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Clin Infect Dis. The Natural History of Influenza Infection in the Severely Immunocompromised versus Non-Immunocompromised Hosts
[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]
The Natural History of Influenza Infection in the Severely Immunocompromised versus Non-Immunocompromised Hosts
Matthew J. Memoli 1,*, Rani Athota 1, Susan Reed 1, Lindsay Czajkowski 1, Tyler Bristol 1, Kathleen Proudfoot 1, Rachel Hagey 1, Jocelyn Voell 2, Charles Fiorentino 2, Angela Ademposi 3, Shmuel Shoham 4, and Jeffery K. Taubenberger 1
Author Affiliations: <SUP>1</SUP>Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases <SUP>2</SUP>Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892 USA <SUP>3</SUP>Department of Infectious Diseases, Medstar Washington Hospital Center, Washington, DC 20010 USA <SUP>4</SUP>Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 USA
*Correspondence: Matthew J. Memoli, M.D., M.S. Director, Clinical Studies Unit, Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 3203 33 North Dr. Bethesda, MD 20892-3203, Phone: 301-443-5971, Email: memolim@niaid.nih.gov
Abstract
Introduction.
Medical advances have led to an increase in the world's population of immunosuppressed individuals. The most severely immunocompromised patients are those who have been diagnosed with a hematologic malignancy, solid organ tumor, or who have other conditions that require immunosuppressive therapies and/or solid organ or stem cell transplants.
Materials and Methods.
Medically attended patients with a positive clinical diagnosis of influenza were recruited prospectively and clinically evaluated. Nasal washes and serum were collected. Evaluation of viral shedding, nasal and serum cytokines, clinical illness, and clinical outcomes were performed to compare severely immunocompromised individuals to non-immunocompromised individuals with influenza infection.
Results.
Immunocompromised patients with influenza had more severe disease/complications, longer viral shedding, and more antiviral resistance while demonstrating less clinical symptoms and signs on clinical assessment.
Conclusion.
Immunocompromised patients are at risk for more severe or complicated influenza induced disease, which may be difficult to prevent with existing vaccines and antiviral treatments. Specific issues to consider when managing a severely immunocompromised host include the development of asymptomatic shedding, multi-drug resistance during prolonged antiviral therapy, and the potential high risk of pulmonary involvement.
Received September 4, 2013. Accepted October 24, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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The Natural History of Influenza Infection in the Severely Immunocompromised versus Non-Immunocompromised Hosts
Matthew J. Memoli 1,*, Rani Athota 1, Susan Reed 1, Lindsay Czajkowski 1, Tyler Bristol 1, Kathleen Proudfoot 1, Rachel Hagey 1, Jocelyn Voell 2, Charles Fiorentino 2, Angela Ademposi 3, Shmuel Shoham 4, and Jeffery K. Taubenberger 1
Author Affiliations: <SUP>1</SUP>Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases <SUP>2</SUP>Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892 USA <SUP>3</SUP>Department of Infectious Diseases, Medstar Washington Hospital Center, Washington, DC 20010 USA <SUP>4</SUP>Johns Hopkins University School of Medicine, Baltimore, Maryland 21205 USA
*Correspondence: Matthew J. Memoli, M.D., M.S. Director, Clinical Studies Unit, Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 3203 33 North Dr. Bethesda, MD 20892-3203, Phone: 301-443-5971, Email: memolim@niaid.nih.gov
Abstract
Introduction.
Medical advances have led to an increase in the world's population of immunosuppressed individuals. The most severely immunocompromised patients are those who have been diagnosed with a hematologic malignancy, solid organ tumor, or who have other conditions that require immunosuppressive therapies and/or solid organ or stem cell transplants.
Materials and Methods.
Medically attended patients with a positive clinical diagnosis of influenza were recruited prospectively and clinically evaluated. Nasal washes and serum were collected. Evaluation of viral shedding, nasal and serum cytokines, clinical illness, and clinical outcomes were performed to compare severely immunocompromised individuals to non-immunocompromised individuals with influenza infection.
Results.
Immunocompromised patients with influenza had more severe disease/complications, longer viral shedding, and more antiviral resistance while demonstrating less clinical symptoms and signs on clinical assessment.
Conclusion.
Immunocompromised patients are at risk for more severe or complicated influenza induced disease, which may be difficult to prevent with existing vaccines and antiviral treatments. Specific issues to consider when managing a severely immunocompromised host include the development of asymptomatic shedding, multi-drug resistance during prolonged antiviral therapy, and the potential high risk of pulmonary involvement.
Received September 4, 2013. Accepted October 24, 2013.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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