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An outbreak of respiratory syncytial virus in a bone marrow transplant center
R D Harrington1, T M Hooton, R C Hackman
1Department of Medicine, University of Washington School of Medicine, Seattle.
Abstract:
An outbreak of respiratory syncytial virus (RSV) infection occurred among 31 patients in a marrow transplant center over a 13-week period beginning in January 1990. RSV infection was also documented in 35 family members and employees. Of 18 patients with pneumonia, 14 (78%) died. None of 13 with upper respiratory infection died. Preengraftment patients tended to develop pneumonia more frequently than did engrafted patients. Early administration of ribavirin may have had a beneficial effect in patients with pneumonia. Antigenic and genomic analysis of 14 available isolates suggested that at least four different viral strains were responsible for the outbreak. One group of patients and 1 employee in spatial proximity were infected with the same strain and likely acquired their infections nosocomially. RSV infection in marrow transplant patients is a serious and life-threatening infection with a high mortality rate once pneumonia develops.
Insights
Respiratory syncytial virus (RSV) outbreaks in marrow transplant patients are life-threatening, particularly when pneumonia develops. Early ribavirin treatment may improve outcomes for these immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Hematology
- Virology
Background:
- Marrow transplant recipients are highly susceptible to severe infections.
- Respiratory Syncytial Virus (RSV) poses a significant threat to immunocompromised populations.
- Nosocomial transmission of RSV can lead to devastating outbreaks in healthcare settings.
Purpose of the Study:
- To investigate an outbreak of RSV infection in a marrow transplant center.
- To determine the clinical outcomes and risk factors associated with RSV infection in this vulnerable patient group.
- To analyze the viral strains involved and identify potential transmission routes.
Main Methods:
- Retrospective analysis of patient records during a 13-week RSV outbreak.
- Clinical data collection on symptoms, pneumonia development, and mortality.
- Antigenic and genomic analysis of RSV isolates.
- Epidemiological investigation of patient and staff infections.
Main Results:
- 31 marrow transplant patients and 35 family members/employees were infected.
- A high mortality rate (78%) was observed in patients who developed pneumonia.
- Preengraftment patients were more prone to developing pneumonia.
- Evidence suggested nosocomial transmission of specific RSV strains.
- Early ribavirin administration showed a potential beneficial effect in pneumonia cases.
Conclusions:
- RSV infection is a serious, life-threatening complication for marrow transplant patients.
- Pneumonia significantly increases mortality risk in this population.
- Control of nosocomial RSV transmission is critical in transplant centers.
- Further research into antiviral therapies like ribavirin is warranted.