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      Burden of severe RSV disease among immunocompromised children and adults: a 10 year retrospective study

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          Abstract

          Background

          Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) recipients, with less known about other immunocompromised patients.

          Methods

          Ten-year retrospective cohort study of immunocompromised patients presenting with RSV disease documented at University Hospitals of Lausanne and Geneva. Severe RSV-related outcomes referred to RSV documented respiratory conditions requiring hospital admission, presenting as lower respiratory tract infection (LRTI) or pneumonia. We used multivariable logistic regression to assess clinical and laboratory correlates of severe RSV disease.

          Results

          From 239 RSV-positive immunocompromised in and out-patients 175 were adults and 64 children of whom 111 (47.8%) presented with LRTI, which resulted in a 38% (89/239) admission rate to hospital. While immunocompromised children were more likely to be admitted to hospital compared to adults (75% vs 62.9%, p = 0.090), inpatients admitted to the intensive care unit (17/19) or those who died (11/11) were mainly adults. From multivariable analyses, adults with solid tumors (OR 5.2; 95% CI: 1.4–20.9 P = 0.015) or those requiring chronic immunosuppressive treatments mainly for rheumatologic conditions (OR 4.1; 95% CI: 1.1–16.0; P = 0.034) were significantly more likely to be admitted to hospital compared to hematopoietic stem cell (HSCT) recipients. Bacterial co-infection was significantly and consistently associated with viral LRTI and pneumonia.

          Conclusions

          From our findings, RSV-related disease results in a significant burden among adults requiring chronic immunosuppressive treatments for rheumatological conditions and those with solid tumors. As such, systematic screening for respiratory viruses, should be extended to other immunocompromised populations than HSCT recipients.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-018-3002-3) contains supplementary material, which is available to authorized users.

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          Most cited references 29

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          Respiratory syncytial virus and parainfluenza virus.

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            Respiratory syncytial viral infection in children with compromised immune function.

            For 10 winters, 608 children five years old or younger who were hospitalized with respiratory syncytial virus (RSV) infection were prospectively studied to evaluate the relation between their immune status and the severity of their infection. Forty-seven had been immunocompromised by chemotherapy, steroid therapy, or a primary immunodeficiency disorder. Among the immunocompromised children, those receiving chemotherapy for cancer and those with immunodeficiency disease had more severe RSV disease, with pneumonia occurring at all ages, and a higher mortality rate. Children receiving long-term steroid therapy did not appear to have more severe clinical manifestations than normal children. Viral shedding, however, was significantly greater and more prolonged in the children receiving steroid therapy, and particularly in those receiving chemotherapy or with an immunodeficiency disease. Giant-cell pneumonia was documented in one child with leukemia. Over half the immunocompromised children acquired the RSV infection nosocomially. These findings indicate that children receiving chemotherapy for cancer and those with immunodeficiency disease are at risk for complicated or fatal infections from RSV and should be considered for antiviral and other therapies as they become available. Efforts should also be made to protect compromised children if hospitalization cannot be avoided.
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              Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection

              Background The clinical significance of viral load and co-infections in children with respiratory infections is not clear. Objective To evaluate the correlation of viral load as well as viral and bacterial co-infections with disease severity in hospitalized children with lower respiratory tract infections (LRTIs). Study design This is a prospective study conducted in children admitted for LRTIs for two seasons. To determine viral and bacterial load of respiratory pathogens we performed multiplex real-time polymerase chain reaction and semiquantitative bacterial cultures on nasopharyngeal aspirates (NPA). Results During the study period 244 (60%) children were hospitalized for LRTI with acute virus-induced wheezing and 160 (40%) for radiologic confirmed pneumonia. In the first NPA, viruses were identified in 315 (78%) of the 404 samples and bacteria in 198 (63.3%) of 311 samples. The viral load significantly decreased between the first and second NPA sample in most single and viral co-infections, except rhinovirus and human bocavirus infections. Viral load was inversely related to CRP in RSV infections, whereas a positive correlation was observed in adenovirus infections. Duration of hospitalization was significantly longer in RSV single infections compared to rhinovirus single infections whereas in the latter, leucocytosis and use of systemic steroids was more common. In RSV viral co-infections the presence of fever, leucocytosis, and the use of antibiotics was significantly more frequent. Positive cultures of Haemophilus influenzae dominated in RSV and rhinovirus single infections and Moraxella catarrhalis in RSV viral co-infections. Conclusions Specific viral single and co-infections as well as viral load contribute to disease severity in children with LRTIs.
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                Author and article information

                Contributors
                Olga.chatzis@hcuge.ch
                stephanie.darbre@gmail.com
                Jerome.Pasquier@chuv.ch
                Pascal.Meylan@chuv.ch
                Oriol.Manuel@chuv.ch
                John-David.Aubert@chuv.ch
                Maja.Beck-Popovic@chuv.ch
                stavroula.masouridi@hcuge.ch
                Marc.Ansari@hcuge.ch
                Laurent.kaiser@hcuge.ch
                klara.posfaybarbe@hcuge.ch
                +41 21 314 10 79 , Sandra.Asner@chuv.ch
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                6 March 2018
                6 March 2018
                2018
                : 18
                Affiliations
                [1 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Paediatric Infectious Disease Unit, Division of General Paediatrics, University Hospitals of Geneva & Faculty of Medicine, , University of Geneva, ; Geneva, Switzerland
                [2 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Department of Paediatrics, Paediatric Infectious Disease Unit, , University Hospital of Lausanne, ; Lausanne, Switzerland
                [3 ]ISNI 0000 0001 2165 4204, GRID grid.9851.5, Institute of Social and Preventive Medicine (IUMSP), , University of Lausanne, ; Lausanne, Switzerland
                [4 ]ISNI 0000 0001 2165 4204, GRID grid.9851.5, Department of Laboratories, Institute of Microbiology, , University Hospital and University of Lausanne, ; Lausanne, Switzerland
                [5 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Department of Medicine, Infectious Diseases Service, , University Hospital of Lausanne, ; Lausanne, Switzerland
                [6 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Department of Surgery, Transplantation Center, , University Hospital of Lausanne, ; Lausanne, Switzerland
                [7 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Unit of Pulmonary transplantation, Pulmonology Service, , University Hospital of Lausanne, ; Lausanne, Switzerland
                [8 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Department of Pediatrics, Paediatric Hematology and Oncology Unit, , University Hospital of Lausanne, ; Lausanne, Switzerland
                [9 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Department of Oncology, Hematology Service, , University Hospital of Geneva, ; Geneva, Switzerland
                [10 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Paediatric Hematology and Oncology Unit, Division of General Pediatrics, University Hospital of Geneva and Faculty of Medicine, , University of Geneva, ; Geneva, Switzerland
                [11 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Department of Medicine, Infectious Diseases Service, University Hospital of Geneva and Faculty of Medicine, , University of Geneva, ; Geneva, Switzerland
                [12 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Department of Genetical and Laboratory Medicine, Virology Laboratory, Laboratory Medicine, , University Hospital of Geneva, ; Geneva, Switzerland
                [13 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Department of Pediatrics, Pediatric Infectious Disease Unit, , CHUV, ; Rue du Bugnon 46, 1011 Lausanne, Switzerland
                Article
                3002
                10.1186/s12879-018-3002-3
                5838875
                29510663
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Abbvie Switzerland
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Infectious disease & Microbiology

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