Parainfluenza virus type 3 infections in a hematology unit

Parainfluenza virus type 3 (PIV3) is associated with a high mortality rate in BMT recipients with lower respiratory tract infections. We describe nine patients with hematological malignancies (five having undergone either all ogeneic or autologous stem cell transplantation) identified as having PIV3 infection during a 2-month period in a Hematology Unit. Four patients with infiltrates on chest radiograph received intravenous ribavirin therapy; all survived. The infection was community-acquired in two patients, while noso comial origin of the disease was evident, or presumed, in the remaining sev en. The policy implemented to control the spread of PIV3 was as follows: (1 ) nasopharyngeal samples for antigen detection were obtained from all patie nts presenting,vith respiratory symptoms; (2) all diagnosed (or suspected) PIV3-positive hematological patients were nursed following contact isolatio n precautions, preferably in the Infectious Diseases Unit; and (3) staff we re given further education on hospital hygiene. Our experience shows that i t may be possible to avoid mortality for PIV3 lower respiratory tract infec tion in immunocompromised patients by early commencement of intravenous rib avirin, It is also possible, even without closing the ward, to contain noso comial spread of PIV3 by implementing systematic nasopharyngeal sampling fo r rapid diagnostics, and by strict adherence to cohorting and contact isola tion precautions.