Viral and atypical bacterial infections in the outpatient pediatric cystic fibrosis clinic.
BACKGROUND
Respiratory viral and atypical bacterial infections are associated with pulmonary exacerbations and hospitalisations in cystic fibrosis patients. We wanted to study the impact of such infections on children attending the outpatient clinic.


METHODS
Seventy-five children were followed for 12 months at regular clinic visits. Routine sputum/laryngeal aspirations were tested with PCR for 7 respiratory viruses. Antibodies against C. pneumoniae, M. pneumoniae and B. pertussis were measured every 3-4 months. FEV-1, FEF(25-75) and specific airway resistance, "viral" symptoms and bacterial culture were recorded.


RESULTS
Ninety-seven viral and 21 atypical bacterial infections were found. FEV-1 was significantly reduced during viral infection (-12.5%, p=0.048), with the exception of rhinovirus infection. A small change in FEV-1 (-3%) was seen during atypical bacterial infection (p=0.039). Viral and atypical bacterial infections caused no change in type and frequency of bacterial culture. Positive predictive value of "viral symptoms" was low (0.64%). Eight patients received "unnecessary" antibiotics because of viral symptoms.


CONCLUSIONS
Some viral infections and atypical bacterial infections affect FEV-1 acutely. Viral infections did not precipitate bacterial infection or change of colonisation. Clinical symptoms failed to diagnose viral infection accurately. Routine surveillance for virus or atypical bacteria seems not to be justified in this patient category.
Olesen
Hanne Vebert
HV
Pediatric Department A, Aarhus University Hospital, Skejby Sygehus, Aarhus N, Denmark. hvo@dadlnet.dk
Nielsen
Lars P
LP
Schiotz
Peter Oluf
PO
D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000907:Antibodies, Bacterial / Q000032:analysis; D001295:Atypical Bacterial Forms / Q000276:immunology* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D014777:Virus Diseases / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D014780:Viruses / Q000235:genetics
D000907:Antibodies, Bacterial; D004279:DNA, Viral