Chronic rhinoviral infection in lung transplant recipients.
BACKGROUND
Lung transplant recipients are particularly at risk of complications from rhinovirus, the most frequent respiratory virus circulating in the community.


OBJECTIVE
To determine whether lung transplant recipients can be chronically infected by rhinovirus and the potential clinical impact.


METHODS
We first identified an index case, in which rhinovirus was isolated repeatedly, and conducted detailed molecular analysis to determine whether this was related to a unique strain or to re-infection episodes. Transbronchial biopsies were used to assess the presence of rhinovirus in the lung parenchyma. The incidence of chronic rhinoviral infections and potential clinical impact was assessed prospectively in a cohort of 68 lung transplant recipients during 19 mo by screening of bronchoalveolar lavages.


RESULTS
We describe 3 lung transplant recipients with graft dysfunctions in whom rhinovirus was identified by reverse transcriptase-polymerase chain reaction in upper and lower respiratory specimens over a 12-mo period. In two cases, rhinovirus was repeatedly isolated in culture. The persistence of a unique strain in each case was confirmed by sequence analysis of the 5'NCR and VP1 gene. In the index case, rhinovirus was detected in the lower respiratory parenchyma. In the cohort of lung transplant recipients, rhinoviral infections were documented in bronchoalveolar lavage specimens of 10 recipients, and 2 presented with a persistent infection.


CONCLUSIONS
Rhinoviral infection can be persistent in lung transplant recipients with graft dysfunction, and the virus can be detected in the lung parenchyma. Given the potential clinical impact, chronic rhinoviral infection needs to be considered in lung transplant recipients.
Kaiser
Laurent
L
Central Laboratory of Virology, Division of Infectious Diseases, Department of Internal Medicine, University Hospitals of Geneva, Switzerland. laurent.kaiser@hcuge.ch
Aubert
John-David
JD
Pache
Jean-Claude
JC
Deffernez
Christelle
C
Rochat
Thierry
T
Garbino
Jorge
J
Wunderli
Werner
W
Meylan
Pascal
P
Yerly
Sabine
S
Perrin
Luc
L
Letovanec
Igor
I
Nicod
Laurent
L
Tapparel
Caroline
C
Soccal
Paola M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003139:Common Cold / Q000635:transmission*; D005260:Female; D006801:Humans; D008168:Lung / Q000821:virology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012229:Rhinovirus / Q000302:isolation & purification