[CIS-PAGID] Treatment of Parainfluenza virus prior to Transplant in SCID

[Kleiner, Gary]

We have had some success utilizing Cidofovir in this setting.  There is an oral cidofovir CMX001 that is undergoing clinical trials in US. You may want to contact the company.
Aside from viral cultures, it would be helpful to obtain viral PCR panels for a multitude of respiratory panels. One lab, Viracor, runs this routinely on a nasal swab/wash.
Parainfluenza type 3 can be quite problematic in the BMT setting.  In general, for a leukemic/metabolic disease child, most centers will wait till URI illness resolves before proceeding to allo transplant. Unfortunately, this is not an option in SCID.


From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Joud Hajjar
Sent: Monday, March 12, 2012 12:01 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Treatment of Parainfluenza virus prior to Transplant in SCID

Dear all,

I'm an Allergy and Immunology fellow at the Virginia Commonwealth University.
I would like to ask for your valuable recommendations for the treatment of Parainfluenza A Virus prior to BMT in patients with SCID
We have a 7 months old biracial (African American and Hispanic) child with suspected (T-B+NK+) SCID (genetic analysis is pending) with no evidence of maternal T cell engraftment
He is currently awaiting transplant, he does not have matched related donor.
He had a Hx of RSV pneumonia before he was referred to us and started on IVIG. In Jan he had a Bronchoscopy with BAL, viral cx was negative for RSV but showed Para-influenza A.
He has been on IVIG and his IgG levels were maintained between 800-1000
He has developed a cough with some new infiltrates on CXR 3 weeks ago, and his repeat Nasopharymgeal viral cx grew Parainfluenza A.
He was empirically covered with PIP/Tazo for possible aspiration pneumonia.
Clinically, he is still having cough, NO O2 requirement or increased work of breathing, his last CXR showed some improvement of the lung infiltrates.

Any recommendations about treatment for Parainfluenza Virus prior to transplant?

Thank you very much.

Respectfully,
Joud Hajjar MD
Virginia Commonwealth University
 McGuire Hall Room 423
Richmond, VA
23223
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