A Prospective Molecular Surveillance Study Evaluating the Clinical Impact of Community-Acquired Respiratory Viruses in Lung Transplant Recipients

Kumar, Deepali; Husain, Shahid; Chen, Maggie Hong; Moussa, George; Himsworth, David; Manuel, Oriol; Studer, Sean M.; Pakstis, Diana L.; McCurry, Kenneth R.; Doucette, Karen; Pilewski, Joseph M.; Janeczko, Richard; Humar, Atul

doi:10.1097/tp.0b013e3181d05a71

Cited by 156 publications

(191 citation statements)

References 22 publications

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“…A significantly higher rate of local adverse events was seen with ID vaccine. These included erythema (p < 0.001), induration (p < 0.001), tenderness (p < 0.001) and 3 Confidence interval per 500 mg increase in MMF dose. Analysis excludes seven patients on Myfortic.…”

Section: Hla Alloantibody and Vaccine Safetymentioning

confidence: 99%

“…In addition to increased rates of lower respiratory infection with influenza, studies have also reported increased acute and chronic allograft rejection after infection, specifically in lung and kidney transplant recipients (1,(3)(4)(5). Therefore, SOT patients are recommended to receive the annual trivalent inactivated influenza vaccine (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

Baluch

Humar

Eurich

et al. 2013

American Journal of Transplantation

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The immunogenicity of standard intramuscular (IM) influenza vaccine is suboptimal in transplant recipients. Also, recent studies suggest that alloantibody may be upregulated due to vaccination. We evaluated a novel high-dose intradermal (ID) vaccine strategy. In conjunction, we assessed alloimmunity. Transplant recipients were randomized to receive IM or high-dose ID vaccine. Strain-specific serology and HLA alloantibody production was determined pre-and postimmunization. In 212 evaluable patients (105 IM, 107 ID), seroprotection to H1N1, H3N2 and B strains was 70.5%, 63.8% and 52.4% in the IM group, and 71.0%, 70.1%, 63.6% in the ID group (p = ns). Seroconversion to ≥1 antigen was 46.7% and 51.4% in the IM and ID groups respectively (p = 0.49). Response was more likely in those ≥6 months posttransplant (53.2% vs. 19.2%; p = 0.001). Use of mycophenolate mofetil was inversely associated with vaccine response in a dose-dependent manner (p < 0.001). Certain organ subgroups had higher response rates for influenza B in the ID vaccine group. Differences in anti-HLA antibody production were detected in only 3/212(1.4%) patients with no clinical consequences. High-dose intradermal vaccine is an alternative to standard vaccine and has potential enhanced immunogenicity in certain subgroups. In this large cohort, we also show that seasonal influenza does not result in significant alloantibody production.

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Section: Hla Alloantibody and Vaccine Safetymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

Baluch

Humar

Eurich

et al. 2013

American Journal of Transplantation

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“…It is also a commonly detected copathogen identified in 24% and 30% of mixed viral and bacterial infections, respectively [3,4]. Rhinovirus infection might contribute to serious complications such as obliterative bronchiolitis and acute graft rejection in lung and stem-cell transplant recipients [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Prolonged shedding of rhinovirus and re-infection in adults with respiratory tract illness

et al. 2014

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Rhinovirus infections occur frequently throughout life and have been reported in about onethird of asymptomatic cases. The clinical significance of sequential rhinovirus infections remains unclear.To determine the incidence and clinical relevance of sequential rhinovirus detections, nasopharyngeal samples from 2485 adults with acute cough/lower respiratory illness were analysed. Patients were enrolled prospectively by general practitioners from 12 European Union countries during three consecutive years (2007)(2008)(2009)(2010). Nasopharyngeal samples were collected at the initial general practitioner consultation and 28 days thereafter and symptom scores were recorded by patients over that period.Rhinovirus RNA was detected in 444 (18%) out of 2485 visit one samples and in 110 (4.4%) out of 2485 visit two respiratory samples. 21 (5%) of the 444 patients had both samples positive for rhinovirus. Genotyping of both virus detections was successful for 17 (81%) out of 21 of these patients. Prolonged rhinovirus shedding occurred in six (35%) out of 21 and re-infection with a different rhinovirus in 11 (65%) out of 21. Rhinovirus re-infections were significantly associated with chronic obstructive pulmonary disease (p50.04) and asthma (p50.02) and appeared to be more severe than prolonged infections.Our findings indicate that in immunocompetent adults rhinovirus re-infections are more common than prolonged infections, and chronic airway comorbidities might predispose to more frequent rhinovirus re-infections. @ERSpublications Chronic airway comorbidities might predispose to more frequent rhinovirus re-infections in immunocompetent adults

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“…The most common chest computed tomography finding is ground-glass attenuation; centrilobular nodules measuring 3 to 10 mm, including a tree-in-bud appearance, can also be seen (9).…”

Section: Clinical and Radiologic Presentationmentioning

confidence: 99%

Managing Viral Respiratory Tract Infections in Lung Transplant Recipients

Schuurmans¹,

Benden²,

Huber³

2015

Eurasian J Pulmonol

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Lung transplant recipients require life-long profound immunosuppression, making them prone to respiratory tract infections (RTIs), in particular viral infections, during the winter season. Since RTIs may have severe consequences, of which acute or chronic allograft dysfunction is feared most, early diagnosis and treatment are recommended. Patients monitor lung function daily at home and are instructed to contact the transplant center in case of signs and symptoms suspicious of RTIs. We then obtain nasopharyngeal swabs for viral and bacteriological examination and initiate pre-emptive treatment with antivirals, broadband antibiotics, and sometimes intravenous immunoglobulins. Treatment duration is guided by virology sampling results. As preventive measures, we provide vaccination against seasonal influenza for patients and household contacts and recommend specific daily hygiene measures. Keywords: Antibiotic, antivirals, immunosuppression, lung transplantation, viral infection ÖzetAkciğer nakil olguları, hayat boyu yoğun bir immünsuresif tedavi almak zorundadırlar. Bu tedavi onları, özellikle kış döneminde, başta viral nedenler olmak üzere, solunum yolu enfeksiyonlarına (SYE) yatkın hale getirir. Solunum yolu enfeksiyonlarının, akut veya kronik allograft rejeksiyonu gibi çok ağır ve korkulan sonuçları olabileceği için, erken tanı ve tedavi önerilmektedir. Tüm akciğer nakil olguları evlerinde gün-lük solunum fonksiyonu takibi yaparlar. Bu takip sırasında SYE şüphesi doğuracak semptom ve bulgular görüldüğünde nakil merkezi ile hemen bağlantı kurmaları konusunda eğitimlidirler. Nakil merkezine SYE şüphesi ile başvuran hastadan viral ve bakteriyolojik inceleme için nazofarengeal sürüntü alınır. Sonrasında önlem olarak geniş spektrumlu antibiyotik, antiviral ve intravenöz immünglobülin tedavi başlanır. Tedavi süresi virolojik örneklemelerin sonuçlarına göre belirlenir. Ayrıca SYE'den korunmak için tüm nakil olgularımıza ve ev içi temaslılarına mevsimsel influenza aşısı yapılır ve özel hijyen önlemleri önerilir.

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A Prospective Molecular Surveillance Study Evaluating the Clinical Impact of Community-Acquired Respiratory Viruses in Lung Transplant Recipients

Abstract: Community-acquired RVIs are frequently detected in BAL samples from lung transplant patients. In a significant percentage of patients, symptomatic or asymptomatic viral infection is a trigger for acute rejection and obliterative bronchiolitis/BOS.

Cited by 156 publications

References 22 publications

Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

Prolonged shedding of rhinovirus and re-infection in adults with respiratory tract illness

Managing Viral Respiratory Tract Infections in Lung Transplant Recipients

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