Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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S96 Abstracts / Journal of Clinical Virology 82S (2016) S1–S142
Abstract no: 146
Presentation at ESCV 2016: Poster 151
Case report: Unexpected cause of respiratory
failure 3 days after heart transplantation
K. Dierickx ∗, A. Vankeerberghen, A. Boel,
K. Van Vaerenbergh, H. De Beenhouwer
Laboratory of Microbiology, OLVZ Aalst, Belgium
Respiratory syncytial virus is an RNA virus belonging to the
Paramyxoviridae and it is mostly found in young children. This
virus can also cause morbidity and mortality in immunocompro-
mised adults. Respiratory virus infection (RSV) is an important
complication in solid organ transplant patients but the longitudi-
nal monitoring of these infections has not been extensively studied.
Little has been described in literature regarding RSV pneumonia in
adult heart transplant patients.
Here we report an interesting case of a 56 year old female with
a history of non-ischemic cardiomyopathy starting in 2011. On
January the 3rd of 2015 she successfully underwent a heart trans-
plantation. Although there were no signs of respiratory disease at
the time of hospitalization she showed respiratory insufficiency
three days post-transplantation.
In the microbiology lab each respiratory sample is cultured and
when indicated screened for a panel of 22 targets detected in 8 in-
house RT-PCR multiplexes. This molecular panel covers the most
important pathogens of viral respiratory infections and atypical
bacterial pneumonia. The first respiratory sample of this patient
was a bronchial aspirate taken three days post transplantation. The
bacterial culture was negative but the sample tested positive for
RSV-A with a high viral load (Ct value of 23). Follow up samples 15
days and 35 days post-surgerywere still RSV positive althoughwith
decreasing viral load (Ct value of 25 and 28 respectively). Culture of
respiratory samples showed the presence of Staphylococcus aureus
only 10 days after surgery so RSV is most probably the primary
cause of the respiratory disease. RSV was still detectable 1 month
after transplantationwhichmight be explained by the immunosup-
pressive treatment of the patient. The heart transplantation was
performed during the RSV season. Some days before the surgery
the lady had taken care of her young grandchildren so there indeed
was a potential risk of community-acquired transmission.
Conclusion: Without testing for viral pathogens no accurate
diagnosis for the respiratory failure of this patient could have been
made. Since screening of adult patients for viral pathogens is not
common practice at the IC-unit, this case illustrates the added value
of molecular screening when signs of respiratory failure arise in
adult immunocompromised patients.
Abstract no: 148
Presentation at ESCV 2016: Poster 152
Respiratory viruses in the intensive care unit:
More frequent than expected
A. Vankeerberghen ∗, K. Dierickx, A. Boel,
K. Van Vaerenbergh, H. De Beenhouwer
Laboratory of Microbiology, OLVZ Aalst, Belgium
In the Laboratory of Microbiology of the OLV Hospital in Aalst
respiratory samples (n = 3500/year), received from multiple hos-
pitals spread all over Flanders, are analysed on a daily basis by
in house multiplex real time PCR for a panel of viral and bacte-
rial pathogens. The panel includes adenovirus, bocavirus, human
metapneumovirus (hMPV), respiratory syncytial virus (RSV), para-
influenzavirus (PIV) 1, 2, 3 and 4, Influenza virus A and B,
enterovirus, rhinovirus, coronaviruses, Bordetella pertussis & para-
pertussis, Mycoplasma pneumoniae and Chlamydia pneumoniae.
Before 2014, the majority of samples originated from children.
The severe influenza epidemic in the winter season 2014–2015
made clinicians aware that viral infections in adults are not that
innocent at all. Moreover, in the “Influenza season”, not only
Influenza circulated but also other viruses were cause of severe
disease. Correct identification of the pathogen is indispensable to
administer or withhold therapy. As a consequence, the request for
the real time PCR respiratory panel on samples from adult hospi-
talized patients increased.
In order to calculate the frequency of these pathogens in adult
critically ill patients, a retrospective study was performed for the
period September 2014 to May 2016 including patients transferred
to the coronary care unit (CCU) and the intensive care unit (ICU)
because of respiratory failure.
Respiratory panel results of samples, obtained in the window
from 3 days before to 5 days after transfer to the CCU and IC units,
were included. From the 126 samples, 44 samples were positive
(34.92%) with 41 samples (93.18%) positive for a viral pathogen and
3 samples (6.82%) positive for a bacterial pathogen (1 M. pneumo-
niae, 1 C. pneumoniae and 1 B. parapertussis). None of the samples
were positive for adenovirus or parainfluenzavirus.
As expected, Influenza A virus (n = 14) and Influenza B virus
(n = 8) were the most frequent and 1 patient had a co-infection of
both viruses. No other co-infection was found. Surprisingly, rhi-
novirus (n = 8) was found to be the third most frequent viral cause
of infection. hMPV and RSV are known to cause severe respiratory
problems in infants and RSV infections have also been observed in
the immunocompromised host. In our study, not only RSV (n = 5)
but also hMPV (n = 7) was found frequently and caused very severe
“Influenza-like” disease.
We can conclude that viral infections are a common cause of
respiratory problems in the intensive care unit and screening of
these patients might be an important clue in diagnosis and correct
treatment.
Abstract no: 161
Presentation at ESCV 2016: Poster 153
Multidrug-resistant cytomegalovirus infection
in a pediatric stem cell transplantation patient
T. Bauters ∗, L. Florin , V. Bordon , R. Snoeck ,
G. Andrei , S. Gillemot , P. Fiten ,
G. Opdenakker , G. Laureys , E. Padalko
1 Department of Pharmacy, Ghent University
Hospital, Ghent, Belgium
2 Department of Clinical Chemistry, Microbiology
and Immunology, Ghent University and Hospital,
Ghent, Belgium
3 Department of Pediatric Hemato-Oncology and
Stem Cell Transplantation, Ghent University
Hospital, Ghent, Belgium
4 Rega Institute for Medical Research, Department of
Microbiology and Immunology, KU Leuven, Leuven,
Belgium
Background: Cytomegalovirus (CMV), a member of the Her-
pesviridae family, is characterized by a lifelong latency in the host.
Clinical presentations of CMV infection are minimal in immuno-