Clinical and radiological features of respiratory syncytial virus in solid organ transplant recipients

A single-center experience

E. J. Ariza-Heredia, Joel Fishman, Timothy Cleary, Lesley J Smith, R. R. Razonable, Lilian Abbo

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Respiratory syncytial virus (RSV) infections range from upper respiratory illness to severe lower respiratory disease. There is no universally accepted treatment for RSV in solid organ transplant (SOT) recipients. Methods: Retrospective review of adult SOT patients with RSV infections, between January 2007 and December 2009, in a single transplant center was performed. Results: During the 3-year period, a total of 24 adults developed RSV infection, including 12 (50%) SOT recipients (5 kidneys, 4 livers, and 3 lungs). Most cases were seen in 2009 during the influenza H1N1 pandemic, likely as a result of increased testing. In 83% of the cases, the diagnosis was based on RSV antigen detection, which was also used to follow subsequent shedding (mean duration: 20.6 days). Most of the cases presented with lower respiratory disease and required hospitalization. All the patients were on at least two classes of immunosuppressive drugs. We observed a lower lymphocyte count in patients with lower respiratory tract infection. Computed tomography was superior to chest x-ray in demonstrating pulmonary disease, with the most common findings being pulmonary nodules and ground-glass opacities. Novel radiographic findings were small cavities and pleural effusions. No co-infections were documented, and no mortality could be attributed to RSV. Inhaled or oral ribavirin was administered in 67% of the cases, with variations in the treatment regimens. Conclusion: SOT recipients accounted for half of all adult cases of RSV at our institution. Type and length of treatment varied widely, and we cannot conclude that outcomes differed between treatments with oral or inhaled ribavirin. Current therapeutic management of RSV in SOT is empiric, and can be rather expensive and difficult, without clear evidence of effectiveness.

Original languageEnglish
Pages (from-to)64-71
Number of pages8
JournalTransplant Infectious Disease
Volume14
Issue number1
DOIs
StatePublished - Feb 1 2012

Fingerprint

Respiratory Syncytial Viruses
Transplants
Respiratory Syncytial Virus Infections
Ribavirin
Therapeutics
Lung
Lymphocyte Count
Pandemics
Pleural Effusion
Immunosuppressive Agents
Coinfection
Respiratory Tract Infections
Human Influenza
Lung Diseases
Glass
Transplant Recipients
Hospitalization
Thorax
Tomography
X-Rays

Keywords

  • Radiological
  • Respiratory syncytical virus
  • Ribavirin
  • RSV
  • Solid organ transplantation

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Clinical and radiological features of respiratory syncytial virus in solid organ transplant recipients : A single-center experience. / Ariza-Heredia, E. J.; Fishman, Joel; Cleary, Timothy; Smith, Lesley J; Razonable, R. R.; Abbo, Lilian.

In: Transplant Infectious Disease, Vol. 14, No. 1, 01.02.2012, p. 64-71.

Research output: Contribution to journalArticle

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abstract = "Background: Respiratory syncytial virus (RSV) infections range from upper respiratory illness to severe lower respiratory disease. There is no universally accepted treatment for RSV in solid organ transplant (SOT) recipients. Methods: Retrospective review of adult SOT patients with RSV infections, between January 2007 and December 2009, in a single transplant center was performed. Results: During the 3-year period, a total of 24 adults developed RSV infection, including 12 (50{\%}) SOT recipients (5 kidneys, 4 livers, and 3 lungs). Most cases were seen in 2009 during the influenza H1N1 pandemic, likely as a result of increased testing. In 83{\%} of the cases, the diagnosis was based on RSV antigen detection, which was also used to follow subsequent shedding (mean duration: 20.6 days). Most of the cases presented with lower respiratory disease and required hospitalization. All the patients were on at least two classes of immunosuppressive drugs. We observed a lower lymphocyte count in patients with lower respiratory tract infection. Computed tomography was superior to chest x-ray in demonstrating pulmonary disease, with the most common findings being pulmonary nodules and ground-glass opacities. Novel radiographic findings were small cavities and pleural effusions. No co-infections were documented, and no mortality could be attributed to RSV. Inhaled or oral ribavirin was administered in 67{\%} of the cases, with variations in the treatment regimens. Conclusion: SOT recipients accounted for half of all adult cases of RSV at our institution. Type and length of treatment varied widely, and we cannot conclude that outcomes differed between treatments with oral or inhaled ribavirin. Current therapeutic management of RSV in SOT is empiric, and can be rather expensive and difficult, without clear evidence of effectiveness.",
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