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Manothummetha K, Mongkolkaew T, Tovichayathamrong P, Boonyawairote R, Meejun T, Srisurapanont K, Phongkhun K, Sanguankeo A, Torvorapanit P, Moonla C, Plongla R, Kates OS, Avery RK, Nematollahi S, Permpalung N. Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:1272-1279. [PMID: 37116860 DOI: 10.1016/j.cmi.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Ribavirin use for respiratory syncytial virus (RSV) infection in patients with haematologic malignancies (HM) and haematopoietic stem cell transplant (HSCT) recipients remains controversial. OBJECTIVES To summarize the current evidence of ribavirin treatment in association with mortality and progression to lower respiratory tract infection (LRTI) among patients with HM/HSCT with RSV infection. DATA SOURCES MEDLINE, Embase, and the Institute for Scientific Information Web of Science. STUDY ELIGIBILITY CRITERIA Randomized controlled trials and observational studies investigating the effects of ribavirin, compared with treatment without ribavirin, for RSV infection. PARTICIPANTS Patients with HM/HSCT. INTERVENTIONS Ribavirin versus no ribavirin. ASSESSMENT OF RISK OF BIAS The risk of bias in non-randomized studies of exposure (ROBIN-E). METHODS OF DATA SYNTHESIS The random-effects model was used to calculate the pooled OR (pOR) with 95% CI for the pooled effect estimates of ribavirin benefits. Grading of recommendation assessment, development, and evaluation was used to evaluate the certainty of evidence. RESULTS One randomized controlled trial and 14 observational studies were included, representing 1125 patients with HM/HSCT. Ribavirin use was not associated with lower all-cause or RSV-associated mortality with pORs [95% CI] of 0.81 [0.40, 1.66], I2 = 55% (low certainty of evidence) and 0.48 [0.11, 2.15], I2 = 64% (very low certainty of evidence), respectively. In subgroup analyses, ribavirin use was associated with lower mortality in patients with HM/HSCT with LRTI with pOR [95% CI] of 0.19 [0.07, 0.51], I2 = 0% (moderate certainty of evidence). In subgroup analyses among studies providing adjusted OR, ribavirin use was associated with lower all-cause mortality with pOR of 0.41 [0.23, 0.74], I2 = 0% (moderate certainty of evidence). In addition, aerosolized ribavirin was associated with lower progression to LRTI with pOR [95% CI] of 0.27 [0.09, 0.80], I2 = 71% (low certainty of evidence). CONCLUSIONS Ribavirin may be a reasonable option to treat RSV in patients with HM/HSCT in the absence of other effective antiviral agents.
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Affiliation(s)
- Kasama Manothummetha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Rabhas Boonyawairote
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kasidis Phongkhun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Olivia S Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Osone S, Shinoda K, Yamamoto N, Suzuki K, Yano M, Ishida Y, Saito Y, Sawada A, Sano H, Kato Y, Shinkoda Y, Kakazu M, Mori N, Mizutani S, Fukushima K. Current methods of preventing infectious disease and managing febrile neutropenia in childhood cancer patients: a nationwide survey in Japan. Int J Clin Oncol 2023; 28:331-340. [PMID: 36585538 PMCID: PMC9803594 DOI: 10.1007/s10147-022-02282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventing infection and managing febrile neutropenia (FN) is mandatory for children with cancer undergoing chemotherapy. However, the current situation in Japan is unknown. METHODS We conducted a nationwide web-based questionnaire survey in 153 institutions treating childhood cancer in Japan. We asked about the type prophylaxis used to prevent infectious disease and manage FN. If patients with childhood cancer were managed by both pediatricians and surgeons at the same institution, we asked both to reply. RESULTS We received replies from 117 departments at 111 centers: of these, 108 were from pediatricians. Laminar air flow for neutropenic patients, and frequent hand sanitization with ethanol, were widespread. Twenty-eight percent and forty percent of departments performed active surveillance by taking cultures from patients and the environment, respectively, before initiation of chemotherapy. Forty-four percent of departments administered prophylactic intravenous antibiotics according to patient status. Many departments measured serum (1,3)-β-D glucan, procalcitonin, and aspergillus galactomannan at the onset of FN. Twenty-eight percent of departments used carbapenem as empirical therapy for FN. Some departments used prophylactic granulocyte-colony stimulating factor for acute leukemia. Seventy-two percent of departments used prophylactic immunoglobulin for hypogammaglobinemia caused by chemotherapy. Palivizumab was administered widely for respiratory syncytial virus prophylaxis in immunocompromised infants. CONCLUSION As a whole, intensive care for infectious prophylaxis or FN is applied in Japan; however, the methods vary among centers, and some are excessive or inadequate. Therefore, it is desirable to conduct clinical trials and establish adequate care protocols for infection in children with cancer in Japan.
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Affiliation(s)
- Shinya Osone
- grid.272458.e0000 0001 0667 4960Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566 Japan
| | - Kunihiro Shinoda
- grid.415535.3Department of Pediatrics, Gifu Municipal Hospital, 7-1 Kashima-Cho, Gifu, 500-8513 Japan
| | - Nobuyuki Yamamoto
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017 Japan
| | - Koji Suzuki
- grid.413114.2Department of Pediatrics, Faculty of Medical Science, University of Fukui Hospital, 23-3 Matsuoka-Shimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193 Japan
| | - Michihiro Yano
- grid.411403.30000 0004 0631 7850Department of Pediatrics, Akita University Hospital, 44-2 Hasunuma, Hirozura, Akita 010-8543 Japan
| | - Yuji Ishida
- grid.415797.90000 0004 1774 9501Department of Pediatrics, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shunto, Shizuoka 411-8777 Japan
| | - Yuya Saito
- grid.417084.e0000 0004 1764 9914Department of Pediatric Hematology and Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561 Japan
| | - Akihisa Sawada
- grid.416629.e0000 0004 0377 2137Department of Pediatric Hematology/Oncology, Osaka Women’s and Children’s Hospital, 840 Murodo, Izumi, Osaka 594-1101 Japan
| | - Hirozumi Sano
- grid.415262.60000 0004 0642 244XDepartment of Pediatrics, Sapporo Hokuyu Hospital, 6-6-5-1 Higashisapporo, Shiroishi-Ku, Sapporo, Hokkaido 003-0006 Japan
| | - Yoko Kato
- grid.411898.d0000 0001 0661 2073Department of Pediatrics, Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo 105-8471 Japan
| | - Yuichi Shinkoda
- grid.410788.20000 0004 1774 4188Department of Pediatrics, Kagoshima City Hospital, 37-1 Uearatacho, Kagoshima, 890-8760 Japan
| | - Mariko Kakazu
- Pediatric Hematology and Oncology Department, Okinawa Prefectural Medical Center and Children’s Medical Center, 118-1 Shinkawa, Haebaru, Shimajiri, Okinawa 901-1193 Japan
| | - Naoko Mori
- Akabane Zaitaku Clinic, 2-69-6 Akabane, Kita-Ku, Tokyo, 115-0045 Japan
| | - Shuki Mizutani
- grid.265073.50000 0001 1014 9130Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519 Japan
| | - Keitaro Fukushima
- grid.255137.70000 0001 0702 8004Department of Pediatrics, Dokkyo Medical University School of Medicine, 880 Kita-Kobayashi, Mibu, Shimo-Tsuga, Tochigi, 321-0293 Japan
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Burden of illness in infants and young children hospitalized for respiratory syncytial virus: A rapid review. ACTA ACUST UNITED AC 2021; 47:381-396. [PMID: 34650335 DOI: 10.14745/ccdr.v47i09a05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory syncytial virus (RSV) infections are common among young children and represent a significant burden to patients, their families and the Canadian health system. Here we conduct a rapid review of the burden of RSV illness in children 24 months of age or younger. Four databases (Medline, Embase, Cochrane Database of Clinical Trials, ClinicalTrials.gov from 2014 to 2018), grey literature and reference lists were reviewed for studies on the following: children with or without a risk factor, without prophylaxis and with lab-confirmed RSV infection. Of 29 studies identified, 10 provided within-study comparisons and few examined clinical conditions besides prematurity. For infants of 33-36 weeks gestation (wGA) versus term infants, there was low-to-moderate certainty evidence for an increase in RSV-hospitalizations (n=599,535 infants; RR 2.05 [95% CI 1.89-2.22]; 1.3 more per 100 [1.1-1.5 more]) and hospital length of stay (n=7,597 infants; mean difference 1.00 day [95% CI 0.88-1.12]). There was low-to-moderate certainty evidence of little-to-no difference for infants born at 29-32 versus 33-36 wGA for hospitalization (n=12,812 infants; RR 1.20 [95% CI 0.92-1.56]). There was low certainty evidence of increased mechanical ventilation for hospitalized infants born at 29-32 versus 33-35 wGA (n=212 infants; RR 1.58, 95% CI 0.94-2.65). Among infants born at 32-35 wGA, hospitalization for RSV in infancy may be associated with increased wheeze and asthma-medication use across six-year follow-up (RR range 1.3-1.7). Children with versus without Down syndrome may have increased hospital length of stay (n=7,206 children; mean difference 3.00 days, 95% CI 1.95-4.05; low certainty). Evidence for other within-study comparisons was of very low certainty. In summary, prematurity is associated with greater risk for RSV-hospitalization and longer hospital length of stay, and Down syndrome may be associated with longer hospital stay for RSV. Respiratory syncytial virus-hospitalization in infancy may be associated with greater wheeze and asthma-medication use in early childhood. Lack of a comparison group was a major limitation for many studies.
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Gabutti G, De Motoli F, Sandri F, Toffoletto MV, Stefanati A. Viral Respiratory Infections in Hematological Patients. Infect Dis Ther 2020; 9:495-510. [PMID: 32638228 PMCID: PMC7339094 DOI: 10.1007/s40121-020-00313-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Viral infections of the respiratory system represent one of the most important complications in hematological patients in terms of both the severity of the clinical picture and its related impact on the duration of hospitalization, and of mortality. The most implicated viruses are those that commonly cause community-based respiratory diseases: respiratory syncytial virus, Influenza virus and rhinovirus. However, in some cases the clinical picture may be triggered by first infection with or reactivation of pathogens normally not responsible for clinically relevant diseases in immunocompetent subjects. This issue is currently being taken into greater consideration within the scientific community. However, the strong heterogeneity in the epidemiology and clinical expression of these infections and the lack of adequate therapeutic options imply that there is currently no uniform consensus on the best management of these patients. The main purpose of this review is to highlight which viruses are currently most implicated in the onset of these infections, what is their incidence in so heterogeneous and fragile patients and the factors that lead to disease's onset and evolution. Possible or available clinical management options, diagnostic and therapeutic tools, and preventive and prophylaxis measures are also discussed.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Francesco De Motoli
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | | | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Baier C, Haid S, Beilken A, Behnert A, Wetzke M, Brown RJP, Schmitt C, Ebadi E, Hansen G, Schulz TF, Pietschmann T, Bange FC. Molecular characteristics and successful management of a respiratory syncytial virus outbreak among pediatric patients with hemato-oncological disease. Antimicrob Resist Infect Control 2018; 7:21. [PMID: 29449938 PMCID: PMC5812225 DOI: 10.1186/s13756-018-0316-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/07/2018] [Indexed: 11/28/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is responsible for upper and lower respiratory tract infection in adults and children. Especially immunocompromised patients are at high risk for a severe course of infection, and mortality is increased. Moreover RSV can spread in healthcare settings and can cause outbreaks. Herein we demonstrate the successful control and characteristics of a RSV outbreak that included 8 patients in our Department of Pediatric Hematology and Oncology. Methods We performed an epidemiologic investigation and a molecular analysis of the outbreak strains. Moreover we present the outbreak control bundle and our concept for RSV screening in the winter season. Results RSV A and B strains caused the outbreak. RSV B strains affected 3 patients, 2 of whom were co-infected with RSV A. Exactly this RSV A strain was detected in another 5 patients. Our multimodal infection control bundle including prophylactic RSV screening was able to rapidly stop the outbreak. Conclusion An infection control bundle in RSV outbreaks should address all potential transmission pathways. In pediatric settings the restriction of social activities might have a temporal negative impact on quality of life but helps to limit transmission opportunities. Molecular analysis allows better understanding of RSV outbreaks and, if done in a timely manner, might be helpful for guidance of infection control measures.
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Affiliation(s)
- Claas Baier
- 1Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Sibylle Haid
- 2Institute for Experimental Virology; Twincore- Centre for Experimental and Clinical Infection Research; a joint venture of Hannover Medical School (MHH) and Helmholtz Centre for Infection Research (HZI), Hannover, Germany
| | - Andreas Beilken
- 3Department of Paediatric Haematology and Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Astrid Behnert
- 3Department of Paediatric Haematology and Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Martin Wetzke
- 4Department for Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Richard J P Brown
- 2Institute for Experimental Virology; Twincore- Centre for Experimental and Clinical Infection Research; a joint venture of Hannover Medical School (MHH) and Helmholtz Centre for Infection Research (HZI), Hannover, Germany
| | - Corinna Schmitt
- 5Institute of Virology, Hannover Medical School (MHH), Hannover, Germany
| | - Ella Ebadi
- 1Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Gesine Hansen
- 4Department for Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Thomas F Schulz
- 5Institute of Virology, Hannover Medical School (MHH), Hannover, Germany
| | - Thomas Pietschmann
- 2Institute for Experimental Virology; Twincore- Centre for Experimental and Clinical Infection Research; a joint venture of Hannover Medical School (MHH) and Helmholtz Centre for Infection Research (HZI), Hannover, Germany
| | - Franz-Christoph Bange
- 1Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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