Respiratory syncytial virus pneumonitis in immunocompromised adults: Clinical features and outcome

Background: Though predominantly an infection of children, respiratory syncytial virus (RSV) also infects adults, particularly those with immune compromise. Objectives: To define the clinical spectrum and impact of RSV pneumonitis on hospitalized, immunocompromised adults. Methods: Retrospective chart review. Clinical parameters including premorbid conditions, presentation, radiologic findings, treatment and outcome were examined in a consecutive patients series from an inpatient tertiary-care center. Eleven immunocompromised adults who had undergone bronchoalveolar lavage (BAL) between January 1987 and December 1996 and who had culture-verified RSV pneumonitis were evaluated. Results: This series consisted primarily of patients undergoing chemotherapy or bone marrow transplantation for lymphoma or leukemia. Two were immunosuppressed due to high-dose corticosteroids. A majority (91%) were admitted between November and May, with dyspnea and productive cough. In contrast to earlier studies, there was a paucity of upper respiratory infection symptoms (i.e. sinus congestion, sore throat) and a preponderance of lower respiratory physical exam findings (i.e. wheezing, bibasilar rales). Patients were typically hypoxemic and febrile prior to BAL. Eight demonstrated co-isolates of bacterial or fungi on BAL. The chest radiographs generally revealed diffuse patchy infiltrates, including alveolar opacities. Histology demonstrated diffuse alveolar damage, bronchiolitis with organizing pneumonia, and hyaline membrane formation. Over half required intubation, and 55% died. Although ribavirin therapy may be beneficial in some intubated patients, its overall efficacy cannot be established from this series. Conclusion: RSV is a serious cause of morbidity and mortality in immunocompromised adults. Further development and implementation of an effective vaccine and additional therapeutic interventions are needed.