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Respiratory viruses and severe lower respiratory tract complications in hospitalized patients [Article de Revue]

 
[Virus respiratoires et complications sévères des voies aériennes respiratoires basses parmi des patients hospitalisés.]
GARBINO J ; GERBASE MW ; WUNDERLI W ; KOLAROVA L ; NICOD LP ; Rochat, T ; Kaiser, L
Chest. 2004/03; 1033-1039
Summary: Parmi 1001 bronchoscopies réalisées en 5 ans (1996-2000) dans un centre hospitalier universitaire de Genève, 33 lavages broncho-alvéolaire (LBA) ont été positifs en cultures cellulaires pour les virus respiratoires. On a analysé le diagnostic principal, la durée d'hospitalisation, la réponse au traitement initial, et le taux de mortalité à 30 jours. Les spirométries réalisées avant et après infection ont été comparées chez les patients ayant bénéficié d'une transplantation pulmonaire. On a identifié : virus influenza A et B (n=13), virus parainfluenza 1-3 (n=7), rhinovirus (n=5), virus respiratoire syncytial (n=4) et adénovirus (n=4). Le taux de mortalité global à un mois a été de 24%.Conclusion : les virus respiratoires isolés dans les prélèvements par LBA de patients présentant un déficit immunitaire sont associés à des complications respiratiores basses sévères.

BACKGROUND: Acute respiratory viral infections are generally self-limited in healthy subjects but can lead to severe complications in immunocompromised hosts. We report the clinical impact of acute lower respiratory tract viral infections in hospitalized patients. MATERIALS AND METHODS: Of 1,001 fiberoptic bronchoscopies performed during a period of 5 years, 33 BAL samples were positive for respiratory viruses by cell culture. The main diagnosis, length of hospitalization, response to initial treatment, and the mortality rate at 30 days were analyzed. Spirometry performed before and after infection was compared in lung transplant recipients. RESULTS: The following respiratory viruses were identified in 33 cases: influenza A or B (n = 13), parainfluenza virus 1-3 (n = 7), rhinovirus (n = 5), respiratory syncytial virus (n = 4), and adenovirus (n = 4). All cases were immunocompromised patients who acquired new respiratory symptoms and/or radiologic abnormalities suggesting a pulmonary infection. Twenty-five patients (74%) did not respond to initial broad-spectrum antibiotics, and 11 patients (33%) required intensive care for respiratory failure. The overall mortality rate at 1 month was 24%. In patients with a sole viral pathogen identified in their BAL, the mortality rate was 39%. In lung transplant recipients (n = 10), the mean FEV(1) decreased from 2.2 to 1.9 L/s before and during the infection episode, respectively (p < 0.01); 3 months later, 60% of the patients had still not completely recovered to baseline values. CONCLUSION: Respiratory viruses recovered in BAL samples of immunocompromised patients are associated with severe lower respiratory complications. In lung transplant recipients, we observed a persisting impairment of pulmonary function.(RESUME D'AUTEUR)
Publication
2004/03

Pages
1033-1039

Language
Anglais

Published in

ID notice
319008

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