CLINICAL IMPACT OF COMMUNITY ACQUIRED RESPIRATORY VIRUSES IN PATIENTS WITH SOLID ORGAN TRANSPLANTS
Chest
; 162(4):A488, 2022.
Article
in English
| EMBASE | ID: covidwho-2060607
ABSTRACT
SESSION TITLE Not the Normal Host Infections Still Matter SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/17/2022 1215 pm - 115 pm PURPOSE:
Community Acquired Respiratory Viruses (CARVs) are associated with poor outcome in Solid Organ Transplant (SOT) recipients. We reviewed some of these outcomes such as respiratory support, length of stay (LOS), ICU admission, steroid use & 30-day all-cause mortality.METHODS:
Multihospital, single center, retrospective review of electronic health records from 01/01/2014-12/31/2019.RESULTS:
23 SOT recipients (M=20, F=3) who tested positive for CARVs were identified. SOT distribution was heart=2, kidney=4, liver=3, lung=11, heart-lung=1, lung-kidney=1 & heart-kidney=1. Mean age at admission was 60 years, average LOS was 8 days with 2 pts needing >2 weeks. 6 pts required intensive care unit;8 pts required supplemental oxygen support. 16 pts had infiltrates on chest imaging. 15 pts had a 90-day readmission with respiratory complaints. 8 pts had bronchoscopy & 20 had positive nasal swab. 3 pts had a negative nasal swab but positive Bronchoalveolar lavage (BAL) for CARV while 2 pts had negative BAL but positive nasal swab. CARV distribution was Rhinovirus 48%, Parainfluenza 29%, Metapneumovirus 12%, Respiratory syncytial virus 0.03%, Adenovirus 0.03% & Non-novel Coronavirus 0.06%. 5 pts had bacterial coinfection (Pseudomonas aeruginosa, Corynebacterium striatum & Stenotrophomonas maltophilia). All pts were immunosuppressed, intravenous immunoglobulins (IVIG) were used in 3 pts, antivirals in 7 pts (ribavirin in 6 & oseltamivir in 1) & steroids in 10 pts. 12 pts had transplant organ biopsy with 5 showing acute cellular rejection. 11 pts had underlying Coronary artery disease and 17 pts had hematologic disorders (Post-transplant lymphoproliferative disorder, leukemia, Myelodysplastic syndrome, & multiple myeloma). 35% pts died within 1 year (2 during same admit). Cause of death was refractory septic shock (1), respiratory failure (3), cardiac arrest (3) & chronic lung allograft dysfunction (CLAD) (1).CONCLUSIONS:
In this cohort, we assessed the SOT recipients positive for CARVs who required admission & evaluated the impact on their clinical course. This analysis noted a significant rate of acute & chronic rejections, bronchiolitis obliterans and CLAD in these patients. Newer tests like multiplex NAT & (semi) quantitative NAT (QNAT) can diagnose CARVs in addition to Human Influenza Virus. Patients can present with wheezing, croup, bronchiolitis, pneumonitis & pneumonia. Impact of CARVs seems to vary by the type of organ transplant, level of neutropenia/lymphopenia, upper versus lower respiratory infection and intrinsic pathogenicity of virus. Various preventive & therapeutic measures were employed in an attempt to improve outcomes in these patients. CLINICAL IMPLICATIONS Transplant receipients are at a high risk of infections especially CARVs which may increase morbidity and mortality. This analysis emphasizes the value of timely diagnosis and treatment in this specific patient population who are immunocompromised. DISCLOSURES No relevant relationships by Supriya Singh
antivirus agent; endogenous compound; immunoglobulin; oseltamivir; oxygen; ribavirin; steroid; acute graft rejection; Adenoviridae; adult; bronchiolitis obliterans; bronchoscopy; cancer patient; cause of death; chronic graft rejection; clinical article; coinfection; conference abstract; controlled study; coronary artery disease; Coronavirinae; Corynebacterium striatum; croup; drug therapy; female; graft recipient; heart arrest; hematologic disease; hospital readmission; human; Human respiratory syncytial virus; Influenza virus; intensive care unit; intravenous drug administration; kidney; length of stay; leukemia; liver; lung lavage; lymphocytopenia; male; Metapneumovirus; middle aged; morbidity; mortality; multiple myeloma; myelodysplastic syndrome; neutropenia; nonhuman; nose smear; outcome assessment; Parainfluenza virus infection; pathogenicity; pneumonia; posttransplant lymphoproliferative disease; prevention; Pseudomonas aeruginosa; quantitative analysis; respiratory failure; respiratory tract infection; respiratory virus; retrospective study; Rhinovirus; septic shock; Stenotrophomonas maltophilia; surgery; thorax; wheezing
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
/
Prognostic study
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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