title: Influenza and parainfluenza respiratory viral infection requiring admission in adult lung transplant recipients.
abstract: BACKGROUND
  Although influenza and parainfluenza viruses commonly cause respiratory tract infections in the community, their incidence and clinical implications in adult lung transplant recipients have received little attention.
  
  
  METHODS
  We performed a retrospective cohort study of influenza and parainfluenza viral infections in adult lung transplant recipients at the University of Pittsburgh Medical Center.
  
  
  RESULTS
  Between January 1989 and March 1999, 39 cases (single-lung 25, double-lung 14) of influenza or parainfluenza respiratory viral infection were identified at a mean of 1.7 years (SD+/-1.4) after transplantation. The mean length of admission was 7 days. The cases included 15 patients with influenza (A, 11; B, 4) and 24 with parainfluenza (para1, 7; para2, 2; para3, 15). The median age at diagnosis was 48 years; there were 19 females and 20 males. Symptoms were reported in 30 patients and lasted for a median of 7 days before admission. These included cough (64%), shortness of breath (56%), and temperature elevation (33%). Chest infiltrates were seen in 14 (36%) patients, and 5 (13%) of them required intubation and mechanical ventilation. Viral pneumonia was diagnosed in 10 (5 influenza and 5 parainfluenza) patients, and concurrent bacterial pneumonia occurred in 4 patients. Transbronchial biopsy was performed in 36 patients, of whom 23 (64%) showed some degree of acute allograft rejection.
  
  
  CONCLUSIONS
  Influenza and parainfluenza respiratory viral infections are associated with significant morbidity in adult lung transplant recipients. Active vaccination programs and the development of new antiviral agents active against these viruses are important for prevention.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, and Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Regis
authors.initials: R
authors.lastname: Vilchez
authors.forename: Kenneth
authors.initials: K
authors.lastname: McCurry
authors.forename: James
authors.initials: J
authors.lastname: Dauber
authors.forename: Aldo
authors.initials: A
authors.lastname: Iacono
authors.forename: Robert
authors.initials: R
authors.lastname: Keenan
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.forename: Shimon
authors.initials: S
authors.lastname: Kusne
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D007902:Length of Stay; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000150:complications* / Q000517:prevention & control / Q000628:therapy; D012189:Retrospective Studies