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Dignani MC, Costantini P, Salgueira C, Jordán R, Guerrini G, Valledor A, Herrera F, Nenna A, Mora C, Roccia-Rossi I, Stecher D, Carbone E, Laborde A, Efron E, Altclas J, Calmaggi A, Cozzi J. Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study. F1000Res 2014; 3:221. [PMID: 25469231 DOI: 10.12688/f1000research.5251.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season. METHODS Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed. RESULTS From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation <96% at presentation was a predictor of mortality (OR 19.5; 95%CI: 2.28 to 165.9). CONCLUSIONS In our cancer patient population, the pandemic 2009 Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation <96% was significantly associated with death. No deaths were observed among vaccinated patients.
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Affiliation(s)
- Maria Cecilia Dignani
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Patricia Costantini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Instituto de Oncología Angel H. Roffo, University of Buenos Aires, Buenos Aires, 1417, Argentina
| | - Claudia Salgueira
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina
| | - Rosana Jordán
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina
| | - Graciela Guerrini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - Alejandra Valledor
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Italiano, Buenos Aires, 1181, Argentina
| | - Fabián Herrera
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, CEMIC, Buenos Aires, 1425, Argentina
| | - Andrea Nenna
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Municipal de Oncología "Marie Curie", Buenos Aires, 1405, Argentina
| | - Claudia Mora
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, FLENI, Buenos Aires, 1428, Argentina
| | - Inés Roccia-Rossi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Hospital San Martín, Buenos Aires, 1900, Argentina
| | - Daniel Stecher
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, 1120, Argentina
| | - Edith Carbone
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Aeronáutico Central, Buenos Aires, 1437, Argentina
| | - Ana Laborde
- Infectious Diseases, FUNDALEU, Buenos Aires, 1114, Argentina
| | - Ernesto Efron
- Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Javier Altclas
- Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Aníbal Calmaggi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - José Cozzi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Bone Marrow Transplant, CETRAMOR, Rosario, Pcia. Sta Fé, 2000, Argentina
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Dignani MC, Costantini P, Salgueira C, Jordán R, Guerrini G, Valledor A, Herrera F, Nenna A, Mora C, Roccia-Rossi I, Stecher D, Carbone E, Laborde A, Efron E, Altclas J, Calmaggi A, Cozzi J. Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study. F1000Res 2014; 3:221. [PMID: 25469231 PMCID: PMC4240245 DOI: 10.12688/f1000research.5251.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season. METHODS Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed. RESULTS From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation <96% at presentation was a predictor of mortality (OR 19.5; 95%CI: 2.28 to 165.9). CONCLUSIONS In our cancer patient population, the pandemic 2009 Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation <96% was significantly associated with death. No deaths were observed among vaccinated patients.
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Affiliation(s)
- Maria Cecilia Dignani
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Patricia Costantini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Instituto de Oncología Angel H. Roffo, University of Buenos Aires, Buenos Aires, 1417, Argentina
| | - Claudia Salgueira
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina
| | - Rosana Jordán
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina
| | - Graciela Guerrini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - Alejandra Valledor
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Italiano, Buenos Aires, 1181, Argentina
| | - Fabián Herrera
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, CEMIC, Buenos Aires, 1425, Argentina
| | - Andrea Nenna
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Municipal de Oncología "Marie Curie", Buenos Aires, 1405, Argentina
| | - Claudia Mora
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, FLENI, Buenos Aires, 1428, Argentina
| | - Inés Roccia-Rossi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Hospital San Martín, Buenos Aires, 1900, Argentina
| | - Daniel Stecher
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, 1120, Argentina
| | - Edith Carbone
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Aeronáutico Central, Buenos Aires, 1437, Argentina
| | - Ana Laborde
- Infectious Diseases, FUNDALEU, Buenos Aires, 1114, Argentina
| | - Ernesto Efron
- Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Javier Altclas
- Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Aníbal Calmaggi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - José Cozzi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Bone Marrow Transplant, CETRAMOR, Rosario, Pcia. Sta Fé, 2000, Argentina
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Weigt SS, Gregson AL, Deng JC, Lynch JP, Belperio JA. Respiratory viral infections in hematopoietic stem cell and solid organ transplant recipients. Semin Respir Crit Care Med 2011; 32:471-93. [PMID: 21858751 PMCID: PMC4209842 DOI: 10.1055/s-0031-1283286] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Respiratory viral infections (RVIs) are common causes of mild illness in immunocompetent children and adults with rare occurrences of significant morbidity or mortality. Complications are more common in the very young, very old, and those with underlying lung diseases. However, RVIs are increasingly recognized as a cause of morbidity and mortality in recipients of hematopoietic stem cell transplants (HSCT) and solid organ transplants (SOTs). Diagnostic techniques for respiratory syncytial virus (RSV), parainfluenza, influenza, and adenovirus have been clinically available for decades, and these infections are known to cause serious disease in transplant recipients. Modern molecular technology has now made it possible to detect other RVIs including human metapneumovirus, coronavirus, and bocavirus, and the role of these viruses in causing serious disease in transplant recipients is still being worked out. This article reviews the current information regarding epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of these infections, as well as the aspects of clinical significance of RVIs unique to HSCT or SOT.
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Affiliation(s)
- S Samuel Weigt
- Division of Pulmonary, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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