Transplant infectionClinical features and outcomes of paramyxoviral infection in lung transplant recipients treated with ribavirin☆
Section snippets
Patients and ribavirin treatment
After institutional review board approval, a review was undertaken of all lung or heart–lung transplant recipients at Vanderbilt University Medical Center who had received aerosolized ribavirin to treat either RSV or PIV infection. Fifteen patients received 17 courses of aerosolized ribavirin therapy between April 1992 and December 2000. Methods of viral identification included BD-Directigen RSV rapid antigen (EIA; BD Diagnostic Systems, Sparks, MD), viral culture, Hexaplex polymerase chain
Results
During the 9-year study period, 15 lung transplant recipients received aerosolized ribavirin for 17 episodes of paramyxoviral respiratory illness, including 12 (71%) cases of RSV and 5 (29%) cases of PIV infection. Two patients had episodes of both RSV and PIV on separate occasions. The median duration of ribavirin therapy was 5 days (range 3 to 7). Ribavirin was well tolerated. The most common side effect was headache, observed in only 2 patients. One intubated patient required discontinuation
Discussion
Viral infections are a major cause of community-acquired respiratory illness in the general population. Paramyxoviruses account for up to 10% of lower respiratory tract disease and can produce dyspnea and wheezing in immunocompetent adults.2, 16, 17 Reports of paramyxoviral infection in kidney and liver transplant recipients have described similar symptoms and morbidity.18, 19 Lung transplant patients with lower respiratory paramyxoviral infection may suffer a significant and sometimes
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Dr McCurdy is currently a research fellow at the Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.