Viruses and atypical bacteria in the respiratory tract of immunocompromised and immunocompetent patients with airway infection

Abstract

Respiratory tract infections (RTI) can take a serious course under immunosuppression. Data on the impact of the underlying pathogens are still controversial. Samples from the upper (n = 322) and lower RT (n = 169) were collected from 136 children and 355 adults; 225 among them have been immunocompromised patients. Exclusion criteria were presence of relevant cultivable microorganisms, C-reactive protein > 20 mg/dl, or procalcitonin > 2.0 ng/ml. Samples were tested by PCR for the presence of herpesviruses (HSV-1/-2; VZV; CMV; HHV6; EBV), adenoviruses, bocaviruses, entero-/rhinoviruses (HRV), parechoviruses, coronaviruses, influenza viruses (IV), parainfluenza viruses as well as for pneumoviruses (HMPV and RSV), and atypical bacteria (Mycoplasma pneumoniae, M.p.; Chlamydia pneumoniae, C.p.). Viral/bacterial genome equivalents were detected in more than two-thirds of specimens. Under immunosuppression, herpesviruses (EBV 30.9%/14.6%, p < 0.001; CMV 19.6%/ 7.9%, p < 0.001; HSV-1: 14.2%/7.1%, p = 0.012) were frequently observed, mainly through their reactivation in adults. Immunocompromised adults tended to present a higher RSV prevalence (6.4%/2.4%, p = 0.078). Immunocompetent patients were more frequently tested positive for IV (15.0%/5.8%, p = 0.001) and M.p. (6.4%/0.4%, p < 0.001), probably biased due to the influenza pandemic of 2009 and an M.p. epidemic in 2011. About 41.8% of samples were positive for a single pathogen, and among them EBV (19.9%) was most prevalent followed by HRV (18.2%) and IV (16.6%). HSV-2 and C.p. were not found. Marked seasonal effects were observed for HRV, IV, and RSV. Differences in pathogen prevalence were demonstrated between immunocompetent and immunocompromised patients. The exact contribution of some herpesviruses to the development of RTI remains unclear.

Isolation of Epstein‐Barr virus‐deoxyribonucleic acid in the lower respiratory tract for distinguishing critically ill patients from those with influenza‐associated pneumonia: A pilot study

“…16 In addition, it has also been found that EBV is easily activated when the immune function declines in some clinical studies. 17,18 However, in the present study, it was revealed that there was no significant difference between the two groups in underlying diseases combined with immunocompromised and diabetes mellitus. The detection rate of EBV-DNA was not correlated with patients' immune status, which could be related to the general susceptibility of influenza A virus population and the fact that nonimmunodeficient patients had the highest proportion people, and only 9.73% of patients had immunodeficiency disorders.…”

Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort

“…The respiratory tract harbors not only viruses, but also other microorganisms, such as bacteria and fungi [ 108 , 109 , 110 , 111 , 112 , 113 ]. The totality of all microorganisms is called the microbiome, and its pathogenic relevance is still investigated in different molecular and clinical contexts [ 113 , 114 , 115 , 116 , 117 , 118 , 119 ].…”

Treatment of the most common respiratory infections in children

“…In children older than five years, atypical agents (Mycoplasma pneumoniae and Chlamydia pneumoniae) have an important role (96). Since immunocompromised children are particularly susceptible to unusual viral, fungal, and protozoal agents, such as cytomegalovirus, Pneumocystis jirovecii, and Aspergillus species with an atypical clinical pattern, special attention is paid to their treatment (98,99).…”