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Influenza infection is increasingly recognized to cause significant morbidity and mortality in the community, especially in pediatric patients and elderly persons. Influenza infection, however, has not been well described among thoracic organ transplant recipients. We provide the first detailed clinical, radiographic, and histologic description of influenza pneumonia among three lung transplant recipients. The presentation varied considerably among the three patients and, in some cases, was atypical for influenza. Despite treatment, a persistent decline in pulmonary function occurred in all three patients after the acute illness. Interestingly, on follow-up biopsy specimens, each patient had histologic evidence of acute rejection and/or obliterative bronchiolitis. Additional research, therefore, is needed to clarify the relationship between influenza infection, acute rejection, and obliterative bronchiolitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate radiologic finding of respiratory viral infection in lung transplant recipients with clinical correlation., Materials and Methods: Over 5 years, 21 episodes of respiratory viral infection (parainfluenza [n = 9], respiratory syncytial virus [n = 8], adenovirus [n = 5], influenza [n = 2]) were diagnosed 6-727 days (mean, 270 days) after lung transplantation in 20 recipients. Chest radiographs, computed tomographic (CT) images, and clinical records were reviewed., Results: Sixteen episodes of respiratory viral infection were diagnosed in patients with symptoms of lower respiratory tract infection or acute allograft dysfunction; five were diagnosed in asymptomatic patients. Chest radiographs were abnormal in 11 (52%) episodes; findings included heterogeneous or homogeneous opacities and masslike consolidation. All patients with radiographic abnormalities were symptomatic. Chest radiographs were unchanged from baseline in 10 (48%) episodes; in one, CT revealed findings not depicted at radiography. Adenoviral infection (n = 5) was typically symptomatic, was associated with new radiographic abnormalities, and was rapidly lethal (n = 4). Infection with parainfluenza and/or respiratory syncytial virus was commonly asymptomatic and was not associated with radiographic abnormalities; affected patients had good outcomes., Conclusion: Respiratory viral infections are important causes of morbidity and mortality in lung transplant recipients. Radiographic abnormalities in patients with respiratory viral infections were usually accompanied by symptoms of lower respiratory tract infection. Adenoviral infection was frequently accompanied by progressive pulmonary opacity and fatal outcome.

Study Objective: To define the epidemiology, clinical manifestations, and long-term complications of respiratory viral infections in adult lung transplant recipients., Design: Retrospective review of the records of 122 adult lung transplant recipients over a 5-year period at one institution., Results: Ten episodes of infection with respiratory syncytial virus, parainfluenza, influenza, or adenovirus were identified. All patients presented with symptoms of respiratory tract infection. Two patients died acutely and four patients subsequently had development of obliterative bronchiolitis (OB)., Conclusions: These data suggest community respiratory viral infections cause significant morbidity and mortality in lung transplant recipients. Further prospective studies are warranted to clarify the relationship between respiratory viral infection and OB and to define the optimal therapy for these viral infections.

Ciliated nasal epithelium obtained from human volunteers exposed under controlled conditions to 0.4 ppm of ozone for 4 hr was examined by transmission electron microscopy. These investigations were initiated to evaluate the utility of human ciliated nasal epithelium as a model for the characterization of possible ultrastructural level cytopathic effects induced by short-term, low-level in vivo exposure to ozone. Particular attention was given to both the qualitative and quantitative evaluation of ciliated cells in the nasal respiratory epithelium in response to ozone exposure. The results of these investigations indicated that cell structure is generally retained and no appreciable manifestation of injury is evident in human nasal mucosa in response to the regimen of ozone exposure employed during these studies. Although these investigations were completed under highly controlled circumstances and with the constraints attendant to research on humans subjects, they may provide a fundamental base for future examinations of the potential injurious effects of ozone on human respiratory epithelium under conditions more relevant to habitual environmental exposure.