PT  - JOURNAL ARTICLE
AU  - Felix C. Ringshausen
AU  - Gernot Rohde
AU  - Marcus Panning
AU  - Jessica Rademacher
AU  - Mark Greer
AU  - Karen Olsson
AU  - Tobias Welte
AU  - Jens Gottlieb
TI  - Acute respiratory infections in lung transplant recipients: Use of a novel multiplex-PCR assay
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - 1367
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/1367.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/1367.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - Background: Acute respiratory infections (ARI) share features with common, non-infectious complications after lung transplantation (LTx) making accurate and rapid diagnosis crucial for the management of LTx recipients. Objectives: To evaluate the performance of a novel multiplex-PCR assay in addition to routine evaluation. Methods: In this ongoing prospective cohort study, LTx-outpatients with any new symptom of ARI were screened for 24 respiratory viruses (RV) and atypical bacteria by a multiplex-PCR assay performed on throat swabs. Routine evaluation included PCR for 14 RV on throat washes and lower respiratory tract (LRT) sampling (BAL for quantitative microbiology, direct immunofluorescence, viral culture, PCR, and transbronchial biopsy), if indicated. Results: Between Sept. 2011 and Feb. 2012, among 104 episodes from 95 LTx recipients, 30 RV were detected in 29 patients (31%): 9 rhino-, 7 parainfluenza, 6 metapneumo-, 4 corona-, 3 adenovirus, 2 RSV, 2 CMV, and 3 viral coinfections. The multiplex-PCR detected RV in 12% (12/104 episodes) compared to 26% (23/90) with routine evaluation (κ=0.20, p=0.03), including additional 4 RV. RV were more frequently detected in LRT than in URT samples (24% vs. 14%; κ=0.10, p=0.40). Agreement between both PCR assays in URT specimens was moderate (RV detected in 7 of 21 throat washes; κ=0.54, p=0.011). Definite clinical diagnoses were suspected (28 subjects) and proven viral infection (26), BOS (23), AR (10), bacterial infection (9), obstructive airway complication (4), pneumonia (3), and CMV infection (1). Conclusions: In LTx recipients, virological methodology and sampling are complementary, with LRT specimens resulting in higher diagnostic yield.