View Abstract

A5505 - Clinical Characteristics of Patients with Bronchial Lavage Positive for Community-Acquired Respiratory Virus
Author Block: D. Nabeya, T. Kinjo, G. Parrott, N. Nishiyama, S. Nahar, K. Miyagi, M. Furugen, S. Haranaga, M. Tateyama, J. Fujita; Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
[Background] PCR methods enable us to detect community-acquired respiratory viruses (CARVs) in respiratory tract infections with increased sensitivity over conventional methods. Although many reports describe the involvement of CARVs in lower respiratory tract infection (LRTI), most of these previous studies examined upper respiratory tract specimens for diagnosis. Here, we reviewed patients for whom CARVs were detected from lower respiratory tract specimens using bronchoscopy and revealed the clinical characteristics of these patients. [Methods] Retrospective analysis was performed for all cases tested for CARV in lower respiratory tract specimens collected by bronchoscopy between August 2012 and September 2016. A commercially available multiplex PCR kit (Seeplex RV15 OneStep ACE Detection, Seegene, Korea), which can detect 15 community-acquired respiratory viruses was used. Medical records of patients were also reviewed. [Results] In total, 179 cases were identified, 133 cases were bronchoalveolar lavage and 46 cases were bronchial washings. The most common primary diseases were: 1) Lung diseases with structural changes (52/179, 29%), followed by 2) solid tumors (25%), 3) hematological malignancies (21%), and 4) autoimmune diseases (18%). Among 179 patients, 28 cases were PCR-positive; 14 cases positive for parainfluenza virus, 7 for rhinovirus, 3 for enterovirus, 2 for influenza A virus, 2 for respiratory syncytial virus, 1 for human metapneumovirus and 1 for coronavirus. Of the 28 cases, 2 patients experienced co-infection. There was no association found between underlying primary disease and PCR positivity. However, in comparison with PCR-negative cases, univariate analysis showed that PCR positive patients were more likely to be less than 60 years old (p=0.039), use nonsteroidal immunosuppressive agents (p=0.018), and experience mortality within 30 days from viral detection (p=0.041). In multivariate analysis, only the use of nonsteroidal immunosuppressive agents remained associated with positive PCR results (p=0.017). [Conclusion] Respiratory viruses were detected in lower respiratory specimens from ~30% of patients receiving nonsteroidal immunosuppressive agents. Age less than 60 could be associated with positive PCR results. Positive PCR results also may also be associated with a poor prognosis.