Clinical manifestations of exacerbations of cystic fibrosis associated with nonbacterial infections

Abstract

The purpose of this study was to determine whether acute pulmonary exacerbations of cystic fibrosis associated with nonbacterial infections are clinically distinguishable from other exacerbations. Eighty exacerbations in 54 patients were studied. Exacerbations associated with influenza (n = 8) were compared with those associated with other nonbacterial infections (n = 15) and those in which no nonbacterial infection was detected (n = 57). Patients with influenza had lower Shwachman scores and were more likely to be seropositive for C-reactive protein than patients in the other two groups. Patients with influenza had a mean decrease in forced expiratory volume per second of 26%, compared with test results obtained before the exacerbation. In contrast, the mean decrease in forced expiratory volume per second was 6% for other nonbacterial infections and 12% for the group without nonbacterial infection (p less than 0.05 for both comparisons). The forced expiratory flow in first 25% of vital capacity decreased 44% in the influenza group compared with 13% and 17% in the other two groups, respectively (p less than 0.01 for both comparisons). The influenza group also had a higher proportion of patients with at least a 20% decrease in forced expiratory volume per second and forced expiratory flow in first 25% of vital capacity than the other two groups had (p less than 0.05 for all comparisons). These data suggest that influenza is associated with severe exacerbations in patients with cystic fibrosis and support recommendations for efforts to prevent influenza in this population.

Viral Respiratory Tract Infections in Cystic Fibrosis

“…They achieved the highest detection rate of 46% amongst all existing literature concerning respiratory viruses in the CF population during reported episodes of respiratory illness. The results compare favourably with previous studies and this may be that earlier studies relied heavily on repeated serological testing, either alone (Petersen, Hoiby et al 1981) or in combination with viral isolation (Wang, Prober et al 1984;Ramsey, Gore et al 1989;Pribble, Black et al 1990;Armstrong, Grimwood et al 1998;Hiatt, Grace et al 1999). They also achieved a viral detection rate of 18.3% from routine nasal samples and this is comparable to the seroconversion rate of 12.3% as reported by Wang et al (Wang, Prober et al 1984).…”

“…Early studies looking at respiratory viruses in CF relied on repeated serological testing, either alone (Petersen, Hoiby et al 1981) or in combination with viral cultures for viral detection (Wang, Prober et al 1984;Ramsey, Gore et al 1989;Pribble, Black et al 1990;Armstrong, Grimwood et al 1998;Hiatt, Grace et al 1999). These methods are relatively insensitive and more recent studies have utilised PCR based methodologies (Smyth, Smyth et al 1995;Collinson, Nicholson et al 1996;Punch, Syrmis et al 2004;Olesen, Nielsen et al 2006;).…”

“…Pribble et al (Pribble, Black et al 1990) assessed acute pulmonary exacerbation isolates from 54 patients with CF. Over the year of the study, 80 exacerbations were identified, of which 21 episodes were associated with an identified viral agent (influenza A-5 episodes; influenza B-4 episodes; RSV-3 episodes) with most agents identified on serology.…”

Influenza-Associated Cystic Fibrosis Pulmonary Exacerbations

“…[8][9][10][13][14][15] Furthermore, nearly two-thirds of all initial infections with P aeruginosa have been found to occur during winter months, suggesting that winter respiratory virus season may affect pulmonary host defenses. 16 Although evidence of infl uenza and other respiratory virus infections has also been observed during pulmonary exacerbations, [17][18][19][20] studies to date have not addressed the role of respiratory viruses in the etiology of the exacerbations.…”

Optimization of influenza vaccine delivery to high risk children and adolescents

“…· children with chronic cardiac or pulmonary disorders, including bronchopulmonary dysplasia, cystic fibrosis (3)(4)(5) and asthma severe enough to require regular medical follow-up or hospital care (6); · children who are residents of chronic care facilities; · children with chronic conditions such as diabetes mellitus and other metabolic diseases, cancer, immunodeficiency, immunosuppression due to an underlying disease or therapy, renal disease, and hemoglobinopathy; · children and adolescents with conditions that are treated for long periods with acetylsalicylic acid; and · children infected with the human immunodeficiency virus.…”