Adams R, Christenson J, Petersen F, Beatty P
Blood and Marrow Transplant Program, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
Bone Marrow Transplant. 1999 Sep;24(6):661-4. doi: 10.1038/sj.bmt.1701959.
Respiratory syncytial virus is a common virus which frequently causes severe lower tract disease in immunocompromised patients. The mortality rate in bone marrow transplant patients with lower tract disease varies from 31% to 100%, depending upon the treatment used, time before initiation of treatment, and whether patients are pre- or post-engraftment. Therapy with inhaled ribavirin has been used with limited success in decreasing mortality rate. Because of concern about conversion from upper respiratory tract disease to lower respiratory tract disease, we conducted a pilot study using aerosolized ribavirin in asymptomatic RSV-positive patients. Patients had NP washes performed on a weekly basis during the RSV season, for the presence of RSV. If patients were positive, but asymptomatic, and could have their transplant postponed, they were treated with ribavirin until negative. Patients who could not be postponed received aerosolized ribavirin, and began transplant conditioning. During this study, we performed 145 nasal aspirations for RSV on 25 patients; 10 aspirates were positive in seven asymptomatic patients. All positive events were successfully treated with ribavirin, which cleared the RSV for a minimum of 3 weeks. No patients became symptomatic. Thus, we conclude that ribavirin can clear asymptomatic infections in immunocompromised pediatric transplant patients.
呼吸道合胞病毒是一种常见病毒，常导致免疫功能低下患者发生严重的下呼吸道疾病。患有下呼吸道疾病的骨髓移植患者的死亡率在31%至100%之间，这取决于所采用的治疗方法、开始治疗前的时间以及患者是在植入前还是植入后。吸入利巴韦林治疗在降低死亡率方面取得的成功有限。由于担心上呼吸道疾病转化为下呼吸道疾病，我们对无症状的呼吸道合胞病毒阳性患者进行了一项使用雾化利巴韦林的试点研究。在呼吸道合胞病毒流行季节，每周对患者进行一次鼻咽冲洗，以检测呼吸道合胞病毒的存在。如果患者呈阳性但无症状，且其移植手术可以推迟，则用利巴韦林治疗直至转阴。无法推迟手术的患者接受雾化利巴韦林治疗，并开始进行移植预处理。在这项研究中，我们对25名患者进行了145次呼吸道合胞病毒鼻咽抽吸；7名无症状患者的10次抽吸结果呈阳性。所有阳性病例均成功接受利巴韦林治疗，呼吸道合胞病毒清除至少3周。没有患者出现症状。因此，我们得出结论，利巴韦林可以清除免疫功能低下的儿科移植患者的无症状感染。
