Association of Respiratory Viral Infections with Pulmonary Deterioration in Patients with Cystic Fibrosis

Abstract

In a two-year prospective study, we examined the effect of respiratory viral infections on pulmonary function in 49 patients with cystic fibrosis (mean age, 13.7 years). Nineteen normal siblings (mean age, 14) served as controls. Subjects were assessed quarterly and at the time of any respiratory illness. Each assessment included nasal washes for viral isolation and blood drawing for respiratory viral serologic studies. Pulmonary-function tests were performed at least twice yearly. Respiratory illnesses were reported significantly more often in the patients (3.7 per year) than in the normal siblings (1.7 per year), although the frequency of proved viral infections (1.67 per year) was identical. In the patients with cystic fibrosis significant correlations (P less than 0.0001) were found between the annual incidence of viral infections and every measure of disease progression in the two-year period, including the rate of decline of the Shwachman score (r = 0.71), the percentage of ideal weight for height (r = 0.80), the forced vital capacity (r = 0.85), the forced expiratory volume in the first second (r = 0.84), the forced midexpiratory flow rate (r = 0.68), and the frequency (r = 0.53) and duration (r = 0.84) of hospitalizations for respiratory exacerbations. We conclude that frequency of viral respiratory infections is closely associated with pulmonary deterioration in patients with cystic fibrosis.

Low Sphingosine-1–Phosphate Impairs Lung Dendritic Cells in Cystic Fibrosis

“…CF mice react with increased inflammation and decreased viral clearance to RSV infection (19). RSV is known to trigger exacerbations of CF lung disease (37)(38)(39) and to facilitate colonization with P. aeruginosa (40). Both cDCs and pDCs are typically activated and increase in number in response to RSV infection (41,42).…”

Human metapneumovirus and respiratory syncytial virus infections in older children with cystic fibrosis

“…Viral respiratory tract infections are important causes of pulmonary exacerbations and hospitalizations in CF children. [1][2][3][4][5][6][7][8][9] These viral respiratory infections may contribute to airway obstruction and progression of CF lung disease by predisposing the lungs of CF patients to future bacterial infection or colonization, although the exact pathophysiology of this microbial synergism has not been defined. 1,4,6,7,10 Although children with CF do not appear to have higher rates of viral respiratory infections than non-CF children, 1,10,11 the effects and clinical outcome of these infections are clearly more severe.…”

Viral Respiratory Tract Infections in Cystic Fibrosis

“…It is now nearly 30 years since Wang et al (Wang, Prober et al 1984) described the relationship between respiratory viral infections and deterioration in clinical status in CF. In this 2 year prospective study (Wang, Prober et al 1984), viruses were identified through repeated serology and nasal lavage for viral isolation in 49 patients with CF (mean age 13.7 years).…”

“…Early studies looking at respiratory viruses in CF relied on repeated serological testing, either alone (Petersen, Hoiby et al 1981) or in combination with viral cultures for viral detection (Wang, Prober et al 1984;Ramsey, Gore et al 1989;Pribble, Black et al 1990;Armstrong, Grimwood et al 1998;Hiatt, Grace et al 1999). These methods are relatively insensitive and more recent studies have utilised PCR based methodologies (Smyth, Smyth et al 1995;Collinson, Nicholson et al 1996;Punch, Syrmis et al 2004;Olesen, Nielsen et al 2006;).…”