Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Microbial Issues

A parainfluenza-3 outbreak in a SCT unit: sepsis with multi-organ failure and multiple co-pathogens are associated with increased mortality

Bone Marrow Transplantation volume 46, pages 1545–1550 (2011)Cite this article

Subjects

Abstract

The estimated frequency of parainfluenza virus 3 (PIV-3) infections following haematopoietic SCT (HSCT) is 2–7%, whereas reported mortality ranges from 18 to 33%. We report a retrospective outcome analysis following an outbreak of PIV-3 infection in our transplant unit. A total of 16 HSCT patients developed PIV-3 infection. All patients had upper respiratory tract infection, whereas lower respiratory tract infection occurred in 8 patients. Overall, 13 patients were treated with aerosolised Ribavirin (2 g t.d.s. for 5 days) and i.v. Ig (0.5 g/kg) as per standard protocol. One patient refused treatment, whereas two patients with full immune reconstitution were not treated. Overall mortality was 62.5%. Sepsis with multi-organ failure and the presence of pulmonary co-pathogens were both significantly associated with PIV-3-related mortality. Our series confirms that high mortality is associated with PIV-3 infection in HSCT recipients. In patients who develop PIV-3 infection, despite strict enforcement of infection control policies, the best strategy might be careful risk assessment, with effective broad-spectrum anti-microbials in those who are at risk of secondary infection.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ljungman P, Ward KN, Crooks BN, Parker A, Martino R, Shaw PJ et al. Respiratory virus infections after stem cell transplantation: a prospective study for the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2001; 28: 479–484.

    Article  CAS  PubMed  Google Scholar 

  2. Schiffer J, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M . Timing and severity of community acquired respiratory infection after myeloablative versus non-myeloablative stem cell transplantation. Haematologica 2009; 94: 1101–1108.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Peck A, Englund J, Kuypers J, Guthrie K, Corey L, Morrow R et al. Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007; 110: 1681–1688.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Reed G, Jewett PH, Thompson J, Tollefson S, Wright PF . Epidemiology and clinical impact of parainfluenza virus infections in otherwise healthy infants and young children. J Infect Dis 1997; 175: 807–813.

    Article  CAS  PubMed  Google Scholar 

  5. Erard V, Chien JW, Kim HW, Nichols WG, Flowers ME, Martin PJ et al. Airflow decline after myeloablative allogeneic hematopoietic cell transplantation: the role of community respiratory viruses. J Infect Dis 2006; 193: 1619–1625.

    Article  PubMed  Google Scholar 

  6. Tyrell DAJ, Bynoe ML, Birkum K, Sutton RNP, Pereira MS . Inoculation of human volunteers with parainfluenza viruses 1 and 3 (HA2 and HA1). Br Med J 1959; 2: 909–911.

    Article  Google Scholar 

  7. Laurichesse H, Dedman D, Watson JM, Zambon MC . Epidemiological features of parainfluenza virus infections: laboratory surveillance in England and Wales, 1975–1997. Eur J Epidemiol 1999; 15: 475–484.

    Article  CAS  PubMed  Google Scholar 

  8. Garrett Nichols W, Corey L, Gooley T, Davis C, Boeckh M . Parainfluenza virus infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood 2001; 98: 573–578.

    Article  Google Scholar 

  9. Lewis VA, Champlin R, Englund J, Couch R, Goodrich JM, Rolston K et al. Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipients. Clin Infect Dis 1996; 23: 1033–1037.

    Article  CAS  PubMed  Google Scholar 

  10. Wendt CH, Weisdorf DJ, Jordan MC, Balfour Jr HH, Hertz MI . Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med 1992; 326: 921–926.

    Article  CAS  PubMed  Google Scholar 

  11. Chakrabarti S, Avivi I, MacKinnon S, Ward K, Kottaridis PD, Osman H et al. Respiratory virus infections in transplant recipients after reduced-intensity conditioning with Campath-1H: high incidence but low mortality. Br J Haematol 2002; 119: 1125–1132.

    Article  PubMed  Google Scholar 

  12. Elizaga J, Olavarria E, Apperley J, Goldman J, Ward K . Parainfluenza virus 3 infection after stem cell transplant: relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32: 413–418.

    Article  CAS  PubMed  Google Scholar 

  13. Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.

    Article  CAS  PubMed  Google Scholar 

  14. Kuypers J, Campbell AP, Cent A, Corey L, Boeckh M . Comparison of conventional and molecular detection of respiratory viruses in hematopoietic cell transplant recipients. Transpl Infect Dis 2009; 11: 298–303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Avadhanula V, Rodriguez C, DeVincenzo J, Wang Y, Webby R, Ulett G et al. Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependant manner. J Virol 2006; 80: 1629–1636.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dignan F, Alvares C, Riley U, Ethell M, Cunnigham D, Treleaven J et al. Parainfluenza type 3 infection post stem cell transplant: high prevalence but low mortality. J Hosp Inf 2006; 63: 452–458.

    Article  CAS  Google Scholar 

  17. Chakrabarti S, Collingham K, Holder K, Oyaide S, Pillay D, Milligan D . Parainfluenza Virus Type 3 Infections in Hematopoietic Stem Cell Transplant Recipients: response to Ribavirin therapy. Clin Infect Dis 2000; 31: 1516–1518.

    Article  CAS  PubMed  Google Scholar 

  18. Henrickson KJ . Parainfluenza viruses. Clin Microbiol Rev 2003; 16: 242–264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Brady MT, Evans J, Cuartas J . Survival and disinfection of parainfluenza viruses on environmental surfaces. Am J Infect Control 1990; 18: 18–23.

    Article  CAS  PubMed  Google Scholar 

  20. Stankova J, Carret AS, Moore D, McCusker C, Mitchell D, Davis M et al. Long-term therapy with aerosolized ribavirin for parainfluenza 3 virus respiratory tract infection in an infant with severe combined immunodeficiency. Pediatr transplant 2007; 11: 209–213.

    Article  PubMed  Google Scholar 

  21. Murrell M, Porotto M, Weber T, Greengard O, Moscona A . Mutations in human parainfluenza virus type 3 haemagglutinin-neuraminidase causing increased receptor binding activity and resistance to the transition state sialic acid analog 4-GU-DANA (Zanamivir). J Virol 2003; 77: 309–317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Alymova IV, Taylor G, Takimoto T, Lin TH, Chand P, Babu YS et al. Efficacy of novel hemagglutinin-neuraminidase inhibitors BCX 2798 and BCX 2855 against human parainfluenza viruses in vitro and in vivo. Antimicrob Agents Chemother 2004; 48: 1495–1502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Watanabe M, Mishin VP, Brown SA, Russell CJ, Boyd K, Babu YS et al. Effect of hemagglutinin-neuraminidase inhibitors BCX 2798 and BCX 2855 on growth and pathogenicity of Sendai/human parainfluenza type 3 chimera virus in mice. Antimicrob Agents Chemother 2009; 53: 3942–3951.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. McCann S, Byrne JL, Rivira M, Shaw P, Ribaud P, Sica S et al. Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes. Bone Marrow Transplant 2004; 33: 519–529.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Haematology, Guy's and St Thomas’ NHS Foundation Trust, London, UK

    A Hodson, M Kasliwal, M Streetly & K Raj

  2. Department of Infection, Guy's and St Thomas’ NHS Foundation Trust, London, UK

    E MacMahon

  3. Department of Infectious Diseases, King's College London School of Medicine at Guy's, King's College and St Thomas’ Hospitals, St Thomas’ Campus, London, UK

    E MacMahon

Authors
  1. A Hodson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Kasliwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Streetly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E MacMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Raj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K Raj.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hodson, A., Kasliwal, M., Streetly, M. et al. A parainfluenza-3 outbreak in a SCT unit: sepsis with multi-organ failure and multiple co-pathogens are associated with increased mortality. Bone Marrow Transplant 46, 1545–1550 (2011). https://doi.org/10.1038/bmt.2010.347

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2010.347

Keywords

This article is cited by

Search

Advanced search

Quick links