title: Respiratory nitric oxide levels in experimental human influenza.
abstract: BACKGROUND
  Exhaled oral nitric oxide (NO), a reported marker of inflammation in the respiratory tract, can be elevated by "upper respiratory tract infections." However, the responsible viruses and the time course of this rise in NO are not clear.
  
  
  OBJECTIVE
  To determine the expired nasal and oral NO levels during experimentally induced influenza A infection in 14 healthy volunteers without a history of asthma, rhinitis, or sinusitis.
  
  
  METHODS
  After being housed in individual rooms, susceptible volunteers were inoculated with 10(6) 50% tissue culture infective dose of influenza A/Texas/36/91/(H1N1) virus on a single occasion by intranasal drops. Volunteers remained in the isolation unit for 8 days and returned for follow-up 21 days after inoculation. Symptom scores and nasal washing for viral culture were obtained daily. NO samples from the mouth and nose were obtained on days 0 through 4, 8, and 21 by having the patient perform a slow vital capacity maneuver through a plastic tube into a Mylar balloon.
  
  
  RESULTS
  All patients had influenza virus cultured from nasal washings (12 of 14 on day 1, 14 of 14 by day 5). Patient symptom scores peaked on day 3 (mean+/-SE; 15.4+/-3.2) and returned to baseline by day 8. Preinfection exhaled nasal NO (right, 28.4+/-3.7 parts per billion [ppb]; left, 27.7+/-4.6 ppb) was significantly higher than oral NO (5.8 ppb; p<0.001). Exhaled oral NO was significantly elevated on day 8 postinoculation (12.9+/-0.8 ppb; p<0.01 Bonferroni) and returned to baseline at follow-up. Nasal NO levels showed a slight decrease on days 2 to 4 but returned to baseline by day 8.
  
  
  CONCLUSIONS
  Experimental influenza virus infection can increase oral but not nasal exhaled NO levels. The timing of exhaled NO changes suggests that NO does not contribute to illness manifestations directly.
authors.affiliation: Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia School of Medicine, Charlottesville, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Murphy
authors.forename: T A
authors.initials: TA
authors.lastname: Platts-Mills
authors.forename: M
authors.initials: M
authors.lastname: Lobo
authors.forename: F
authors.initials: F
authors.lastname: Hayden
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009980:Influenza A virus / Q000254:growth & development / Q000302:isolation & purification*; D007251:Influenza, Human / Q000378:metabolism* / Q000821:virology; D008168:Lung / Q000503:physiopathology; D008297:Male; D009061:Mouth Mucosa / Q000378:metabolism / Q000821:virology; D009297:Nasal Mucosa / Q000378:metabolism / Q000821:virology; D009569:Nitric Oxide / Q000378:metabolism*; D012189:Retrospective Studies; D014779:Virus Replication; D014797:Vital Capacity
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide