Respiratory viruses and severe lower respiratory tract complications in hospitalized patients.
BACKGROUND
Acute respiratory viral infections are generally self-limited in healthy subjects but can lead to severe complications in immunocompromised hosts. We report the clinical impact of acute lower respiratory tract viral infections in hospitalized patients.


METHODS
Of 1,001 fiberoptic bronchoscopies performed during a period of 5 years, 33 BAL samples were positive for respiratory viruses by cell culture. The main diagnosis, length of hospitalization, response to initial treatment, and the mortality rate at 30 days were analyzed. Spirometry performed before and after infection was compared in lung transplant recipients.


RESULTS
The following respiratory viruses were identified in 33 cases: influenza A or B (n = 13), parainfluenza virus 1-3 (n = 7), rhinovirus (n = 5), respiratory syncytial virus (n = 4), and adenovirus (n = 4). All cases were immunocompromised patients who acquired new respiratory symptoms and/or radiologic abnormalities suggesting a pulmonary infection. Twenty-five patients (74%) did not respond to initial broad-spectrum antibiotics, and 11 patients (33%) required intensive care for respiratory failure. The overall mortality rate at 1 month was 24%. In patients with a sole viral pathogen identified in their BAL, the mortality rate was 39%. In lung transplant recipients (n = 10), the mean FEV(1) decreased from 2.2 to 1.9 L/s before and during the infection episode, respectively (p < 0.01); 3 months later, 60% of the patients had still not completely recovered to baseline values.


CONCLUSIONS
Respiratory viruses recovered in BAL samples of immunocompromised patients are associated with severe lower respiratory complications. In lung transplant recipients, we observed a persisting impairment of pulmonary function.
Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland.
Jorge
J
Garbino
Margaret W
MW
Gerbase
Werner
W
Wunderli
Lenka
L
Kolarova
Laurent P
LP
Nicod
Thierry
T
Rochat
Laurent
L
Kaiser
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000175:diagnosis / Q000821:virology; D005260:Female; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000821:virology; D015996:Survival Rate; D014777:Virus Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000821:virology