Parainfluenza virus 3 infection after stem cell transplant: Relevance to outcome of rapid diagnosis and ribavirin treatment

All 456 recipients of hemopoietic stem cell transplants (SCT) at the Hammer smith Hospital, London, from January 1990 through September 1996 were revie wed for parainfluenza virus (PIV) infections. Of the 24 (5.3%) PIV type 3 ( PIV3)-infected patients, 10 had upper respiratory tract infection and all s urvived, but 8 of 14 with pneumonia died. A same-day immunofluorescence tes t diagnosed PIV3 infection in 20 (83%) of the 24 cases, but virus culture d iagnosed only 10 (42%) of the 24 cases after a mean delay of 12 days. Eight een PIV3-infected patients first received ribavirin at a median of 3 days a fter onset of symptoms, but, nevertheless, 2 patients shed PIV3 for 4 month s. Six of 10 patients with pneumonia died despite early ribavirin therapy. The cause of death was not established by autopsy; 3 patients had concurren t infections, but in 3, only PIV3 was detected. The value of immunofluoresc ence testing for early diagnosis and treatment of PIV3 infection after SCT is demonstrated, but the outcome was not altered.