 patients with RSV detected while outpatients, 15 (28%) were hospitalized, 7 (13%) received ribavirin, and one (2%) received intravenous immunoglobulin. One (2%) patient was critically ill, but there were no deaths due to RSV infection. Fever (P < 0·01) was associated with increased risk of hospitalization.

Conclusions: Most immunocompromised children with RSV detected while outpatients did not require hospitalization or receive antiviral treatment. Potential studies of RSV therapies should consider inclusion of patients in an ambulatory setting.

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References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Shah J, Chemaly R . Management of RSV infections in adult recipients of hematopoietic stem cell transplantation. Blood. 2010; 117(10):2755-63. DOI: 10.1182/blood-2010-08-263400. View

Mazzulli T, Peret T, McGeer A, Cann D, Macdonald K, Chua R . Molecular characterization of a nosocomial outbreak of human respiratory syncytial virus on an adult leukemia/lymphoma ward. J Infect Dis. 1999; 180(5):1686-9. DOI: 10.1086/315085. View

Sicre de Fontbrune F, Robin M, Porcher R, Scieux C, Peffault de Latour R, Ferry C . Palivizumab treatment of respiratory syncytial virus infection after allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2007; 45(8):1019-24. DOI: 10.1086/521912. View

Englund J, Sullivan C, Jordan M, Dehner L, Vercellotti G, Balfour Jr H . Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med. 1988; 109(3):203-8. DOI: 10.7326/0003-4819-109-3-203. View

Blanchard S, Gerrek M, Siegel C, Czinn S . Significant morbidity associated with RSV infection in immunosuppressed children following liver transplantation: case report and discussion regarding need of routine prophylaxis. Pediatr Transplant. 2006; 10(7):826-9. DOI: 10.1111/j.1399-3046.2006.00583.x. View

Zhou H, Thompson W, Viboud C, Ringholz C, Cheng P, Steiner C . Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis. 2012; 54(10):1427-36. PMC: 3334364. DOI: 10.1093/cid/cis211. View

Asner S, Stephens D, Pedulla P, Richardson S, Robinson J, Allen U . Risk factors and outcomes for respiratory syncytial virus-related infections in immunocompromised children. Pediatr Infect Dis J. 2013; 32(10):1073-6. DOI: 10.1097/INF.0b013e31829dff4d. View

Kuypers J, Wright N, Morrow R . Evaluation of quantitative and type-specific real-time RT-PCR assays for detection of respiratory syncytial virus in respiratory specimens from children. J Clin Virol. 2004; 31(2):123-9. PMC: 7128826. DOI: 10.1016/j.jcv.2004.03.018. View

10.

El Saleeby C, Somes G, DeVincenzo J, Gaur A . Risk factors for severe respiratory syncytial virus disease in children with cancer: the importance of lymphopenia and young age. Pediatrics. 2008; 121(2):235-43. DOI: 10.1542/peds.2007-1102. View

11.

DeVincenzo J, Whitley R, Mackman R, Scaglioni-Weinlich C, Harrison L, Farrell E . Oral GS-5806 activity in a respiratory syncytial virus challenge study. N Engl J Med. 2014; 371(8):711-22. DOI: 10.1056/NEJMoa1401184. View

12.

Shah D, Ghantoji S, Shah J, El Taoum K, Jiang Y, Popat U . Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections. J Antimicrob Chemother. 2013; 68(8):1872-80. PMC: 6296322. DOI: 10.1093/jac/dkt111. View

13.

Hall C, Weinberg G, Iwane M, Blumkin A, Edwards K, Staat M . The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009; 360(6):588-98. PMC: 4829966. DOI: 10.1056/NEJMoa0804877. View

14.

Thompson W, Shay D, Weintraub E, Brammer L, Cox N, Anderson L . Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003; 289(2):179-86. DOI: 10.1001/jama.289.2.179. View

15.

Chu H, Chin J, Pollard J, Zerr D, Englund J . Clinical outcomes in outpatient respiratory syncytial virus infection in immunocompromised children. Influenza Other Respir Viruses. 2016; 10(3):205-10. PMC: 4814860. DOI: 10.1111/irv.12375. View

16.

DeVincenzo J, McClure M, Symons J, Fathi H, Westland C, Chanda S . Activity of Oral ALS-008176 in a Respiratory Syncytial Virus Challenge Study. N Engl J Med. 2015; 373(21):2048-58. DOI: 10.1056/NEJMoa1413275. View

17.

Tran T, Gonzalez I, Tekin A, McLaughlin G . Lower respiratory tract viral infections in pediatric abdominal organ transplant recipients: a single hospital inpatient cohort study. Pediatr Transplant. 2013; 17(5):461-5. PMC: 7159153. DOI: 10.1111/petr.12093. View

18.

Lerret S, Mavis A, Biank V, Telega G . Respiratory syncytial virus and pediatric liver transplant: one center's experience. Prog Transplant. 2013; 23(3):253-7. DOI: 10.7182/pit2013446. View

19.

Chu H, Englund J, Podczervinski S, Kuypers J, Campbell A, Boeckh M . Nosocomial transmission of respiratory syncytial virus in an outpatient cancer center. Biol Blood Marrow Transplant. 2014; 20(6):844-51. PMC: 4036533. DOI: 10.1016/j.bbmt.2014.02.024. View

20.

. Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial virus immune globulin prophylaxis. The PREVENT Study Group. Pediatrics. 1997; 99(1):93-9. DOI: 10.1542/peds.99.1.93. View