Current management of parainfluenza pneumonitis in immunocompromised patients: a review

Abstract

Parainfluenza viruses (PIV) are common respiratory viruses that belong to the Paramyxoviridae family. PIV infection can lead to a wide variety of clinical syndromes ranging from mild upper respiratory illness to severe pneumonia. Severe disease can be seen in elderly or chronically ill persons and may be fatal in persons with compromised immune systems, particularly children with severe combined immunodeficiency disease syndrome and hematopathic stem cell transplant recipients. At present, there are no licensed antiviral agents for the treatment of PIV infection. Aerosolized or systemic ribavirin in combination with intravenous gamma globulin has been reported in small, uncontrolled series and case reports of immunocompromised patients. A number of agents show antiviral activity in vitro and in animals, but none are currently approved for human use.

Keywords: antiviral agents; immunocompromised host; parainfluenza virus.

Figure 1

Schematic of the parainfluenza virion. © 2005, American Society for Clinical Investigation. Reproduced with permission from Moscona A. Entry of parainfluenza virus into cells as a target for interrupting childhood respiratory disease. J Clin Invest. 2005;115(7):1688–1698. Abbreviation: HN, Hemagglutinin-neuraminidase protein.

Figure 2

Schematic illustration of the parainfluenza life cycle. © 2005, American Society for Clinical Investigation. Reproduced with permission from Moscona A. Entry of parainfluenza virus into cells as a target for interrupting childhood respiratory disease. J Clin Invest. 2005;115(7):1688–1698. Abbreviation: RER, rough endoplasmic reticulum; HPIV, human parainfluenza virus; L, large RNA polymerase protein; M, matrix protein; NP, nucleocapsid protein; P, phosphoprotein.

Figure 3

Percent mortality broken down by treatment group and presence or absence of co-pathogens. Figure © 2001, American Society for Blood and Marrow Transplantation. Adapted with permission from Nichols WG, Gooley T, Boeckh M. Community-acquired respiratory syncytial virus and parainfluenza virus infections after hematopoietic stem cell transplantation: the Fred Hutchinson Cancer Research Center experience. Biol Blood Marrow Transplant. 2001;7 Suppl:11S–15S. Abbreviation: IVIG, intravenous gammaglobulin.