Viral Respiratory Infections in Hematological Patients
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REVIEW
Viral Respiratory Infections in Hematological Patients Giovanni Gabutti
. Francesco De Motoli . Federica Sandri .
Maria Vittoria Toffoletto . Armando Stefanati
Received: March 31, 2020 Ó The Author(s) 2020
ABSTRACT Viral infections of the respiratory system represent one of the most important complications in hematological patients in terms of both the severity of the clinical picture and its related impact on the duration of hospitalization, and of mortality. The most implicated viruses are those that commonly cause community-based respiratory diseases: respiratory syncytial virus, Influenza virus and rhinovirus. However, in some cases the clinical picture may be triggered by first infection with or reactivation of pathogens normally not responsible for clinically relevant diseases in immunocompetent subjects. This issue is currently being taken into
greater consideration within the scientific community. However, the strong heterogeneity in the epidemiology and clinical expression of these infections and the lack of adequate therapeutic options imply that there is currently no uniform consensus on the best management of these patients. The main purpose of this review is to highlight which viruses are currently most implicated in the onset of these infections, what is their incidence in so heterogeneous and fragile patients and the factors that lead to disease’s onset and evolution. Possible or available clinical management options, diagnostic and therapeutic tools, and preventive and prophylaxis measures are also discussed.
Keywords: Cancer; Hematological malignancy; Immunocompromised; Respiratory viral infections; Stem cell transplantation
Enhanced Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare. 12497915. G. Gabutti (&) A. Stefanati Department of Medical Sciences, University of Ferrara, Ferrara, Italy e-mail: [email protected] F. De Motoli F. Sandri M. V. Toffoletto Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
Infect Dis Ther
Key Summary Points Respiratory viral infections represent one of the most feared complications in the hematological patient in terms of both clinical severity and mortality. Influenza (IFV) and parainfluenza viruses (PIV), respiratory syncytial virus (RSV), adenovirus (AdV), rhinovirus (RhV) and coronavirus (CoV) are the most relevant agents involved in respiratory infections. Respiratory infections in immunocompromised patients have an initial involvement of the upper respiratory tract; the feared progression to the lower respiratory tract is strictly related to clinical conditions of patients as well as several risk factors. Defining effective therapeutic and prophylactic strategies is challenging, especially considering the variability spectrum of onco-hematological patients and the variety of respiratory viruses involved. Although the scientific community recognizes the relevance of these infections, there is no uniform consensus on available clinical ma
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