Viral respiratory infections (VRI) are common in children with cystic fibrosis (CF) and are associated with significant clinical deterioration. Little previous research has been conducted on VRI in adults with CF. This thesis describes a prospective study to determine the epidemiology and clinical impact of VRI among 100 adults with CF.The incidence of identifiable VRI was 1.66 cases/patient-year. Rhinovirus accounted for 72.5% of viruses. Identifiable VRI was associated with increased risk of pulmonary exacerbation, increased respiratory symptoms and higher C-reactive protein levels. Changes in the climate and seasons affected the incidence of identifiable VRI. Rhinovirus was most common in autumn and other viruses predominated during winter. Warmer ambient temperatures were associated with increased risk of rhinovirus infection while other viruses were more common in colder temperatures. Genetic sequencing of a subset of 42 rhinoviruses identified during the study showed that rhinovirus A accounted for 69% of cases and was associated with more severe respiratory symptoms and higher C-reactive protein levels than rhinovirus B.The impact of identifiable VRI on changes to bacterial communities within the lungs of patients with CF was investigated. Ribosomal intergenic spacer analysis (RISA) was developed as a tool to profile the bacterial diversity of CF sputum and was compared with standard culture and 16S rRNA gene pyrosequencing. No consistent effect of identifiable VRI on the microbial diversity of CF sputum was detected with any of these methods in longitudinal analysis of a subset of 18 patients.

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La grippe est une infection respiratoire responsable de complications respiratoires ou neurologiques nécessitant une prise en charge rapide et adaptée. L’émergence des technologies de séquençage à haut débit (NGS) permet l’étude des communautés microbiennes résidentes ainsi qu’une étude approfondie du génome des pathogènes impliqués. Cette thèse a pour objectif de caractériser le microbiome respiratoire et la diversité génomique virale des patients infectés par les virus grippaux, en corrélant les données clinicobiologiques recueillies. Après recueil des prélèvements respiratoires d’enfants hospitalisés entre 2010 et 2014, le séquençage de leur microbiome respiratoire a mis en évidence une augmentation de la diversité microbienne ainsi qu’une signature microbienne différentielle entre formes cliniques. Une répartition différentielle de taxons (OTU) permet la prédiction de complications chez les enfants infectés. L’étude d’échantillons respiratoires de patients adultes permettra de compléter la signature prédictive. Après validation des processus analytiques et bioinformatiques par reconstitution artificielles de quasi espèces et recueil de 125 prélèvements cliniques respiratoires, le séquençage du génome entier par NGS des virus grippaux permet de différencier les diversités initiales en fonction de la nature du virus infectant et de la complication. En comparaison du prélèvement initial précoce les échantillons prélevés successivement mettent en évidence une diversification différentielle entre les différents segments des virus grippaux infectant les patients, que ce soit chez les patients immunocompétents ou chez un patient immunodéprimé à l’excrétion prolongé / Influenza is a respiratory infection responsible for respiratory or neurological complications and require rapid and adapted management. The emergence of next-generation sequencing (NGS) allows the study of resident microbial communities as well as an in-depth study of the genome of the pathogens. This thesis aimed to characterize the respiratory microbiome and the viral genomic diversity of influenza virus infected patients, correlating these data to the collected clinical data. After sampling of respiratory specimens from hospitalized children between 2010 and 2014, the sequencing of their respiratory microbiome revealed an increase in microbial diversity and a differential microbial signature between clinical forms. A differential taxon distribution (OTU) allows the prediction of complications in infected children. The study of adult respiratory samples will complete the predictive signature.After validation of the analytical and bioinformatic processes by artificial reconstitution of quasi-species and collection of 125 respiratory clinical specimens, the sequencing of the whole genome by NGS of the influenza viruses allow to differentiate the initial diversities according to the nature of the infecting virus and the complication. Compared to early samples, specimen sampled successively show a differential diversification between the different segments of influenza viruses, whether in immunocompetent patients or in an immunocompromised patient with prolonged excretion