Severe Bacterial Superinfection Based on Influenza A (H1N1) Pneumonia in a Heart–Lung Transplant Recipient

Abstract

A 47-year-old heart–lung transplant recipient presented to our outpatient transplant clinic with respiratory infection. Her nose and throat swabs for influenza A (H1N1) infection were negative. Broncheoalveolar lavage showed a positive result for H1N1 infection. Antiviral therapy was initiated. Because of superinfection with Pseudomonas aeruginosa and Aspergillus terreus, her clinical condition worsened. The clinical condition of the patient improved with antibiotic and antifungal treatment. Negative nose and throat swab results cannot rule out H1N1 infection safely. We therefore advocate to routinely perform broncheoalveolar lavage.

Keywords

infection - transplantation - heart–lung - cardiac

• References

• 1 Dawood FS, Jain S, Finelli L , et al; Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009; 360 (25) 2605-2615
• 2 Meyer S, Ilchmann C, Adam M , et al. Asymptomatic infection with novel influenza A/H1N1 virus in a heart transplant recipient. J Heart Lung Transplant 2010; 29 (5) 585-586
• 3 Mason DP, Murthy SC, Yun JJ , et al. Lung transplantation in a recipient with novel 2009 H1N1 influenza: lessons learned. Thorac Cardiovasc Surg 2011; 59 (2) 126-127
• 4 Kumar D, Michaels MG, Morris MI , et al; American Society of Transplantation H1N1 Collaborative Study Group. Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study. Lancet Infect Dis 2010; 10 (8) 521-526
• 5 Fox BD, Raviv Y, Rozengarten D, Rusanov V, Bakal I, Kramer MR. Pandemic influenza (H1N1): impact on lung transplant recipients and candidates. J Heart Lung Transplant 2010; 29 (9) 1034-1038
• 6 Ison MG. Influenza, including the novel H1N1, in organ transplant patients. Curr Opin Infect Dis 2010; 23 (4) 365-373