Outline

  • Abstract
  • Clinical Syndromes
  • Clinical Diagnosis
  • Risk Factors for Progression to Lrti and Death
  • Management of Respiratory Viral Infections
  • Summary
  • Supplementary Data
  • Notes
  • References

رئوس مطالب

  • چکیده
  • کلید واژه ها
  • مقدمه
  • علائم بالینی
  • تشخیص بالینی
  • عوامل خطرساز پیشرفت بیماری به سوی عفونت‌های مجاری تنفسی تحتانی (LRTI) و مرگ
  • مدیریت عفونت‌های تنفسی ویروسی
  • ویروس آنفلوانزا
  • استراتژی‌های پیشگیرانه
  • خلاصه

Abstract

Despite preventive strategies and increased awareness, a high incidence of respiratory viral infections still occur in patients with hematologic malignancies (HMs) and in recipients of hematopoietic cell transplant (HCT). Progression of these viral infections to lower respiratory tract may prove fatal, especially in HCT recipients. Increasing evidence on the successful use of ribavirin (alone or in combination with immunomodulators) for the treatment of respiratory syncytial virus infections in HM patients and HCT recipients is available from retrospective studies; however, prospective clinical trials are necessary to establish its efficacy with confidence. The impact on progression to pneumonitis and/or mortality of treating parainfluenza virus infections with available (ribavirin) or investigational (DAS181) antiviral agents still needs to be determined. Influenza infections have been successfully treated with neuraminidase inhibitors (oseltamivir or zanamivir); however, the efficacy of these agents for influenza pneumonia has not been established, and immunocompromised patients are highly susceptible to emergence of antiviral drug resistance, most probably due to prolonged viral shedding. Infection control measures and an appreciation of the complications following respiratory viral infections in immunocompromised patients remain crucial for reducing transmission. Future studies should focus on strategies to identify patients at high risk for increased morbidity and mortality from these infections and to determine the efficacy of novel or available antiviral drugs.

Keywords: - - - -

SUMMARY

High incidence of respiratory viral infection along with resulting LRTI and mortality continues to be a major clinical problem in patients with HM and HCT recipients. Lack of directed antiviral therapy and vaccination against most of these viruses makes the matters worse. In the absence of randomized clinical trials, it is crucial to identify high-risk patients within this patient population who may benefit the most from preemptive antiviral therapy. Novel antiviral agents and potent vaccines are needed to prevent outbreaks and epidemics in the community. In addition, data are needed to describe the epidemiology, risk factors, and outcome characteristics of respiratory viruses that are now routinely detected by multiplex PCR assays, such as coronaviruses and human rhinoviruses. Infection control and awareness among healthcare workers and patients alike remain the mainstays for reducing the burden of these viral infections.

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