Symptomatic parainfluenza virus infections in children undergoing hematopoietic stem cell transplantation

Area of Science:

• Pediatric Hematology
• Infectious Diseases
• Transplantation Immunology

Background:

• Parainfluenza virus (PIV) infections pose a significant mortality risk in adults post-hematopoietic stem cell transplantation (HSCT).
• Limited data exist on PIV epidemiology and outcomes in pediatric HSCT recipients, despite children being more susceptible.
• This study addresses the knowledge gap regarding PIV infections in children undergoing HSCT.

Purpose of the Study:

• To determine the incidence of symptomatic PIV infections in pediatric HSCT patients.
• To identify risk factors for developing lower respiratory tract infection (LRTI) following PIV infection.
• To assess the impact of PIV infection on mortality in this vulnerable population.

Main Methods:

• Retrospective analysis of 1028 children undergoing HSCT between 1995 and 2009.
• Detection of PIV infections among patients tested for respiratory infections.
• Multivariate logistic regression to identify risk factors for PIV infection, LRTI, and mortality.

Main Results:

• PIV infection was detected in 6.2% of tested pediatric HSCT patients, making it the most common symptomatic viral respiratory infection.
• Allogeneic transplant and total body irradiation-based conditioning increased PIV infection risk.
• LRTI occurred in 39% of PIV-infected patients, associated with early post-HSCT infection, steroid use, and low absolute leukocyte count (ALC).
• Mortality (13%) was linked to African-American ethnicity, LRTI, steroid use, mechanical ventilation, and very low ALC (<100 cells/μL).

Conclusions:

• PIV infection is a significant cause of morbidity and mortality in children undergoing HSCT.
• Risk factors for PIV infection, LRTI, and mortality highlight the need for vigilant monitoring and management.
• Further research into prevention and treatment strategies for PIV in pediatric HSCT is warranted.