Community-acquired respiratory viral infections in lung transplant recipients: a single season cohort study.
BACKGROUND
The impact of community-acquired respiratory virus (CARV) infections on bronchiolitis obliterans syndrome (BOS) and outcome after lung transplantation (LTx) and diagnostic techniques were prospectively evaluated.


METHODS
A single-center prospective cohort study was performed in LTx-outpatients between October 31, 2005 and April 30, 2006. Symptoms of respiratory tract infections were recorded and nasopharyngeal and oropharyngeal swabs were obtained. Lower respiratory sampling was performed when indicated. Immunofluorescence testing, cultures, and polymerase chain reaction for 12 different CARV were applied. Patients were followed up until December 31, 2007. New onset and BOS-stage was recorded 1 year after presentation.


RESULTS
Three hundred eighty-eight LTx-recipients were screened. Fifty-one percent reported of symptoms of respiratory tract infection. Seven hundred seventy upper and 180 lower respiratory samples were obtained. Thirty-four CARV were detected in 30 patients (7.7%): 12 parainfluenza, 7 respiratory syncytial virus, 6 metapneumovirus, 5 coronavirus, 3 rhinovirus, and 1 influenza virus. At 1 year, 43 new cases of BOS developed. One-year incidence of BOS was 25.0% in CARV-positive versus 9.0% in CARV-negative patients (log-rank P=0.01). Symptomatic CARV-infection proved to be a significant covariate for 1-year BOS-free survival in multivariate analysis (P=0.002, adjusted hazard ratio 4.13). CARV-infection did not influence BOS progression in 88 patients with prior BOS (P 0.45). After paramyxovirus infection, 8 of 24 patients developed new-onset BOS, whereas no case was recorded after rhinovirus and coronavirus infection.


CONCLUSIONS
Surveillance detected CARV in LTx outpatients infrequently. Symptomatic CARV-infection increases the risk for new onset of BOS, but not progression. Risk to develop BOS was especially increased after paramyxovirus infection.
Gottlieb
Jens
J
Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany. gottlieb.jens@mh-hannover.de
Schulz
Thomas F
TF
Welte
Tobias
T
Fuehner
Thomas
T
Dierich
Martin
M
Simon
Andre R
AR
Engelmann
Ilka
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000601:surgery; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000821:virology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D013997:Time Factors; D014777:Virus Diseases / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult
D000998:Antiviral Agents; D007252:Influenza Vaccines