The prevalence of viral infections in children with cystic fibrosis in a tertiary care center in Saudi Arabia

Hanaa Banjar; Mohammad Chaballout; Kawthar Karkour; Hadeel Al-Ghamdi; Ibrahim Al-Mogarri; Sami Al-Haider; Imran Nizami; Rawia Raja; Ali AlNakhli

doi:10.1016/j.ijpam.2019.09.003

The prevalence of viral infections in children with cystic fibrosis in a tertiary care center in Saudi Arabia

Int J Pediatr Adolesc Med. 2020 Jun;7(2):83-87. doi: 10.1016/j.ijpam.2019.09.003. Epub 2019 Sep 12.

Authors

Hanaa Banjar¹, Mohammad Chaballout², Kawthar Karkour², Hadeel Al-Ghamdi¹, Ibrahim Al-Mogarri¹, Sami Al-Haider¹, Imran Nizami³, Rawia Raja², Ali AlNakhli²

Affiliations

¹ Department of Pediatrics, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh, Saudi Arabia.
² College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.
³ Organ Transplant Center, (King Faisal Specialist Hospital and Research Center), Riyadh, Saudi Arabia.

Abstract

Introduction: Studies have shown that pulmonary exacerbations in cystic fibrosis (CF) patients are associated with respiratory viruses. The most common agent causing viral infections in patients with CF before the age of 3 years is respiratory syncytial virus.

Objectives: To obtain the prevalence of the different types of viral infection in CF patients and to identify its relation with the type of bacterial infection, (CFTR) mutations and pulmonary function test (PFT).

Methodology: A retrospective charts review of 387 patients with CF of all age groups who were screened for the detection of viruses during respiratory exacerbation from the period of January 1, 1984 to June 1, 2016.

Results: A total of 159 CF patients had pulmonary exacerbation and had viral PCR obtained. Fifty-eight patients (36%) had positive viral PCR. Males were more commonly infected in 30/58 patients (52%) compared to females in 28 patients (48%). Forty-five of 58 patients (78%) were alive and 13 patients (22%) died. Rhinovirus was the most frequently reported viral PCR in 33/74 sample (45%). Out of 74 viral PCR, 41 (55.4%) were during the colder seasons (October-February) and 33 (44.5%) during the warmer seasons (March-September). During viral infection and viral recurrence, there was an increase in bacterial colonization specifically of H. influenza and staphylococcus aureus. The most common CFTR mutation for the CF viral infection is: 3120+1G>A in Intron 16 in 11/57 patients (19%). The Eastern Province had the highest viral infection of 24 out of 57 patients (42%). Follow-up PFT post viral infection showed no significant difference in the type and the severity of PFT compared to the initial PFT during the viral illness.

Conclusion: Viral infections contributed to the increase in morbidity and mortality of CF patients in our population, and rhinovirus was the most common causative agent. Viral infections and viral recurrence increased the prevalence of bacterial infection of specific pathogens such as H. influenza and S. aureus. Physicians should be aware to prevent progressive lung damage in CF patients by treating the concomitant viral and bacterial infections. Viral infection may be associated with some common CFTR mutations.

Keywords: Arab; CFTR; Cystic fibrosis bacteriology; Pulmonary function test.