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Parainfluenza virus type 3 infections in a hematology unit
U Hohenthal1, J Nikoskelainen, R Vainionpää
1Department of Medicine, Turku University Central Hospital, Finland.
Abstract:
Parainfluenza virus type 3 (PIV3) is associated with a high mortality rate in BMT recipients with lower respiratory tract infections. We describe nine patients with hematological malignancies (five having undergone either allogeneic or autologous stem cell transplantation) identified as having PIV3 infection during a 2-month period in a Hematology Unit. Four patients with infiltrates on chest radiograph received intravenous ribavirin therapy; all survived. The infection was community-acquired in two patients, while nosocomial origin of the disease was evident, or presumed, in the remaining seven. The policy implemented to control the spread of PIV3 was as follows: (1) nasopharyngeal samples for antigen detection were obtained from all patients presenting with respiratory symptoms; (2) all diagnosed (or suspected) PIV3-positive hematological patients were nursed following contact isolation precautions, preferably in the Infectious Diseases Unit; and (3) staff were given further education on hospital hygiene. Our experience shows that it may be possible to avoid mortality for PIV3 lower respiratory tract infection in immunocompromised patients by early commencement of intravenous ribavirin. It is also possible, even without closing the ward, to contain nosocomial spread of PIV3 by implementing systematic nasopharyngeal sampling for rapid diagnostics, and by strict adherence to cohorting and contact isolation precautions.
Insights
Early intravenous ribavirin therapy can prevent deaths from parainfluenza virus type 3 (PIV3) lower respiratory tract infections in immunocompromised patients. Strict isolation and rapid diagnostics help contain PIV3 spread in hematology units.
Area of Science:
- Medical Microbiology
- Hematology
- Infectious Diseases
Background:
- Parainfluenza virus type 3 (PIV3) poses a significant mortality risk for bone marrow transplant (BMT) recipients with lower respiratory tract infections.
- Hematological malignancies and stem cell transplantation increase patient vulnerability to severe PIV3 infections.
Purpose of the Study:
- To describe PIV3 infections in a hematology unit, focusing on outcomes and control measures.
- To evaluate the efficacy of intravenous ribavirin and infection control strategies for PIV3 in immunocompromised patients.
Main Methods:
- Retrospective case series of nine patients with hematological malignancies and PIV3 infection.
- Administration of intravenous ribavirin to four patients with pulmonary infiltrates.
- Implementation of infection control policies including rapid antigen detection, contact isolation, and staff education.
Main Results:
- All four patients treated with intravenous ribavirin survived.
- PIV3 infections were both community-acquired and nosocomially acquired.
- Implemented infection control measures, including isolation and rapid diagnostics, were effective in containing nosocomial spread.
Conclusions:
- Early initiation of intravenous ribavirin may be crucial for improving survival rates in immunocompromised patients with PIV3 lower respiratory tract infections.
- Systematic nasopharyngeal sampling, cohorting, and contact isolation are effective in controlling nosocomial PIV3 transmission within a hematology ward.