Influenza and Parainfluenza Infection in Hematopoietic Stem Cell and Solid Organ Transplant Recipients

Abstract

Respiratory viral infections are a cause of morbidity and mortality after stem cell and solid organ transplantation. Most of our knowledge of these viral infections in the transplant population comes from hospitalized patients, which may underrate the incidence and overestimate the severity of disease caused by these respiratory viruses. Besides rhinovirus, influenza and parainfluenza are among the most common viruses affecting transplant recipients. Because clinical presentation of these infections may not be distinctive and the etiology could be broad, the knowledge of the epidemiology of these respiratory viruses coupled with high clinical suspicion and early diagnosis is critical for managing these immunocompromised patients. In this book chapter, we underscore the early recognition of these viral infections, the rapid isolation to prevent hospital spread, the prompt empiric therapy specifically for influenza, the awareness of the risk factors for progression to the lower respiratory tract, and the appreciation of the potential long term impact on pulmonary function in this vulnerable transplant population. In addition to an extensive review of the current literature and update on management, we also discuss specific issues around these respiratory viral infections in patients after transplantation including drug resistance, nosocomial outbreaks, prolonged viral shedding, and future directions in prevention and management.