The prevalence of viral infections in children with cystic fibrosis in a tertiary care center in Saudi Arabia

Abstract

Introduction: Studies have shown that pulmonary exacerbations in cystic fibrosis (CF) patients are associated with respiratory viruses. The most common agent causing viral infections in patients with CF before the age of 3 years is respiratory syncytial virus. Objectives: To obtain the prevalence of the different types of viral infection in CF patients and to identify its relation with the type of bacterial infection, (CFTR) mutations and pulmonary function test (PFT). Methodology: A retrospective charts review of 387 patients with CF of all age groups who were screened for the detection of viruses during respiratory exacerbation from the period of January 1,1984 to June 1, 2016. Results: A total of 159 CF patients had pulmonary exacerbation and had viral PCR obtained. Fifty-eight patients (36%) had positive viral PCR. Males were more commonly infected in 30/58 patients (52%) compared to females in 28 patients (48%). Forty-five of 58 patients (78%) were alive and 13 patients (22%) died. Rhinovirus was the most frequently reported viral PCR in 33/74 sample (45%). Out of 74 viral PCR, 41 (55.4%) were during the colder seasons (October–February) and 33 (44.5%) during the warmer seasons (March–September). During viral infection and viral recurrence, there was an increase in bacterial colonization specifically of H. influenza and staphylococcus aureus. The most common CFTR mutation for the CF viral infection is: 3120+1G>A in Intron 16 in 11/57 patients (19%). The Eastern Province had the highest viral infection of 24 out of 57 patients (42%). Follow-up PFT post viral infection showed no significant difference in the type and the severity of PFT compared to the initial PFT during the viral illness. Conclusion: Viral infections contributed to the increase in morbidity and mortality of CF patients in our population, and rhinovirus was the most common causative agent. Viral infections and viral recurrence increased the prevalence of bacterial infection of specific pathogens such as H. in fluenza and S. aureus. Physicians should be aware to prevent progressive lung damage in CF patients by treating the concomitant viral and bacterial infections. Viral infection may be associated with some common CFTR mutations.

Is there a role of viral infection in cystic fibrosis exacerbation in children?

“…Similarly, it was reported as the most common respiratory virus in exacerbations of CF in many other studies. 2,3,6,7 In our study, influenza A virus was detected in only 6.7% of patients although no one had a history of influenza vaccination. Similarly, a French study found that its prevalence was 9%.…”

“…Wat et al 9 didn't find statistical differences between the viral and non-viral groups for bacteria isolation (p=0.909). Charles and 6 Also, Garcia et al 12 has shown that human metapneumovirus behaves similarly to respiratory syncytial virus in CF and leads to an increased risk of hospitalization and exacerbation.…”

Identification of cystic fibrosis transmembrane conductance regulator gene (CFTR) variants

“…17 Interestingly, c.3419T>A )p.Met1140Lys(, which accounted for 7.2% of the cases in this study, has been reported in only one patient in Saudi Arabia, and c.4124A>C )p.His1375Pro( )in 5.8% of our cases( has not been previously reported in Saudi patients with CF. 47 In addition, our study reports variants of the CFTR gene that have not been previously reported in the Saudi population. However, these variants have been reported or published in the literature in other Arab and American populations.…”