phenylephrine-hydrochloride and Hematologic-Diseases

Respiratory viruses are a cause of upper respiratory tract infections (URTI), but can be associated with severe lower respiratory tract infections (LRTI) in immunocompromised patients. The objective of this study was to investigate the genetic variability of influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) and the duration of viral shedding in hematological patients. Nasopharyngeal swabs from hematological patients were screened for influenza, parainfluenza and RSV on admission as well as on development of respiratory symptoms. Consecutive swabs were collected until viral clearance. Out of 672 tested patients, a total of 111 patients (17%) were infected with one of the investigated viral agents: 40 with influenza, 13 with parainfluenza and 64 with RSV; six patients had influenza/RSV or parainfluenza/RSV co-infections. The majority of infected patients (n = 75/111) underwent stem cell transplantation (42 autologous, 48 allogeneic, 15 autologous and allogeneic). LRTI was observed in 48 patients, of whom 15 patients developed severe LRTI, and 13 patients with respiratory tract infection died. Phylogenetic analysis revealed a variety of influenza A(H1N1)pdm09, A(H3N2), influenza B, parainfluenza 3 and RSV A, B viruses. RSV A was detected in 54 patients, RSV B in ten patients. The newly emerging RSV A genotype ON1 predominated in the study cohort and was found in 48 (75%) of 64 RSV-infected patients. Furthermore, two distinct clusters were detected for RSV A genotype ON1, identical RSV G gene sequences in these patients are consistent with nosocomial transmission. Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation (p = 0.01) and was most pronounced in patients with RSV infection (n = 16) with a median duration of viral shedding for 80 days (range 35-334 days). Long-term shedding of respiratory viruses might be a catalyzer of nosocomial transmission and must be considered for efficient infection control in immunocompromised patients.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Communicable Disease Control; Cross Infection; Female; Genotype; Hematologic Diseases; Humans; Influenza, Human; Male; Middle Aged; Mutation; Nose; Orthomyxoviridae; Parainfluenza Virus 3, Human; Paramyxoviridae Infections; Phylogeny; Polymerase Chain Reaction; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Retrospective Studies; Sequence Analysis, DNA; Time Factors; Transplantation, Homologous; Virus Shedding; Young Adult

Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.

Topics: Adenoviridae; Adenoviridae Infections; Adolescent; Antiviral Agents; Child; Child, Preschool; DNA, Viral; Feces; Ganciclovir; Hematologic Diseases; Humans; Immunosuppressive Agents; Infant; Logistic Models; Nasopharynx; Nose; Polymerase Chain Reaction; Prognosis; Prospective Studies; Risk Factors; Stem Cell Transplantation; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Topics: Adolescent; Adult; Child; Diagnosis, Differential; Epistaxis; Facial Injuries; Female; Hematologic Diseases; Humans; Hypertension; Incidence; India; Male; Neoplasms; Nose; Prospective Studies; Retrospective Studies; Rhinitis, Atrophic

Topics: Adult; Anticoagulants; Arteries; Blood Coagulation Disorders; Craniocerebral Trauma; Epistaxis; Hematologic Diseases; Hemostasis; Humans; Hypertension; Liver Diseases; Methods; Nose; Nose Diseases; Tampons, Surgical

Topics: Anemia; Arteriosclerosis; Deafness; Diagnosis, Differential; Ear; Hemangioma; Hematologic Diseases; Hematoma; Hemophilia A; Histiocytoma, Benign Fibrous; Humans; Infectious Mononucleosis; Leukemia; Nose; Pathology; Pharynx; Polycythemia; Telangiectasis