Respiratory viruses and severe lower respiratory tract complications in hospitalized patients
Respiratory viruses and severe lower respiratory tract complications in hospitalized patients
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DOI：
10.1378/chest.125.3.1033
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发表时间：
2004-03-01
期刊：
影响因子：
9.6
通讯作者：
Kaiser, L
中科院分区：
文献类型：
--
作者：
Garbino, J;Gerbase, MW;Kaiser, L
背景：急性呼吸道病毒感染在健康受试者中通常是自限性的，但在免疫功能低下的宿主中可能导致严重的并发症。我们报告了住院患者急性下呼吸道病毒感染的临床影响。材料和方法：在 5 年期间进行的 1,001 例纤维支气管镜检查中，33 份 BAL 样本经细胞培养显示呼吸道病毒呈阳性。分析主要诊断、住院时间、初始治疗反应以及30天死亡率。比较肺移植受者感染前后进行的肺活量测定。结果：在 33 例病例中鉴定出以下呼吸道病毒：甲型或乙型流感病毒（n = 13）、副流感病毒 1-3 型（n = 7）、鼻病毒（n = 5）、呼吸道合胞病毒（n = 4）和腺病毒（n = 4）。所有病例都是免疫功能低下的患者，他们出现了新的呼吸道症状和/或放射学异常，提示肺部感染。 25 名患者 (74%) 对最初的广谱抗生素没有反应，11 名患者 (33%) 因呼吸衰竭需要重症监护。 1个月时的总体死亡率为24%。在 BAL 中发现单一病毒病原体的患者中，死亡率为 39%。在肺移植受者 (n = 10) 中，感染前和感染期间的平均 FEV1 分别从 2.2 下降至 1.9 L/s (p < 0.01)； 3个月后，60%的患者仍未完全恢复至基线值。结论：免疫功能低下患者BAL样本中回收的呼吸道病毒与严重的下呼吸道并发症有关。在肺移植受者中，我们观察到肺功能持续受损。
Background: Acute respiratory viral infections are generally self-limited in healthy subjects but can lead to severe complications in immunocompromised hosts. We report the clinical impact of acute lower respiratory tract viral infections in hospitalized patients.Materials and methods: Of 1,001 fiberoptic bronchoscopies performed during a period of 5 years, 33 BAL samples were positive for respiratory viruses by cell culture. The main diagnosis, length of hospitalization, response to initial treatment, and the mortality rate at 30 days were analyzed. Spirometry performed before and after infection was compared in lung transplant recipients.Results: The following respiratory viruses were identified in 33 cases: influenza A or B (n = 13), parainfluenza virus 1-3 (n = 7), rhinovirus (n = 5), respiratory syncytial virus (n = 4), and adenovirus (n = 4). All cases were immunocompromised patients who acquired new respiratory symptoms and/or radiologic abnormalities suggesting a pulmonary infection. Twenty-five patients (74%) did not respond to initial broad-spectrum antibiotics, and 11 patients (33%) required intensive care for respiratory failure. The overall mortality rate at 1 month was 24%. In patients with a sole viral pathogen identified in their BAL, the mortality rate was 39%. In lung transplant recipients (n = 10), the mean FEV1 decreased from 2.2 to 1.9 L/s before and during the infection episode, respectively (p < 0.01); 3 months later, 60% of the patients had still not completely recovered to baseline values.Conclusion: Respiratory viruses recovered in BAL samples of immunocompromised patients are associated with severe lower respiratory complications. In lung transplant recipients, we observed a persisting impairment of pulmonary function.