Abstract
BackgroundViral infections such as influenza are thought to impact respiratory parameters and to promote infection with Pseudomonas aeruginosa in patients with cystic fibrosis (CF). However, the real morbidity of the influenza virus in CF needs to be further investigated because previous studies were only observational.MethodsCF patients were included in a case–control study (n = 44 cases and n = 371 controls) during the 2009 pandemic A/H1N1 influenza. Cases were patients with polymerase reaction chain-confirmed influenza A/H1N1 infection. Controls did not report any influenza symptoms during the same period. Sputum colonization and lung function were monitored during 1 year after inclusion.ResultsCases were significantly younger than controls (mean(SD) 14.9 years(11) versus 20.1 years (13.2) and significantly less frequently colonized with P. aeruginosa (34 % versus 53 %). During influenza infection, 74 % of cases had pulmonary exacerbation, 92 % had antibiotics adapted to their usual sputum colonization and 82 % were treated with oseltamivir. Two cases required lung transplantation after A/H1N1 infection (one had not received oseltamivir and the other one had been treated late). The cases received a mean number of antibiotic treatments significantly higher during the year after the influenza infection (mean(SD) 2.8 (2.4) for cases versus 1.8(2.1) for controls; p = 0.002). An age-matched comparison did not demonstrate any significant modification of bronchopulmonary bacterial colonization during the year after influenza infection nor any significant change in FEV1 at months 1, 3 and 12 after A/H1N1 infection.ConclusionsOur results do not demonstrate any change in sputum colonization nor significant lung disease progression after pandemic A/H1N1 influenza.Trial registrationClinical Trials.gov registration number: NCT01499914
Highlights
Viral infections such as influenza are thought to impact respiratory parameters and to promote infection with Pseudomonas aeruginosa in patients with cystic fibrosis (CF)
Cystic fibrosis (CF) is characterized by a chronic obstructive bronchopathy with bacterial colonization and recurrent infections which progresses towards an irreversible deterioration of the respiratory function and terminal respiratory failure [1]
Study design MucoFlu (Clinical Trials.gov registration number: NCT 01499914) was a prospective study initiated by INSERM (Institut National de la Santé et de la Recherche Médicale) and APHP (Assistance Publique des Hôpitaux de Paris) to study A/H1N1 infection in CF patients during the 2009 pandemy
Summary
Viral infections such as influenza are thought to impact respiratory parameters and to promote infection with Pseudomonas aeruginosa in patients with cystic fibrosis (CF). Very importantly, new bacterial colonizations predominantly occur following viral upper respiratory tract infections [13, 14] This has been related to the fact that viral infections alter host defense equilibrium and increase mucus production [10]. This promotes bacterial overgrowth, and in turn, potentiates chronic colonization because of abnormal mucociliary clearance of CF sputum and intrinsic defect in innate immunity [14]. The real morbidity of the influenza virus in CF, and its impact on new P. aeruginosa colonization, needs to be further investigated because all previous studies were mainly observational and did not achieve clear-cut conclusions [4, 6, 11, 13, 15]
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