Role of rhinovirus load in the upper respiratory tract and severity of symptoms in lung transplant recipients.
BACKGROUND
Rhinovirus is the most common cause of respiratory viral infections and leads to frequent respiratory symptoms in lung transplant recipients. However, it remains unknown whether the rhinovirus load correlates with the severity of symptoms.


OBJECTIVE
This study aimed to better characterize the pathogenesis of rhinoviral infection and the way in which viral load correlates with symptoms.


METHODS
We assessed rhinovirus load in positive upper respiratory specimens of patients enrolled prospectively in a cohort of 116 lung transplant recipients. Rhinovirus load was quantified according to a validated in-house, real-time, reverse transcription polymerase chain reaction in pooled nasopharyngeal and pharyngeal swabs. Symptoms were recorded in a standardised case report form completed at each screening/routine follow-up visit, or during any emergency visit occurring during the 3-year study.


RESULTS
Rhinovirus infections were very frequent, including in asymptomatic patients not seeking a specific medical consultation. Rhinovirus load ranged between 4.1 and 8.3 log copies/ml according to the type of visit and clinical presentation. Patients with highest symptom scores tended to have higher viral loads, particularly those presenting systemic symptoms. When considering symptoms individually, rhinovirus load was significantly higher in the presence of symptoms such as sore throat, fever, sputum production, cough, and fatigue. There was no association between tacrolimus levels and rhinovirus load.


CONCLUSIONS
Rhinovirus infections are very frequent in lung transplant recipients and rhinoviral load in the upper respiratory tract is relatively high even in asymptomatic patients. Patients with the highest symptom scores tend to have a higher rhinovirus load.
Laboratory of Virology, Division of Laboratory Medicine, University Hospitals of Geneva, Geneva, Switzerland; Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland. Electronic address: jambrosioni@intramed.net.
Juan
J
Ambrosioni
Division of Respiratory Medicine, University Hospitals of Geneva, Geneva, Switzerland; Service of Respiratory Medicine, Hôpital du Valais, Sion, Switzerland.
Pierre-Olivier
PO
Bridevaux
Division of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
John-David
JD
Aubert
Division of Respiratory Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Paola
P
Soccal
Laboratory of Virology, Division of Laboratory Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Ghislaine
G
Wagner
Laboratory of Virology, Division of Laboratory Medicine, University Hospitals of Geneva, Geneva, Switzerland; Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland; School of Medicine, University of Geneva, Geneva, Switzerland.
Laurent
L
Kaiser
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000821:virology*; D010850:Picornaviridae Infections / Q000821:virology*; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000821:virology*; D012229:Rhinovirus / Q000302:isolation & purification / Q000502:physiology*; D016559:Tacrolimus / Q000097:blood; D013997:Time Factors; D066027:Transplant Recipients; D019562:Viral Load
D016559:Tacrolimus
HRV; Lung transplant recipient; Rhinovirus; Tacrolimus; Viral load