Immunosuppressants Reactions 1680, p172 - 2 Dec 2017 symptoms of URTI on day 3, 4, and 5 post-DFA testing, which disappeared day 7 onwards and lower respiratory symptoms on day 3, 4, 5 and 7 post-DFA testing, which disappeared day 14 onwards. He received palivizumab three days after the Respiratory syncytial virus infection and onset of the symptoms due to his severe reactivation, upper respiratory tract infection and immunocompromised state and rapid progression to lower pneumonia: 2 case reports respiratory tract infection. His respiratory symptoms did not In a study, two patients (girl aged 13 years and boy aged progress and supplemental oxygen was stopped seven days 12 years) were described. Out of these two patients, one after palivizumab initiation. RSV was negative by DFA 12 days patient (girl) developed respiratory syncytial virus (RSV) post-palivizumab treatment. However, RSV remained positive infection reactivation and upper respiratory tract infection by qPCR until discharge. (URTI) during treatment with busulfan, ciclosporin Author comment: "Respiratory syncytial virus (RSV) can be [cyclosporine A] and cyclophosphamide and the other patient associated with severe respiratory tract infections in (boy) developed RSV infection, URTI, lower respiratory tract immunocompromised patients." "We suspected a viral infection and pneumonia during treatment with ciclosporin, reactivation rather than RSV reinfection." cyclophosphamide, methotrexate and methylprednisolone [not all dosage stated; routes not stated]. Torres JP, et al. Intravenous palivizumab in respiratory syncytial virus infection after hematopoietic stem cell transplant in children. Pediatric Blood and Cancer 64: Patient 1: The 13-year-old girl, who was diagnosed with No. 12, Dec 2017. Available from: URL: - acute promyelocytic leukaemia in July 2012 had a second Chile 803284328 relapse. She was planned for a haematopoietic stem cell transplant (HSCT). Two weeks prior to admission, she had symptoms of URTI and RSV was detected by direct fluorescent antibody (DFA). However, her symptoms did not progress. Then, she was started on myeloablative conditioning regimen – – with busulfan 16 mg/kg/total dose on days 6 to 3 (prior to transplant) and cyclophosphamide 60 mg/kg/day on days 2 – – and 1. She also received ciclosporin from day 1 at 200 250 ng/mL for prophylaxis of graft versus host disease (GvHD). She also received other infection prophylaxis regimen. She underwent an matched sibling donor (MSD) HSCT on 9 July 2014. On day +4, she had a febrile neutropenia episode, and was started on meropenem and linezolid due to isolation of Klebsiella pneumonia extended spectrum beta lactamase positive in the urine culture. She completed 13 days of treatment. However, on day +11 post- HSCT, she developed URTI symptoms. The RSV was identified by DFA and confirmed by qPCR. The genotyping test revealed RSV-B (Buenos Aires strain). Viral loads of RSV-RNA were 3.67 and 5.09 log10copies/mL via the nasopharyngeal PCR on day 3 and 4 post DFA testing, respectively. The viral loads of RSV- RNA via blood PCR on day 3 was 4.35 log10copies/mL. The viral loads via nasopharyngeal PCR were negative from day 5 onwards and via blood PCR were negative day 4 onwards. She had symptoms of URTI on day 3 and 4 post-second DFA test and none day 5 onwards. She received palivizumab on day +13 post-transplant. Within 24 hours of administration, a decrease in viral loads in nasopharynx were noted as well as clinical resolution of respiratory symptoms. The infection did not progress to lower respiratory tract. She was engrafted on day +19 post-transplant and was discharged from hospital on day +23. Patient 2: The 12-year-old boy, who was diagnosed with severe aplastic anaemia in January 2012, underwent a MSD HSCT in July 2012 with a conditioning regimen of cyclophosphamide 50 mg/kg/day for 4 days and total nodal irradiation. He also received prophylaxis for GvHD with ciclosporin and methotrexate. He developed multiple post- HSCT complications including 10 episodes of cytomegalovirus (CMV) reactivation, CMV retinitis, unspecified severe adverse reactions to various other drugs and multiple bacterial infections. He was also on various other drugs for infection prophylaxis. His immunosuppressive therapy was intensified with methotrexate weekly and methylprednisolone 1 mg/kg/day 23 months post-transplantation due to extensive chronic GvHD. After one month during hospitalisation, he developed URTI symptoms, which progressed to pneumonia within 48 hours and was administered supplemental oxygen administration. CT scan of chest revealed parenchyma involvement, which was compatible with atypical pneumonia. Nasopharyngeal samples were obtained and tested by DFA and qPCR and detected RSV. Genotype analysis revealed an RSV-A (Ontario strain). The results of RSV-RNA detection in blood were negative. Nasopharyngeal PCR revealed RSV-RNA viral load of 6.47, 7, 6.37 and 5.01 log10copies/mL on day 3, 4, 5, and 14 post-DFA testing, respectively. Also he had 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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