Wendt C H, Fox J M, Hertz M I
Pulmonary and Critical Care Division, University of Minnesota, Minneapolis 55455, USA.
J Heart Lung Transplant. 1995 May-Jun;14(3):479-85.
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.
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.
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).
Lower respiratory tract infection with paramyxovirus is common in lung transplant recipients and capable of causing death or a permanent reduction in pulmonary function.
肺移植后呼吸道感染很常见。呼吸道副粘病毒、呼吸道合胞病毒和副流感病毒在肺移植受者中的意义尚未确定。
我们以回顾性方式，研究了1986年至1993年明尼苏达大学医院及诊所连续84例肺移植受者中副粘病毒感染的发生率和临床特征。
我们在18例患者中确定了19例副粘病毒感染病例（占所有移植受者的21%）。所有患者均有下呼吸道受累症状，9例（47%）同时有上呼吸道受累。症状出现于移植后24至2056天（中位数=260天）。呼吸道合胞病毒感染具有季节性（1月至6月），但副流感病毒感染全年均可发生。6例患者肺活量测定值下降（第1秒用力呼气量下降26%±2.8%）；4例恢复至基线水平。15例通过支气管肺泡灌洗确诊，3例通过鼻咽拭子确诊，1例通过痰液确诊。大多数患者（74%）接受了利巴韦林治疗，除1例接受治疗的患者外，其余均完全康复。未接受治疗的患者中，呼吸道合胞病毒导致1例死亡，1例副流感病毒感染导致肺活量测定值持续下降。年龄是感染的最强预测因素，18岁以下患者感染发生率较高（57%，p<0.05）。既往存在闭塞性细支气管炎与副粘病毒感染发生率增加无关（有闭塞性细支气管炎者为20%，无闭塞性细支气管炎者为22%；p>0.05）。
肺移植受者中副粘病毒引起的下呼吸道感染很常见，且可导致死亡或肺功能永久性下降。
