Ten years of viral and non-bacterial serology in adults with cystic fibrosis

Abstract

SUMMARYViral infections are associated with pulmonary exacerbations in children with cystic fibrosis (CF), but few studies have addressed the frequency in adults. This paper investigates the frequency and impact of viral infections in adults with CF receiving intravenous antibiotics. Pre-and posttreatment spirometry, inflammatory markers and antibody titres against influenza A, influenza B, adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, Chlamydia psittaci, and Coxiella burnetti were analysed over a 10-year period. Non-bacterial infections were identified in 5 . 1% of 3156 courses of treatment. The annual incidence of admissions per patient associated with viral infection was 4 . 9 %. The presence of viral infection in association with a pulmonary exacerbation did not adversely affect lung function or inflammatory markers in the short term. Adults with CF have a lower incidence of respiratory viral infections associated with pulmonary exacerbations requiring intravenous antibiotics compared to children and infants with CF.

Differential Responses to Rhinovirus- and Influenza-associated Pulmonary Exacerbations in Patients with Cystic Fibrosis

“…Viruses have been detected in 40-52% of patients with pulmonary exacerbations compared with only 9-18% of patients in stable clinical condition (1)(2)(3). Viruses detected include rhinovirus (RV), influenza A/B, respiratory syncytial virus (RSV), parainfluenza, adenovirus and human metapneumovirus, with RV being the most common (1)(2)(3)(4)(5)(6)(7).…”

“…Viruses have been detected in 40-52% of patients with pulmonary exacerbations compared with only 9-18% of patients in stable clinical condition (1)(2)(3). Viruses detected include rhinovirus (RV), influenza A/B, respiratory syncytial virus (RSV), parainfluenza, adenovirus and human metapneumovirus, with RV being the most common (1)(2)(3)(4)(5)(6)(7). Although the frequency of viral isolation is similar in normal healthy control subjects and patients with CF, the clinical impact of viral infection in patients with CF is higher than in control subjects (5,(8)(9)(10).…”

“…Although the frequency of viral isolation is similar in normal healthy control subjects and patients with CF, the clinical impact of viral infection in patients with CF is higher than in control subjects (5,(8)(9)(10). Patients with virus-associated lower respiratory symptoms had a higher frequency of exacerbations and hospitalizations (5,8,9,(11)(12)(13), increased use of antibiotics at longterm follow-up (2,(4)(5)(6)14), and had a shorter time to next pulmonary exacerbation (14). Viral infections also lead to deterioration in clinical status (3,4,6,8,10,11).…”

Diagnosis of respiratory viral infections in cystic fibrosis by PCR using sputum samples

“…Tissue culture and serology were previously used as the standard tools for screening for viral infections, but have disadvantages compared with modern molecular methods, including a lower sensitivity and greater delay before the result is available [7,8]. The prompt and accurate detection of a respiratory virus infection in patients with underlying lung disease is important for a number of reasons.…”

Pseudomonas aeruginosa Suppresses Interferon Response to Rhinovirus Infection in Cystic Fibrosis but Not in Normal Bronchial Epithelial Cells

“…Similarly, RV was also detected in 22 to 58% of virus-associated CF exacerbations (8,11,35,41). Other respiratory viruses detected in CF patients include respiratory syncytial virus, influenza A/B virus, parainfluenza virus, and adenovirus (1,7,8,11,26,35,41). RV infection in CF patients was associated with increased lower respiratory symptoms and required prolonged use of intravenous antibiotics and hospitalization (8,25), suggesting that RV may synergize with existing bacterial flora in exacerbating the disease.…”