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Parainfluenza viruses in adults

Michael G Ison, MD, MS
Section Editor
Martin S Hirsch, MD
Deputy Editor
Anna R Thorner, MD


Parainfluenza viruses are important respiratory pathogens in adults and children. Although parainfluenza viruses are commonly recognized as a significant cause of morbidity and mortality in children, their impact in adults is less well characterized [1]. In adults, parainfluenza viruses usually cause mild upper respiratory infections but can lead to life-threatening lower respiratory tract infections, particularly in immunocompromised patients [2,3].

The virology, clinical manifestations, diagnosis, and treatment of parainfluenza viruses in adults will be reviewed here. Infection with parainfluenza viruses in children is discussed separately. (See "Parainfluenza viruses in children".)


Parainfluenza viruses (PIVs) are single-stranded, enveloped RNA viruses belonging to the genus Paramyxovirus in the Paramyxoviridae family [4]. This family also includes mumps, measles, respiratory syncytial viruses, human metapneumovirus, and Nipah and Hendra viruses [5-7].

Structure — Parainfluenza virions are pleomorphic, range in diameter from 150 to 200 microns, and contain approximately 15,500 nucleotides [5]. The single strand of negative-sense RNA encodes the following viral proteins: nucleocapsid protein (N), phosphoprotein (P), matrix protein (M), fusion glycoprotein (F), hemagglutinin-neuraminidase glycoprotein (HN), and polymerase (L) (figure 1) [5]. In addition, serotype PIV-3 encodes C, D, and V proteins, PIV-1 encodes a C protein, and PIV-2 encodes a V protein.

The HN and F proteins project through the lipid envelope and form the major antigenic targets for neutralizing antibody [8].

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Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2017.
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  1. Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med 2001; 344:1917.
  2. Ison MG. Respiratory viral infections in transplant recipients. Antivir Ther 2007; 12:627.
  3. Russell E, Ison MG. Parainfluenza Virus in the Hospitalized Adult. Clin Infect Dis 2017; 65:1570.
  4. Lambert DM, Barney S, Lambert AL, et al. Peptides from conserved regions of paramyxovirus fusion (F) proteins are potent inhibitors of viral fusion. Proc Natl Acad Sci U S A 1996; 93:2186.
  5. Karron RA, Collins PL. Parainfluenza Viruses. In: Fields Virology, 5th ed, Knipe D, Howley P (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.1497.
  6. Piedra PA, Glezen WP. Respiratory Syncytial Virus and Parainfluenza Viruses. In: Clinical Virology, 2nd ed, Richman DD, Whitley RJ, Hayden FG (Eds), ASM Press, Washington, DC 2002. p.763.
  7. Wright PF. Parainfluenza Viruses. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Elsevier Churchill Livingstone, Philadelphia 2005. p.1998.
  8. Tao T, Durbin AP, Whitehead SS, et al. Recovery of a fully viable chimeric human parainfluenza virus (PIV) type 3 in which the hemagglutinin-neuraminidase and fusion glycoproteins have been replaced by those of PIV type 1. J Virol 1998; 72:2955.
  9. Hamaguchi M, Yoshida T, Nishikawa K, et al. Transcriptive complex of Newcastle disease virus. I. Both L and P proteins are required to constitute an active complex. Virology 1983; 128:105.
  10. Moscona A. Interaction of human parainfluenza virus type 3 with the host cell surface. Pediatr Infect Dis J 1997; 16:917.
  11. Huberman K, Peluso RW, Moscona A. Hemagglutinin-neuraminidase of human parainfluenza 3: role of the neuraminidase in the viral life cycle. Virology 1995; 214:294.
  12. Henrickson KJ, Savatski LL. Genetic variation and evolution of human parainfluenza virus type 1 hemagglutinin neuraminidase: analysis of 12 clinical isolates. J Infect Dis 1992; 166:995.
  13. Castleman WL, Brundage-Anguish LJ, Kreitzer L, Neuenschwander SB. Pathogenesis of bronchiolitis and pneumonia induced in neonatal and weanling rats by parainfluenza (Sendai) virus. Am J Pathol 1987; 129:277.
  14. Porter DD, Prince GA, Hemming VG, Porter HG. Pathogenesis of human parainfluenza virus 3 infection in two species of cotton rats: Sigmodon hispidus develops bronchiolitis, while Sigmodon fulviventer develops interstitial pneumonia. J Virol 1991; 65:103.
  15. Prince GA, Porter DD. Treatment of parainfluenza virus type 3 bronchiolitis and pneumonia in a cotton rat model using topical antibody and glucocorticosteroid. J Infect Dis 1996; 173:598.
  16. Welliver RC, Wong DT, Middleton E Jr, et al. Role of parainfluenza virus-specific IgE in pathogenesis of croup and wheezing subsequent to infection. J Pediatr 1982; 101:889.
  17. Welliver RC, Wong DT, Sun M, McCarthy N. Parainfluenza virus bronchiolitis. Epidemiology and pathogenesis. Am J Dis Child 1986; 140:34.
  18. Einarsson O, Geba GP, Zhu Z, et al. Interleukin-11: stimulation in vivo and in vitro by respiratory viruses and induction of airways hyperresponsiveness. J Clin Invest 1996; 97:915.
  19. Jacoby DB, Xiao HQ, Lee NH, et al. Virus- and interferon-induced loss of inhibitory M2 muscarinic receptor function and gene expression in cultured airway parasympathetic neurons. J Clin Invest 1998; 102:242.
  20. Matsuse H, Kondo Y, Saeki S, et al. Naturally occurring parainfluenza virus 3 infection in adults induces mild exacerbation of asthma associated with increased sputum concentrations of cysteinyl leukotrienes. Int Arch Allergy Immunol 2005; 138:267.
  21. Ansari SA, Springthorpe VS, Sattar SA, et al. Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14. J Clin Microbiol 1991; 29:2115.
  22. Fry AM, Curns AT, Harbour K, et al. Seasonal trends of human parainfluenza viral infections: United States, 1990-2004. Clin Infect Dis 2006; 43:1016.
  23. Marx A, Török TJ, Holman RC, et al. Pediatric hospitalizations for croup (laryngotracheobronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. J Infect Dis 1997; 176:1423.
  24. Chew FT, Doraisingham S, Ling AE, et al. Seasonal trends of viral respiratory tract infections in the tropics. Epidemiol Infect 1998; 121:121.
  25. CDC: The National Respiratory and Enteric Virus Surveillance System (NREVSS) http://www.cdc.gov/surveillance/nrevss/human-paraflu/natl-trend.html (Accessed on November 24, 2008).
  26. Falsey AR, Walsh EE. Viral pneumonia in older adults. Clin Infect Dis 2006; 42:518.
  27. Kim YJ, Boeckh M, Englund JA. Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med 2007; 28:222.
  28. Wendt CH, Weisdorf DJ, Jordan MC, et al. Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med 1992; 326:921.
  29. Nichols WG, Corey L, Gooley T, et al. Parainfluenza virus infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood 2001; 98:573.
  30. Vilchez RA, Dauber J, McCurry K, et al. Parainfluenza virus infection in adult lung transplant recipients: an emergent clinical syndrome with implications on allograft function. Am J Transplant 2003; 3:116.
  31. Chemaly RF, Hanmod SS, Rathod DB, et al. The characteristics and outcomes of parainfluenza virus infections in 200 patients with leukemia or recipients of hematopoietic stem cell transplantation. Blood 2012; 119:2738.
  32. Parainfluenza infections in the elderly 1976-82. Br Med J (Clin Res Ed) 1983; 287:1619.
  33. Parainfluenza outbreaks in extended-care facilities -- United States. MMWR Morb Mortal Wkly Rep 1978; 27:475.
  34. Glasgow KW, Tamblyn SE, Blair G. A respiratory outbreak due to parainfluenza virus type 3 in a home for the aged--Ontario. Can Commun Dis Rep 1995; 21:57.
  35. Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest 2008; 134:1141.
  36. Angeles Marcos M, Camps M, Pumarola T, et al. The role of viruses in the aetiology of community-acquired pneumonia in adults. Antivir Ther 2006; 11:351.
  37. Diederen BM, Van Der Eerden MM, Vlaspolder F, et al. Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia. Scand J Infect Dis 2009; 41:45.
  38. Johnston NW. The similarities and differences of epidemic cycles of chronic obstructive pulmonary disease and asthma exacerbations. Proc Am Thorac Soc 2007; 4:591.
  39. Hansbro NG, Horvat JC, Wark PA, Hansbro PM. Understanding the mechanisms of viral induced asthma: new therapeutic directions. Pharmacol Ther 2008; 117:313.
  40. Gwaltney JM Jr, Scheld WM, Sande MA, Sydnor A. The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis: a fifteen-year experience at the University of Virginia and review of other selected studies. J Allergy Clin Immunol 1992; 90:457.
  41. Arisoy ES, Demmler GJ, Thakar S, Doerr C. Meningitis due to parainfluenza virus type 3: report of two cases and review. Clin Infect Dis 1993; 17:995.
  42. Wilks D, Burns SM. Myopericarditis associated with parainfluenza virus type 3 infection. Eur J Clin Microbiol Infect Dis 1998; 17:363.
  43. Román G, Phillips CA, Poser CM. Parainfluenza virus type 3: isolation from CSF of a patient with Guillain-Barré syndrome. JAMA 1978; 240:1613.
  44. Kumar D, Husain S, Chen MH, et al. A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients. Transplantation 2010; 89:1028.
  45. Campbell AP, Chien JW, Kuypers J, et al. Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT. J Infect Dis 2010; 201:1404.
  46. Weinberg A, Lyu DM, Li S, et al. Incidence and morbidity of human metapneumovirus and other community-acquired respiratory viruses in lung transplant recipients. Transpl Infect Dis 2010; 12:330.
  47. Whimbey E, Bodey GP. Viral pneumonia in the immunocompromised adult with neoplastic disease: the role of common community respiratory viruses. Semin Respir Infect 1992; 7:122.
  48. Madhi SA, Ramasamy N, Petersen K, et al. Severe lower respiratory tract infections associated with human parainfluenza viruses 1-3 in children infected and noninfected with HIV type 1. Eur J Clin Microbiol Infect Dis 2002; 21:499.
  49. Peck AJ, Englund JA, Kuypers J, et al. Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007; 110:1681.
  50. Nichols WG, Gooley T, Boeckh M. Community-acquired respiratory syncytial virus and parainfluenza virus infections after hematopoietic stem cell transplantation: the Fred Hutchinson Cancer Research Center experience. Biol Blood Marrow Transplant 2001; 7 Suppl:11S.
  51. Nichols WG, Erdman DD, Han A, et al. Prolonged outbreak of human parainfluenza virus 3 infection in a stem cell transplant outpatient department: insights from molecular epidemiologic analysis. Biol Blood Marrow Transplant 2004; 10:58.
  52. Zambon M, Bull T, Sadler CJ, et al. Molecular epidemiology of two consecutive outbreaks of parainfluenza 3 in a bone marrow transplant unit. J Clin Microbiol 1998; 36:2289.
  53. Vilchez R, McCurry K, Dauber J, et al. Influenza and parainfluenza respiratory viral infection requiring admission in adult lung transplant recipients. Transplantation 2002; 73:1075.
  54. Kuo E, Bharat A, Goers T, et al. Respiratory viral infection in obliterative airway disease after orthotopic tracheal transplantation. Ann Thorac Surg 2006; 82:1043.
  55. Winter JB, Gouw AS, Groen M, et al. Respiratory viral infections aggravate airway damage caused by chronic rejection in rat lung allografts. Transplantation 1994; 57:418.
  56. Billings JL, Hertz MI, Savik K, Wendt CH. Respiratory viruses and chronic rejection in lung transplant recipients. J Heart Lung Transplant 2002; 21:559.
  57. Garbino J, Gerbase MW, Wunderli W, et al. Respiratory viruses and severe lower respiratory tract complications in hospitalized patients. Chest 2004; 125:1033.
  58. Erard V, Chien JW, Kim HW, et al. Airflow decline after myeloablative allogeneic hematopoietic cell transplantation: the role of community respiratory viruses. J Infect Dis 2006; 193:1619.
  59. Ferguson PE, Sorrell TC, Bradstock K, et al. Parainfluenza virus type 3 pneumonia in bone marrow transplant recipients: multiple small nodules in high- resolution lung computed tomography scans provide a radiological clue to diagnosis. Clin Infect Dis 2009; 48:905.
  60. Sung RY, Chan PK, Choi KC, et al. Comparative study of nasopharyngeal aspirate and nasal swab specimens for diagnosis of acute viral respiratory infection. J Clin Microbiol 2008; 46:3073.
  61. Leland DS. Parainfluenza and Mumps Viruses. In: Manual of Clinical Microbiology, Murray PR, Baron EJ, Jorgensen JH, et al (Eds), ASM Press, Washington, DC 2007. p.1352.
  62. Engler HD, Preuss J. Laboratory diagnosis of respiratory virus infections in 24 hours by utilizing shell vial cultures. J Clin Microbiol 1997; 35:2165.
  63. Kuypers J, Wright N, Ferrenberg J, et al. Comparison of real-time PCR assays with fluorescent-antibody assays for diagnosis of respiratory virus infections in children. J Clin Microbiol 2006; 44:2382.
  64. Mahony JB. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev 2008; 21:716.
  65. Fan J, Henrickson KJ. Rapid diagnosis of human parainfluenza virus type 1 infection by quantitative reverse transcription-PCR-enzyme hybridization assay. J Clin Microbiol 1996; 34:1914.
  66. Fan J, Henrickson KJ, Savatski LL. Rapid simultaneous diagnosis of infections with respiratory syncytial viruses A and B, influenza viruses A and B, and human parainfluenza virus types 1, 2, and 3 by multiplex quantitative reverse transcription-polymerase chain reaction-enzyme hybridization assay (Hexaplex). Clin Infect Dis 1998; 26:1397.
  67. Liolios L, Jenney A, Spelman D, et al. Comparison of a multiplex reverse transcription-PCR-enzyme hybridization assay with conventional viral culture and immunofluorescence techniques for the detection of seven viral respiratory pathogens. J Clin Microbiol 2001; 39:2779.
  68. Templeton KE, Scheltinga SA, Beersma MF, et al. Rapid and sensitive method using multiplex real-time PCR for diagnosis of infections by influenza a and influenza B viruses, respiratory syncytial virus, and parainfluenza viruses 1, 2, 3, and 4. J Clin Microbiol 2004; 42:1564.
  69. Li PQ, Yang ZF, Chen JX, et al. Simultaneous detection of different respiratory virus by a multiplex reverse transcription polymerase chain reaction combined with flow-through reverse dot blotting assay. Diagn Microbiol Infect Dis 2008; 62:44.
  70. Pabbaraju K, Wong S, Tokaryk KL, et al. Comparison of the Luminex xTAG respiratory viral panel with xTAG respiratory viral panel fast for diagnosis of respiratory virus infections. J Clin Microbiol 2011; 49:1738.
  71. Pierce VM, Elkan M, Leet M, et al. Comparison of the Idaho Technology FilmArray system to real-time PCR for detection of respiratory pathogens in children. J Clin Microbiol 2012; 50:364.
  72. Krunic N, Merante F, Yaghoubian S, et al. Advances in the diagnosis of respiratory tract infections: role of the Luminex xTAG respiratory viral panel. Ann N Y Acad Sci 2011; 1222:6.
  73. Endimiani A, Hujer KM, Hujer AM, et al. Are we ready for novel detection methods to treat respiratory pathogens in hospital-acquired pneumonia? Clin Infect Dis 2011; 52 Suppl 4:S373.
  74. Elizaga J, Olavarria E, Apperley J, et al. Parainfluenza virus 3 infection after stem cell transplant: relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32:413.
  75. Chakrabarti S, Collingham KE, Holder K, et al. Parainfluenza virus type 3 infections in hematopoetic stem cell transplant recipients: response to ribavirin therapy. Clin Infect Dis 2000; 31:1516.
  76. Cobian L, Houston S, Greene J, Sinnott JT. Parainfluenza virus respiratory infection after heart transplantation: successful treatment with ribavirin. Clin Infect Dis 1995; 21:1040.
  77. Wright JJ, O'driscoll G. Treatment of parainfluenza virus 3 pneumonia in a cardiac transplant recipient with intravenous ribavirin and methylprednisolone. J Heart Lung Transplant 2005; 24:343.
  78. Casey J, Morris K, Narayana M, et al. Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 2013; 48:1558.
  79. Alymova IV, Portner A, Takimoto T, et al. The novel parainfluenza virus hemagglutinin-neuraminidase inhibitor BCX 2798 prevents lethal synergism between a paramyxovirus and Streptococcus pneumoniae. Antimicrob Agents Chemother 2005; 49:398.
  80. Alymova IV, Taylor G, Takimoto T, et al. Efficacy of novel hemagglutinin-neuraminidase inhibitors BCX 2798 and BCX 2855 against human parainfluenza viruses in vitro and in vivo. Antimicrob Agents Chemother 2004; 48:1495.
  81. Moscona A, Porotto M, Palmer S, et al. A recombinant sialidase fusion protein effectively inhibits human parainfluenza viral infection in vitro and in vivo. J Infect Dis 2010; 202:234.
  82. Chen YB, Driscoll JP, McAfee SL, et al. Treatment of parainfluenza 3 infection with DAS181 in a patient after allogeneic stem cell transplantation. Clin Infect Dis 2011; 53:e77.
  83. Guzmán-Suarez BB, Buckley MW, Gilmore ET, et al. Clinical potential of DAS181 for treatment of parainfluenza-3 infections in transplant recipients. Transpl Infect Dis 2012; 14:427.
  84. Chalkias S, Mackenzie MR, Gay C, et al. DAS181 treatment of hematopoietic stem cell transplant patients with parainfluenza virus lung disease requiring mechanical ventilation. Transpl Infect Dis 2014; 16:141.
  85. Drozd DR, Limaye AP, Moss RB, et al. DAS181 treatment of severe parainfluenza type 3 pneumonia in a lung transplant recipient. Transpl Infect Dis 2013; 15:E28.
  86. Ottolini MG, Hemming VG, Piazza FM, et al. Topical immunoglobulin is an effective therapy for parainfluenza type 3 in a cotton rat model. J Infect Dis 1995; 172:243.
  87. Bitko V, Musiyenko A, Shulyayeva O, Barik S. Inhibition of respiratory viruses by nasally administered siRNA. Nat Med 2005; 11:50.
  88. Siegel JD, Rhinehart E, Jackson M, et al. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65.