Community acquired respiratory virus infections in cancer patients-Guideline on diagnosis and management by the Infectious Diseases Working Party of the German Society for haematology and Medical Oncology

Abstract

Background: Community acquired viruses (CRVs) may cause severe disease in cancer patients. Thus, efforts should be made to diagnose CRV rapidly and manage CRV infections accordingly.

Methods: A panel of 18 clinicians from the Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology have convened to assess the available literature and provide recommendations on the management of CRV infections including influenza, respiratory syncytial virus, parainfluenza virus, human metapneumovirus and adenovirus.

Results: CRV infections in cancer patients may lead to pneumonia in approximately 30% of the cases, with an associated mortality of around 25%. For diagnosis of a CRV infection, combined nasal/throat swabs or washes/aspirates give the best results and nucleic acid amplification based-techniques (NAT) should be used to detect the pathogen. Hand hygiene, contact isolation and face masks have been shown to be of benefit as general infection management. Causal treatment can be given for influenza, using a neuraminidase inhibitor, and respiratory syncytial virus, using ribavirin in addition to intravenous immunoglobulins. Ribavirin has also been used to treat parainfluenza virus and human metapneumovirus, but data are inconclusive in this setting. Cidofovir is used to treat adenovirus pneumonitis.

Conclusions: CRV infections may pose a vital threat to patients with underlying malignancy. This guideline provides information on diagnosis and treatment to improve the outcome.

Keywords: Influenza; Parainfluenza; Pneumonia; Respiratory syncytial virus; Superinfection; Upper respiratory tract infection.

Fig. 1

A–B: pneumonia caused by influenza, first CT scan (A) and follow-up scan after 4 d (B). The bilateral diffuse ground-glass opacities progress over time to cover most parts of the lung. In addition, consolidations with positive bronchopneumogram develop, indicative of possible bacterial superinfection. C–E: CT scans from three different patients with pneumonia caused by RSV. Again, ground-glass opacities can be found but are of a more patchy character (Fig. 1C). They are often combined with centrilobular nodules (tree-in-bud, Fig. 1D). In some cases, only nodules with a ground-glass character are detected (Fig. 1E). RSV, respiratory syncytial virus.