RESPIRATORY-DISEASE DUE TO PARAINFLUENZA VIRUS IN ADULT BONE-MARROW TRANSPLANT RECIPIENTS

We reviewed the frequency and clinical course of parainfluenza virus ( PIV) infections in 1,173 adult bone marrow transplant (BMT) recipients cared for at The University of Texas M,D. Anderson Cancer Center (Hou ston). Between January 1991 and September 1994, PIV was isolated from the respiratory secretions of 61 (5.2%) of these patients, Thirty-four (56%) of the 61 patients had uncomplicated upper respiratory tract il lnesses and survived. The remaining 27 patients (44%) developed pneumo nia, and the associated mortality was 37% (10 of 27 patients). Twenty- three (85%) of the patients with pneumonia had had preceding upper res piratory illnesses. Of the 10 patients who died, nine died within 100 days after transplantation. Histopathologic examination of lung tissue from seven patients revealed intracytoplasmic viral inclusions in six , a finding consistent with invasive PIV pneumonia, and viral changes in the seventh patient, Seven of the 10 patients who died had other se rious concurrent infections. Of 42 patients who developed PIV infectio n early after transplantation (i,e., <100 days), the frequency of pneu monia was higher among the 18 allogeneic BMT recipients (61%) than amo ng the 24 autologous BMT recipients (42%), and the associated mortalit y was also higher (55% vs, 30%, respectively). PIVs are an important c ause of life-threatening pneumonia in adult BMT recipients, particular ly patients who have recently undergone allogeneic bone marrow transpl antation.