Paramyxovirus infection in lung transplant recipients

Background: Respiratory infections are common after lung transplantation. The significance of respiratory paramyxoviruses, respiratory syncytial virus, and parainfluenza virus in lung transplant recipients has not been determined. Methods: In a retrospective fashion, we examined the incidence and clinical characteristics of paramyxovirus infection in 84 consecutive lung transplant recipients at the University of Minnesota Hospital and Clinics from 1986 through 1993. Results: We identified 19 cases of paramyxovirus infection in 18 patients (21% of all transplant recipients). All patients had symptoms with lower respiratory tract involvement, and nine (47%) had coexisting upper respiratory involvement. Symptom onset was 24 to 2056 days after transplantation (median = 260 days). Respiratory syncytial virus infection was seasonal (January through June), but parainfluenza virus infection occurred throughout the year. Six patients showed a decline in spirometry (26% ± 2.8% decrease in forced expiratory volume in 1 second); four returned to baseline. Diagnosis was made by bronchoalveolar lavage in 15 cases, nasopharyngeal swab in three cases, and sputum in one case. Most patients (74%) were treated with ribavirin, and all but one treated patient recovered fully. In untreated patients, respiratory syncytial virus contributed to one death and one parainfluenza virus infection resulted in a persistent reduction in spirometry. Age was the strongest predictor of infection, with a higher incidence in patients under 18 years old (57%, p < 0.05). Preexisting obliterative bronchiolitis did not correlate with an increased incidence of paramyxovirus infection (20% with obliterative bronchiolitis, 22% without obliterative bronchiolitis; p > 0.05). Conclusions: Lower respiratory tract infection with paramyxovirus is common in lung transplant recipients and capable of causing death or a permanent reduction in pulmonary function.