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Parainfluenza virus respiratory infection after bone marrow transplantation
C H Wendt1, D J Weisdorf, M C Jordan
1Department of Internal Medicine, University of Minnesota Medical School, Minneapolis.
Background:
Pneumonia complicates about half of all bone marrow transplantations, and in about a third of the cases no specific cause is identified. Although parainfluenza virus is a common cause of respiratory infection in normal children, its role in transplant recipients is unknown.
Methods:
We describe the incidence and clinical course of parainfluenza infection among the 1253 recipients of bone marrow transplants at our center from 1974 through 1990. We performed viral cultures on all such recipients who had manifestations of a viral infection or fever without apparent cause.
Results:
Among the 1253 patients, we found 27 (2.2 percent) who had parainfluenza virus infection as demonstrated by culture (12 of 580 adults and 15 of 673 children). Eight of these patients had only upper respiratory tract involvement, all of whom had positive nasopharyngeal cultures. Of the remaining 19, 8 had symptoms of both upper and lower respiratory tract involvement, and 11 had only lower respiratory involvement, of whom only 6 had positive nasopharyngeal cultures. Four required bronchoalveolar lavage for diagnosis. A median of nine days elapsed from the onset of symptoms until the culture became positive, and overall only 33 of 118 cultures obtained were positive. Respiratory failure developed in 6 of the 19 patients with lower respiratory tract involvement, and all died.
Conclusions:
Parainfluenza virus is a cause of serious lower respiratory tract involvement in both adults and children who undergo bone marrow transplantation. Given the insensitivity of current culturing techniques, it may be underdiagnosed.
Insights
Parainfluenza virus causes severe respiratory illness in bone marrow transplant patients. Diagnosis is challenging due to insensitive culturing methods, suggesting it may be underdiagnosed.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Virology
Background:
- Pneumonia affects approximately 50% of bone marrow transplant recipients, with an unidentified cause in one-third.
- The role of parainfluenza virus, a common respiratory pathogen in children, in transplant recipients was previously unknown.
Observation:
- A study reviewed 1253 bone marrow transplant recipients from 1974-1990 to assess parainfluenza virus infection.
- Viral cultures were performed on patients with viral infection symptoms or unexplained fever.
Findings:
- Parainfluenza virus infection was identified in 2.2% (27/1253) of transplant recipients.
- Lower respiratory tract involvement occurred in 19 patients, with 6 developing respiratory failure and all succumbing.
- Culture positivity was low (33/118), with a median delay of nine days from symptom onset.
Implications:
- Parainfluenza virus is a significant cause of severe lower respiratory tract disease in bone marrow transplant recipients.
- Current diagnostic culturing techniques are insensitive, potentially leading to underdiagnosis of parainfluenza virus infections.