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[Severe respiratory syncytial virus pneumonia following bone marrow autograft. 3 cases]
L Mouthon1, L Fouillard, J P Laporte
1Unité de Transplantation médulaire, Hôpital Saint-Antoine, Parix.
Abstract:
Three patients developed severe respiratory syncytial virus pneumonia after bone marrow autograft for acute leukaemia. Clinically, the disease presents as interstitial or bilateral alveolo-interstitial pneumonia with hypoxaemia. Signs of ENT infection (otitis media, sinusitis) are present in 30 percent of the cases. In all 3 patients, the syncytial virus was isolated by direct immunofluorescence in bronchoalveolar lavage fluid. In 2 patients the infection began soon after the autograft, in deeply aplastic subjects, and required intubation and assisted ventilation. These 2 patients died despite inhalation of aerosolized ribavirin combined, in one of them, with ribavirin injections. In the third patient the infection began some time after the autograft and responded well to ribavirin in aerosols. In these three cases the viral infection occurred in an epidemic and nosocomial context. The respiratory syncytial virus is usually transmitted by the hands. Owing to the severity of this infection with lung involvement in immunodepressed patients, specific prophylactic measures should be taken side by side with the conventional measures.
Insights
Severe respiratory syncytial virus pneumonia can occur after bone marrow transplants. This serious infection, often nosocomial, requires specific prophylactic measures in immunocompromised patients.
Area of Science:
- Medicine
- Virology
- Hematology
Background:
- Bone marrow autografting is a critical treatment for acute leukemia.
- Immunocompromised patients are highly susceptible to opportunistic infections.
- Respiratory Syncytial Virus (RSV) poses a significant threat in healthcare settings.
Observation:
- Three patients developed severe pneumonia following autologous bone marrow transplantation for acute leukemia.
- Clinical presentation included interstitial or bilateral alveolo-interstitial pneumonia with hypoxemia.
- Ear, nose, and throat infections were noted in 30% of cases.
Findings:
- Respiratory syncytial virus was identified in bronchoalveolar lavage fluid via direct immunofluorescence in all three patients.
- Two patients experienced rapid onset of infection post-transplant, requiring mechanical ventilation and resulting in mortality despite ribavirin treatment.
- One patient with later onset infection responded favorably to aerosolized ribavirin.
Implications:
- RSV infection can be severe and fatal in immunocompromised patients undergoing bone marrow transplantation.
- Nosocomial transmission, particularly hand-borne, is a likely route for RSV in these settings.
- Enhanced prophylactic strategies, alongside standard measures, are crucial to prevent RSV pneumonia in transplant recipients.