Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study

Abstract

BackgroundThe incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR. Methods Patients were seen in three contexts: studyspecific screenings covering all seasons; routine posttransplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses.Results One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively ( p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3). Conclusions There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection.

Azithromycin reduces airway inflammation induced by human rhinovirus in lung allograft recipients

“…Previous investigations have illustrated that the duration of RV‐induced viral shedding is approximately 1–2 weeks in immunocompetent individuals but is prolonged for up to 12 months in lung allograft recipients . RV infection in allograft lung is also likely to trigger a secondary infection with other pathogens due to impaired mucociliary function, altered lymphatic drainage as well as absence of cough reflex, increasing the severity of RV infections. To date, a number of clinical studies have associated lower respiratory tract infection with acute rejection and the development of BOS with long‐term declined lung function .…”

Managing Viral Respiratory Tract Infections in Lung Transplant Recipients

“…Suggestive symptoms of RTIs are throat pain or pain on swallowing, rhinorrhea, (dry) cough, fever, and myalgias (10). In LTRs, a number of symptoms should be considered as possible indicators for an early stage of infection, since oligosymptomatic infections do occur.…”

Year in review 2014. Paediatric and adult clinical studies

“…A good example is the study by Bridevaux et al 66 investigating viral infections in lung transplant recipients. These occurred frequently, commonly involved Picornavirus and were associated with temporary reduction in lung function, but not with rejection.…”