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Paramyxovirus infection in lung transplant recipients
Background:
Respiratory infections are common after lung transplantation. The significance of respiratory paramyxoviruses, respiratory syncytial virus, and parainfluenza virus in lung transplant recipients has not been determined.
Methods:
In a retrospective fashion, we examined the incidence and clinical characteristics of paramyxovirus infection in 84 consecutive lung transplant recipients at the University of Minnesota Hospital and Clinics from 1986 through 1993.
Results:
We identified 19 cases of paramyxovirus infection in 18 patients (21% of all transplant recipients). All patients had symptoms with lower respiratory tract involvement, and nine (47%) had coexisting upper respiratory involvement. Symptom onset was 24 to 2056 days after transplantation (median = 260 days). Respiratory syncytial virus infection was seasonal (January through June), but parainfluenza virus infection occurred throughout the year. Six patients showed a decline in spirometry (26% +/- 2.8% decrease in forced expiratory volume in 1 second); four returned to baseline. Diagnosis was made by bronchoalveolar lavage in 15 cases, nasopharyngeal swab in three cases, and sputum in one case. Most patients (74%) were treated with ribavirin, and all but one treated patient recovered fully. In untreated patients, respiratory syncytial virus contributed to one death and one parainfluenza virus infection resulted in a persistent reduction in spirometry. Age was the strongest predictor of infection, with a higher incidence in patients under 18 years old (57%, p < 0.05). Preexisting obliterative bronchiolitis did not correlate with an increased incidence of paramyxovirus infection (20% with obliterative bronchiolitis, 22% without obliterative bronchiolitis; p > 0.05).
Conclusions:
Lower respiratory tract infection with paramyxovirus is common in lung transplant recipients and capable of causing death or a permanent reduction in pulmonary function.
Insights
Paramyxovirus infections are common in lung transplant recipients, causing lower respiratory tract issues and potentially death. Younger patients are more susceptible to these serious respiratory infections.
Area of Science:
- Pulmonology
- Infectious Diseases
- Transplantation Medicine
Background:
- Respiratory infections frequently occur post-lung transplantation.
- The specific impact of paramyxoviruses, including respiratory syncytial virus and parainfluenza virus, in lung transplant recipients remains unclear.
Purpose of the Study:
- To determine the incidence and clinical characteristics of paramyxovirus infections in lung transplant recipients.
- To assess the outcomes and risk factors associated with these infections.
Main Methods:
- Retrospective analysis of 84 lung transplant recipients from 1986-1993.
- Examined incidence, clinical presentation, diagnostic methods (bronchoalveolar lavage, nasopharyngeal swab, sputum), and treatment (ribavirin).
Main Results:
- 19 cases (21%) of paramyxovirus infection identified in 18 patients, primarily affecting the lower respiratory tract.
- Infections occurred 24-2056 days post-transplant; respiratory syncytial virus was seasonal, parainfluenza occurred year-round.
- Younger patients (<18 years) had a higher incidence (57%). Six patients experienced spirometry decline, with one death linked to respiratory syncytial virus and one parainfluenza case causing persistent lung function reduction.
Conclusions:
- Paramyxovirus infections are a significant cause of lower respiratory tract illness in lung transplant recipients.
- These infections can lead to mortality or permanent pulmonary function impairment.
- Age is a key predictor, with younger individuals being more vulnerable.