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Chronic Rhinoviral Infection in Lung Transplant Recipients

Central Laboratory of Virology, Division of Infectious Diseases, Department of Internal Medicine; Department of Pathology; Division of Pulmonary Medicine, Department of Internal Medicine; Clinic of Thoracic Surgery, Department of Surgery, University Hospitals of Geneva, Geneva; Division of Pulmonary Medicine, Department of Medicine; Institute of Microbiology and Division of Infectious Diseases, Department of Pathology, University Hospital of Lausanne, Lausanne; and Division of Pulmonary Medicine, University Hospital, Bern, Switzerland

Correspondence and requests for reprints should be addressed to Laurent Kaiser, M.D., Central Laboratory of Virology, Division of Infectious Diseases, University Hospitals of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. E-mail: laurent.kaiser{at}hcuge.ch

Rationale: Lung transplant recipients are particularly at risk of complications from rhinovirus, the most frequent respiratory virus circulating in the community.

Objectives: To determine whether lung transplant recipients can be chronically infected by rhinovirus and the potential clinical impact.

Methods: We first identified an index case, in which rhinovirus was isolated repeatedly, and conducted detailed molecular analysis to determine whether this was related to a unique strain or to re-infection episodes. Transbronchial biopsies were used to assess the presence of rhinovirus in the lung parenchyma. The incidence of chronic rhinoviral infections and potential clinical impact was assessed prospectively in a cohort of 68 lung transplant recipients during 19 mo by screening of bronchoalveolar lavages.

Measurements and Main Results: We describe 3 lung transplant recipients with graft dysfunctions in whom rhinovirus was identified by reverse transcriptase–polymerase chain reaction in upper and lower respiratory specimens over a 12-mo period. In two cases, rhinovirus was repeatedly isolated in culture. The persistence of a unique strain in each case was confirmed by sequence analysis of the 5'NCR and VP1 gene. In the index case, rhinovirus was detected in the lower respiratory parenchyma. In the cohort of lung transplant recipients, rhinoviral infections were documented in bronchoalveolar lavage specimens of 10 recipients, and 2 presented with a persistent infection.

Conclusions: Rhinoviral infection can be persistent in lung transplant recipients with graft dysfunction, and the virus can be detected in the lung parenchyma. Given the potential clinical impact, chronic rhinoviral infection needs to be considered in lung transplant recipients.

Key Words: lung transplantation • picornavirus • respiratory virus • rhinovirus • VP1

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Rhinovirus is the most common respiratory virus but its impact in lung transplant recipients is not well established. What This Study Adds to the Field Rhinovirus causes chronic infections and may contribute to respiratory complications in lung transplant recipients.

 

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