The Aerogen® Solo Is an Alternative to the Small Particle Aerosol Generator (SPAG-2) for Administration of Inhaled Ribavirin

Clinical Outcomes of Respiratory Syncytial Virus Infection Among Pediatric Immunocompromised Hosts

BACKGROUND

Pediatric immunocompromised patients are at an increased risk of severe respiratory syncytial virus (RSV) infection. Here, we aimed to describe the clinical course and outcomes of RSV infection in immunocompromised children.

METHODS

This single-center study at St. Jude Children's Research Hospital involved immunocompromised children ≤21 years old with a positive RSV clinical test from 2007 to 2019. Demographic and clinical characteristics, laboratory values, treatment delays for underlying conditions, and outcomes were gathered from electronic medical records. Multivariate models identified risk factors predictive of severe RSV-lower respiratory tract infection (LRTI).

RESULTS

A total of 391 patients, predominantly children over 2 years old (median age: 5), were included in the study. Acute lymphoblastic leukemia (ALL) was the most prevalent underlying disease. Most patients (85.7%) exhibited upper respiratory tract infections, while approximately 6% progressed to LRTIs. Over half of the patients (58.8%) required hospitalization, and one-third experienced modifications or delays in their underlying disease treatment due to RSV infection. Severe RSV infections were observed in 15.9% of patients. All-cause mortality was 2.6%, with 0.7% of deaths attributed to RSV.

CONCLUSIONS

One-third of patients experienced a delay in treatment for their underlying disease due to RSV infection, a phenomenon not well understood but potentially significant. Many immunocompromised children with RSV require hospitalization, including those over 2 years old. RSV imposes a significant burden on immunocompromised children of all ages, affecting their cancer treatment plans both directly and indirectly.

Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series

Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.

Approach to hematopoietic cell transplant candidates with respiratory viral detection

The management of respiratory viruses prior to hematopoietic cell transplant (HCT) can be controversial and requires special consideration of host factors, transplant parameters, and the specific respiratory virus (RV). In the setting of adenovirus (ADV), human metapneumovirus (HMPV), influenza, parainfluenza virus (PIV), and respiratory syncytial virus (RSV) detection prior to hematopoietic cell transplant (HCT), clinical practice guidelines recommend transplant delay when possible; however, there is much more ambiguity when other respiratory viruses, such as seasonal coronaviruses (CoVs), human rhinovirus (HRV), and SARS-CoV-2, are detected. Our aims for this review include detailing clinical practical guidelines and reviewing current literature on pre-transplant respiratory viral infections (RVIs), including antiviral therapies and prevention strategies, when available. We will center our discussion on three representative clinical scenarios, with the goal of providing practical guidance to clinicians.