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Published ahead of print on September 28, 2006, doi:10.1164/rccm.200604-489OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 12, December 2006, 1392-1399

A more recent version of this article appeared on December 15, 2006
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Submitted on April 7, 2006
Accepted on September 26, 2006

Chronic Rhinoviral Infection in Lung Transplant Recipients

Laurent Kaiser1*, John-David Aubert2, Jean-Claude Pache3, Christelle Deffernez1, Thierry Rochat4, Jorge Garbino5, Werner Wunderli1, Pascal Meylan6, Sabine Yerly1, Luc Perrin1, Igor Letovanec7, Laurent Nicod8, Caroline Tapparel1, and Paola M Soccal9

1 Central Laboratory of Virology, Division of Infectious Diseases, Department of Internal Medicine, University Hospitals of Geneva, Genevea, Switzerland, 2 Division of Pulmonary Medicine, Department of Medicine, University Hospital of Lausanne, Lausanne, Switzerland, 3 Department of Pathology, University Hospitals of Geneva, Geneva, Switzerland, 4 Division of Pulmonary Medicine, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland, 5 Division of Infectious Diseases, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland, 6 Institute of Microbiology and Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland, 7 Department of Pathology, University Hospital of Lausanne, Lausanne, Switzerland, 8 Division of Pulmonary Medicine, University Hospital, Bern, Switzerland, 9 Institute of Microbiology and Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland; Division of Pulmonary Medicine, University Hospital, Bern, Switzerland; Clinic of Thoracic Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland

* To whom correspondence should be addressed. 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 months by screening of bronchoalveolar lavages (BAL). Measurements and Main Results: We describe three lung transplant recipients with graft dysfunctions in whom rhinovirus was identified by RT-PCR in upper and lower respiratory specimens over a 12-month 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 BAL specimens of 10 recipients and two 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: rhinovirus, respiratory virus, lung transplantation, VP1, picornavirus




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