Respiratory syncytial virus pneumonitis in immunocompromised adults: Clinical features and outcome
Respiratory syncytial virus pneumonitis in immunocompromised adults: Clinical features and outcome
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DOI：
10.1159/000085367
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发表时间：
2005-01-01
期刊：
影响因子：
3.7
通讯作者：
Limper, AH
中科院分区：
文献类型：
--
作者：
Ebbert, JO;Limper, AH
背景资料：尽管呼吸道合胞病毒（RSV）主要感染儿童，但也感染成人，特别是免疫功能低下的成人。目的：确定RSV肺炎的临床谱和对住院免疫功能低下成人的影响。方法：回顾性病历分析。临床参数，包括发病前的条件，介绍，放射学检查结果，治疗和结果进行了检查，在一个连续的病人系列从住院三级保健中心。11名免疫功能低下的成年人进行了支气管肺泡灌洗（BAL）在1987年1月至1996年12月，谁有培养验证RSV肺炎进行了评价。结果：该系列主要包括接受化疗或骨髓移植治疗淋巴瘤或白血病的患者。2例因使用高剂量皮质类固醇而出现免疫抑制。大多数（91%）在11月至5月期间入院，伴有呼吸困难和排痰性咳嗽。与早期研究相反，上呼吸道感染症状（即鼻窦充血、咽喉痛）较少，下呼吸道体格检查结果（即喘息、双基底罗音）较多。患者在BAL前通常为低氧血症和发热。在BAL上发现8株细菌或真菌共分离株。胸部X线片通常显示弥漫性斑片状浸润，包括肺泡混浊。组织学显示弥漫性肺泡损伤、毛细支气管炎伴机化性肺炎和透明膜形成。一半以上需要插管，55%死亡。虽然利巴韦林治疗可能对某些插管患者有益，但其总体疗效无法从该系列中确定。结论：RSV是免疫功能低下成人发病和死亡的一个严重原因。需要进一步开发和实施有效的疫苗和额外的治疗干预措施。版权所有（C）2005 S. Karger AG，巴塞尔。
Background: Though predominantly an infection of children, respiratory syncytial virus (RSV) also infects adults, particularly those with immune compromise. Objectives: To define the clinical spectrum and impact of RSV pneumonitis on hospitalized, immunocompromised adults. Methods: Retrospective chart review. Clinical parameters including premorbid conditions, presentation, radiologic findings, treatment and outcome were examined in a consecutive patients series from an inpatient tertiary-care center. Eleven immunocompromised adults who had undergone bronchoalveolar lavage (BAL) between January 1987 and December 1996 and who had culture-verified RSV pneumonitis were evaluated. Results: This series consisted primarily of patients undergoing chemotherapy or bone marrow transplantation for lymphoma or leukemia. Two were immunosuppressed due to high-dose corticosteroids. A majority (91%) were admitted between November and May, with dyspnea and productive cough. In contrast to earlier studies, there was a paucity of upper respiratory infection symptoms (i.e. sinus congestion, sore throat) and a preponderance of lower respiratory physical exam findings (i.e. wheezing, bibasilar rales). Patients were typically hypoxemic and febrile prior to BAL. Eight demonstrated co-isolates of bacterial or fungi on BAL. The chest radiographs generally revealed diffuse patchy infiltrates, including alveolar opacities. Histology demonstrated diffuse alveolar damage, bronchiolitis with organizing pneumonia, and hyaline membrane formation. Over half required intubation, and 55% died. Although ribavirin therapy may be beneficial in some intubated patients, its overall efficacy cannot be established from this series. Conclusion: RSV is a serious cause of morbidity and mortality in immunocompromised adults. Further development and implementation of an effective vaccine and additional therapeutic interventions are needed. Copyright (C) 2005 S. Karger AG, Basel.