Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5-Year Prospective Study

Abstract

The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009-2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow-up of 3.4 years (interquartile range 2.5-4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case-control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID.

Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

“…More recently, an association between IA and infections due to influenza H1N1 virus, adenovirus and RSV was reported in a cohort of variable immunocompromised hosts, including SOTr, with the vast majority being patients with hematologic malignancies . In contrast, another recent study failed to identify any possible association between respiratory viral infections and IA in a cohort of asymptomatic lung transplant recipients with positive nasopharyngeal swabs for a respiratory virus . The direct bronchial wall epithelial damage induced by respiratory viral pathogens and indirect effect on the local defense mechanisms may predispose patients to superinfection with other pathogens, such as Aspergillus spp .…”

Respiratory virus detection and co‐infection in children and adults in a large Australian hospital in 2009–2015

“…This may be as a primary pathogen, a co‐factor for other viral or bacterial infections or as a trigger for non‐infective respiratory presentations such as asthma. It is important to recognise, however, that it is the high detection of the picornavirus amongst healthy individuals has been well described . However, recent concomitant blood and respiratory PCR detection of the rhinovirus in children with signs of lower RTI suggests it may play a role in up to one in six children with RTI who test positive for the rhinovirus …”

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

“…Second, the multiplex PCR panel used herein had a limited pathogen coverage. As viral respiratory infections are common in LTx recipients and often mimic non‐viral LRTI and may precipitate subsequent rejections as described in a prospective multi‐centric trial, PCR detection of respiratory viruses is pivotal and its inclusion into a single PCR panel seems highly desirable . Conversely, in 10 of the 12 cases, where cultures were positive and PCR negative, the isolate was covered by the PCR panel.…”