How to manage HMPV-positive bone marrow transplant recipients?

Question

Hello doctor,

A bone marrow transplant recipient is diagnosed with HMPV pneumonia. Day 100 post-transplant, on immunosuppression. CT shows bilateral ground-glass opacities. Considering Ribavirin, pulmonologist managing respiratory support. Several family members have mild cold symptoms. How should immunosuppression be modified?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Based on your patient's history, he is at high risk for severe respiratory failure and prolonged viral shedding. He likely has moderate to severe lower respiratory tract involvement.

If his chances of graft rejection are low, reduce or hold his Calcineurin inhibitor medicines (Tacrolimus/Cyclosporine). If the risk is high, consider a moderate dose reduction. Ask your doctor about this. Do not stop the medicine suddenly. If the graft rejection risk is low, reduce or discontinue Mycophenolate Mofetil as they can cause a worse viral outcome.

If the patient is on ≥0.5 mg/kg/day of Prednisone, taper to ≤0.25 mg/kg/day. If the patient is already on low-dose steroids, maintain but avoid increasing. Do a blood test: Serum IgG (immunoglobulin G). If IgG levels are low (<400 mg/dL), administer IVIG (intravenous immunoglobulin).

No matter what you do, do it under the supervision of your doctor.

I hope this helps.

Thank you.

Regards.