Respiratory viral infections in primary immune deficiencies: significance and relevance to clinical outcome in a single BMT unit

Respiratory viral infections are major causes of morbidity and mortality in children with SCID and other primary immunodeficiencies who require BMT, T wenty-two of 73 (30%) such children were admitted with respiratory viral in fections, of whom 13/22 (59%) died. All viruses were detected in nasopharyn geal aspirate (NPA), Virus was only found in BAL in those with LRTI, Eleven of 22 (50%) had paramyxovirus infections, all with severe viral pneumoniti s which worsened post BMT, Five of 11 (45.5%) survived overall. All 11 rece ived aerosolised ribavirin; five of 11 received additional inhaled immunogl obulin and corticosteroid. Three of 5 (60%) survived compared with two of s ix (33.3%) not thus treated. Three of 22 (13.6%) had adenoviruses; one died of disseminated disease, including pneumonia despite intravenous ribavirin , Eleven patients had rhinovirus detected; nine of 11 (82%) were asymptomat ic or coryzal and survived. Two patients with additional severe lung pathol ogies had LRT rhinovirus and died. All patients received intravenous immuno globulin, No treatments resulted in viral clearance without successful T ce ll engraftment, Respiratory viruses, particularly paramyxoviruses and adeno viruses are common, significant pathogens in these patients, significantly worsening outcome of BMT, NPA is an ideal specimen for diagnosis and monito ring of infection. Aggressive treatments may reduce viral replication and d amage. Nebulised immunoglobulin and corticosteroid in LRTI may improve resp iratory function and outcome.