The Experts below are selected from a list of 22116 Experts worldwide ranked by ideXlab platform
Michael Boeckh - One of the best experts on this subject based on the ideXlab platform.
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respiratory Virus Pneumonia after hematopoietic cell transplantation hct associations between viral load in bronchoalveolar lavage samples viral rna detection in serum samples and clinical outcomes of hct
The Journal of Infectious Diseases, 2010Co-Authors: Angela P Campbell, Jason W Chien, Jane Kuypers, Janet A Englund, Anna Wald, Katherine A Guthrie, Lawrence Corey, Michael BoeckhAbstract:Background. Few data exist on respiratory Virus quantitation in lower respiratory samples and detection in serum from hematopoietic cell transplant (HCT) recipients with respiratory Virus-associated Pneumonia. Methods. We retrospectively identified HCT recipients with respiratory syncytial Virus (RSV), parainfluenza Virus, influenza Virus, metapneumoVirus (MPV), and coronaVirus (CoV) detected in bronchoalveolar lavage (BAL) samples, and we tested stored BAL and/or serum samples by quantitative polymerase chain reaction. Results. In 85 BAL samples from 82 patients, median viral loads were as follows: for RSV (n = 35), 2.6 × 10 6 copies/mL; for parainfluenza Virus (n = 35), 4.9 × 10 7 copies/mL; for influenza Virus (n = 9), 6.8 × 10 5 copies/mL; for MPV (n = 7), 3.9 × 10 7 copies/mL; and for CoV (n = 4), 1.8 × 10 5 copies/mL. Quantitative viral load was not associated with mechanical ventilation or death. Viral RNA was detected in serum samples from 6 of 66 patients: 4 of 41 with RSV Pneumonia, 1 with influenza B, and 1 with MPV/influenza A Virus/CoV coinfection (influenza A Virus and MPV RNA detected). RSV detection in serum was associated with high viral load in BAL samples (P = .05), and viral RNA detection in serum was significantly associated with death (adjusted rate ratio, 1.8; P = .02). Conclusion. Quantitative polymerase chain reaction detects high viral loads in BAL samples from HCT recipients with respiratory Virus Pneumonia. Viral RNA is also detectable in the serum of patients with RSV, influenza, and MPV Pneumonia and may correlate with the severity of disease.
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randomized controlled multicenter trial of aerosolized ribavirin for respiratory syncytial Virus upper respiratory tract infection in hematopoietic cell transplant recipients
Clinical Infectious Diseases, 2007Co-Authors: Jane Kuypers, Janet A Englund, Michael Boeckh, Yufeng Li, Carole B Miller, Alan S Cross, Humberto Fernandez, Hyung W KimAbstract:Background. Respiratory syncytial Virus infection of the upper airways may progress to fatal Pneumonia in hematopoietic cell transplant recipients. The safety and efficacy of aerosolized ribavirin in preventing disease progression is unknown. Methods. In a multicenter prospective trial, hematopoietic cell transplant recipients with respiratory syncytial Virus infection of the upper airways were randomized to receive ribavirin (2 g 3 times daily) or supportive care for 10 days. The primary end point was progression to radiographically proven Pneumonia. Secondary end points included virologically proven respiratory syncytial Virus Pneumonia, viral load changes, and safety. Results. Fourteen patients were randomized to 1 of 2 treatment arms. The trial was discontinued after 5 years because of slow accrual. Pneumonia at 1 month after randomization occurred in 1 of 9 patients who received ribavirin and in 2 of 5 patients who received supportive care (P = .51); virologically proven respiratory syncytial Virus Pneumonia occurred in 0 of 9 and 2 of 5 patients, respectively (P = .11). At 10 days after randomization, the average viral load decreased by 0.75 log 10 copies/mL in ribavirin recipients, compared with a viral load increase of 1.26 log 10 copies/mL in untreated patients (P = .07). No discontinuations of ribavirin therapy because of adverse effects occurred during 84 drug administrations. Rates of adverse events were similar in both groups. Conclusions. Preemptive aerosolized ribavirin treatment appeared to be safe, and trends of decreasing viral load over time were observed. However, proof of efficacy remains elusive in hematopoietic cell transplant recipients.
Janet A Englund - One of the best experts on this subject based on the ideXlab platform.
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respiratory Virus Pneumonia after hematopoietic cell transplantation hct associations between viral load in bronchoalveolar lavage samples viral rna detection in serum samples and clinical outcomes of hct
The Journal of Infectious Diseases, 2010Co-Authors: Angela P Campbell, Jason W Chien, Jane Kuypers, Janet A Englund, Anna Wald, Katherine A Guthrie, Lawrence Corey, Michael BoeckhAbstract:Background. Few data exist on respiratory Virus quantitation in lower respiratory samples and detection in serum from hematopoietic cell transplant (HCT) recipients with respiratory Virus-associated Pneumonia. Methods. We retrospectively identified HCT recipients with respiratory syncytial Virus (RSV), parainfluenza Virus, influenza Virus, metapneumoVirus (MPV), and coronaVirus (CoV) detected in bronchoalveolar lavage (BAL) samples, and we tested stored BAL and/or serum samples by quantitative polymerase chain reaction. Results. In 85 BAL samples from 82 patients, median viral loads were as follows: for RSV (n = 35), 2.6 × 10 6 copies/mL; for parainfluenza Virus (n = 35), 4.9 × 10 7 copies/mL; for influenza Virus (n = 9), 6.8 × 10 5 copies/mL; for MPV (n = 7), 3.9 × 10 7 copies/mL; and for CoV (n = 4), 1.8 × 10 5 copies/mL. Quantitative viral load was not associated with mechanical ventilation or death. Viral RNA was detected in serum samples from 6 of 66 patients: 4 of 41 with RSV Pneumonia, 1 with influenza B, and 1 with MPV/influenza A Virus/CoV coinfection (influenza A Virus and MPV RNA detected). RSV detection in serum was associated with high viral load in BAL samples (P = .05), and viral RNA detection in serum was significantly associated with death (adjusted rate ratio, 1.8; P = .02). Conclusion. Quantitative polymerase chain reaction detects high viral loads in BAL samples from HCT recipients with respiratory Virus Pneumonia. Viral RNA is also detectable in the serum of patients with RSV, influenza, and MPV Pneumonia and may correlate with the severity of disease.
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randomized controlled multicenter trial of aerosolized ribavirin for respiratory syncytial Virus upper respiratory tract infection in hematopoietic cell transplant recipients
Clinical Infectious Diseases, 2007Co-Authors: Jane Kuypers, Janet A Englund, Michael Boeckh, Yufeng Li, Carole B Miller, Alan S Cross, Humberto Fernandez, Hyung W KimAbstract:Background. Respiratory syncytial Virus infection of the upper airways may progress to fatal Pneumonia in hematopoietic cell transplant recipients. The safety and efficacy of aerosolized ribavirin in preventing disease progression is unknown. Methods. In a multicenter prospective trial, hematopoietic cell transplant recipients with respiratory syncytial Virus infection of the upper airways were randomized to receive ribavirin (2 g 3 times daily) or supportive care for 10 days. The primary end point was progression to radiographically proven Pneumonia. Secondary end points included virologically proven respiratory syncytial Virus Pneumonia, viral load changes, and safety. Results. Fourteen patients were randomized to 1 of 2 treatment arms. The trial was discontinued after 5 years because of slow accrual. Pneumonia at 1 month after randomization occurred in 1 of 9 patients who received ribavirin and in 2 of 5 patients who received supportive care (P = .51); virologically proven respiratory syncytial Virus Pneumonia occurred in 0 of 9 and 2 of 5 patients, respectively (P = .11). At 10 days after randomization, the average viral load decreased by 0.75 log 10 copies/mL in ribavirin recipients, compared with a viral load increase of 1.26 log 10 copies/mL in untreated patients (P = .07). No discontinuations of ribavirin therapy because of adverse effects occurred during 84 drug administrations. Rates of adverse events were similar in both groups. Conclusions. Preemptive aerosolized ribavirin treatment appeared to be safe, and trends of decreasing viral load over time were observed. However, proof of efficacy remains elusive in hematopoietic cell transplant recipients.
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respiratory syncytial Virus Pneumonia in hospitalized adult patients with leukemia
Clinical Infectious Diseases, 1995Co-Authors: Estella Whimbey, Janet A Englund, Robert B Couch, Michael Andreeff, James Goodrich, Issam I Raad, Victor Lewis, Nadeem Q Mirza, M Luna, Barbara D BaxterAbstract:Respiratory syncytial Virus (RSV) has been demonstrated to be an important cause of life-threatening Pneumonia in adult bone marrow transplant recipients; however, its role in other immunocompromised adults has not been defined. We prospectively studied all adult patients with leukemia who were hospitalized at M. D. Anderson Cancer Center (Houston) during a 1-year period (November 1993 through October 1994). During a 19-week period when RSV was prevalent in the community, it was isolated from 9 (10%) of 87 patients with leukemia who developed an acute respiratory illness. In 6 (75%) of 8 patients with profound chemotherapy-induced myelosuppression, the RSV infection was complicated by Pneumonia, with an 83% mortality rate. RSV appears to be an important cause of severe and often fatal Pneumonia in myelosuppressed patients with leukemia.
Naïke Bigé - One of the best experts on this subject based on the ideXlab platform.
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Severe varicella-zoster Virus Pneumonia: a multicenter cohort study
Critical Care, 2017Co-Authors: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke BigéAbstract:Background Pneumonia is a dreaded complication of varicella-zoster Virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired Pneumonia (VZV-CAP). Methods This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32–51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1–3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1–2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO_2/FiO_2) = 150 (80–284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33–2.70); p
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Severe varicella-zoster Virus Pneumonia: a multicenter cohort study
Critical Care, 2017Co-Authors: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke BigéAbstract:Background: Pneumonia is a dreaded complication of varicella-zoster Virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired Pneumonia (VZV-CAP). Methods: This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results: One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32-51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1-3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1-2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO(2)) = 150 (80-284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33-2.70); p < 0.001), oxygen flow at ICU admission (OR 1.25 (1.08-1.45); p = 0.004), and early bacterial co-infection (OR 14.94 (2.00-111.8); p = 0.009) were independently associated with the need for mechanical ventilation. Duration of mechanical ventilation was 14 (7-21) days. ICU and hospital mortality rates were 17% and 24%, respectively. All patients were treated with aciclovir and 10 received adjunctive therapy with steroids. Compared to 60 matched steroid-free controls, patients treated with steroids had a longer mechanical ventilation duration, ICU length of stay, and a similar hospital mortality, but experienced more ICU-acquired infections. Conclusions: Severe VZV-CAP is responsible for an acute pulmonary involvement associated with a significant morbidity and mortality. Steroid therapy did not influence mortality, but increased the risk of superinfection.
Larry J Anderson - One of the best experts on this subject based on the ideXlab platform.
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respiratory syncytial Virus Pneumonia among the elderly an assessment of disease burden
The Journal of Infectious Diseases, 1999Co-Authors: Linda L Han, James P Alexander, Larry J AndersonAbstract:Respiratory syncytial Virus (RSV) is an important cause of acute lower respiratory tract disease among the elderly, but national estimates of the burden of this disease have not been made. To estimate the morbidity, mortality, and medical costs of RSV-associated Pneumonia among US elderly, national hospital discharge data, vital statistics, etiologic studies of adult Pneumonia hospitalizations, and Medicare cost data were reviewed. In the United States, 687,000 hospitalizations and 74,000 deaths caused by Pneumonia occur annually among the elderly; ∼2%-9% of these are caused by RSV. At a cost of $11,000 per RSV Pneumonia hospitalization, the estimated annual cost of RSV Pneumonia hospitalizations is $150-$680 million. Exacerbations of congestive heart failure and other chronic conditions may also contribute substantially to RSV disease burden among the elderly. The total RSV disease burden is probably great enough to justify development of an RSV vaccine for use in this group.
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respiratory syncytial Virus Pneumonia among the elderly an assessment of disease burden
The Journal of Infectious Diseases, 1999Co-Authors: Linda L Han, James P Alexander, Larry J AndersonAbstract:Respiratory syncytial Virus (RSV) is an important cause of acute lower respiratory tract disease among the elderly, but national estimates of the burden of this disease have not been made. To estimate the morbidity, mortality, and medical costs of RSV-associated Pneumonia among US elderly, national hospital discharge data, vital statistics, etiologic studies of adult Pneumonia hospitalizations, and Medicare cost data were reviewed. In the United States, 687,000 hospitalizations and 74,000 deaths caused by Pneumonia occur annually among the elderly; approximately 2%-9% of these are caused by RSV. At a cost of $11,000 per RSV Pneumonia hospitalization, the estimated annual cost of RSV Pneumonia hospitalizations is $150-$680 million. Exacerbations of congestive heart failure and other chronic conditions may also contribute substantially to RSV disease burden among the elderly. The total RSV disease burden is probably great enough to justify development of an RSV vaccine for use in this group.
Adrien Mirouse - One of the best experts on this subject based on the ideXlab platform.
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Severe varicella-zoster Virus Pneumonia: a multicenter cohort study
Critical Care, 2017Co-Authors: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke BigéAbstract:Background Pneumonia is a dreaded complication of varicella-zoster Virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired Pneumonia (VZV-CAP). Methods This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32–51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1–3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1–2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO_2/FiO_2) = 150 (80–284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33–2.70); p
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Severe varicella-zoster Virus Pneumonia: a multicenter cohort study
Critical Care, 2017Co-Authors: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke BigéAbstract:Background: Pneumonia is a dreaded complication of varicella-zoster Virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired Pneumonia (VZV-CAP). Methods: This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results: One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32-51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1-3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1-2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO(2)) = 150 (80-284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33-2.70); p < 0.001), oxygen flow at ICU admission (OR 1.25 (1.08-1.45); p = 0.004), and early bacterial co-infection (OR 14.94 (2.00-111.8); p = 0.009) were independently associated with the need for mechanical ventilation. Duration of mechanical ventilation was 14 (7-21) days. ICU and hospital mortality rates were 17% and 24%, respectively. All patients were treated with aciclovir and 10 received adjunctive therapy with steroids. Compared to 60 matched steroid-free controls, patients treated with steroids had a longer mechanical ventilation duration, ICU length of stay, and a similar hospital mortality, but experienced more ICU-acquired infections. Conclusions: Severe VZV-CAP is responsible for an acute pulmonary involvement associated with a significant morbidity and mortality. Steroid therapy did not influence mortality, but increased the risk of superinfection.
