Managing viral infections in severely immunocompromised patients

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Oncology nurses play a vital role in patient care, including assessment, early recognition of infections, and patient and family education. Providing evidence-based care and education to severely immunocompromised patients requires knowledge about the association between viruses and diseases, the rationale of specific diagnostic tests, and current treatments.

In a presentation at the Oncology Nursing Society 36th Annual Congress, Yazhen Zhong and Maria Luzalie Niangar, M.D. Anderson Cancer Center, Houston, Texas, provided insight into rare types of viruses; disease conditions associated with viruses; limitations of current antiviral management; and explore ongoing research for antiviral treatments.

They noted that despite advances in current antiviral prophylaxis and treatment, viral infections cause significant morbidity and mortality in severely immunocompromised patients, such as those receiving stem cell transplantation. While herpes viruses, the most common causes of viral infections, are well known to oncology nurses, awareness is also necessary of less common infections related to adenoviruses, respiratory viruses, enteroviruses, JC virus, and parvovirus. Certain viral infections may affect multiple organs, making treatment more difficult.

For example, cytomegalovirus can be associated with pneumonia and colitis, and JC virus with multifocal leukoencephalopathy, while stomatitis and mucositis are associated with herpes simplex viruses. Other conditions caused by viral infections that may be more acute or life threatening include pneumonia, pneumonitis, disseminated infection, hemorrhagic cystitis, colitis, posttransplant lymphoproliferative disease (PTLD), encephalitis, progressive multifocal leukoencephalopathy (PML), and bone marrow suppression or graft failure.

Nursing implications include helping to distinguish infection and disease; weighing severity of disease complications; identifying risk factors; understanding diagnostic tests; being aware of current antiviral limitations; being knowledgeable on future treatment direction; and improving patient/family care and education, they concluded.
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