Community-Acquired Pneumonia and Infection with Respiratory Syncitial Virus

Zaroukian, Michael H.; Leader, Isabel

doi:10.7326/0003-4819-109-6-515

Cited by 19 publications

(8 citation statements)

References 4 publications

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“…There is evidence that both bacterial superinfection and primary viral pneumonia may occur in elderly persons with RSV‐associated lower respiratory tract disease. Where adequate quality sputum samples have been obtained, both the presence and absence of bacterial superinfection have been reported 9,25,26 . Additionally, histological evidence of viral lower respiratory tract involvement has been reported in a fatal RSV infection affecting a previously healthy, community‐dwelling elderly person 27 .…”

Section: Discussionmentioning

confidence: 99%

Can Respiratory Syncytial Virus and Influenza A be Distinguished Clinically in Institutionalized Older Persons?

Wald

Miller

Shult³

et al. 1995

J American Geriatrics Society

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espiratory syncytial virus (RSV) is the most frequent R cause of lower respiratory tract illness in infants and young children. Early studies in adults indicated that RSV infection was associated with a mild illness resembling the common cold.' Later studies, however, demonstrated that infection could be associated with significant morbidity, absenteeism, and prolonged alterations in airway resistance.' It has also been reported that RSV infection may cause severe or fatal pneumonia in adults immunocompromised as the result of organ transplantation, hematologic malignancy, or HIV infe~tion.~-~ In the last 15 years, a number of studies have also demonstrated that RSV infection may be associated with a clinically significant, influenza-like illness in residents of longterm care Early reports described several outbreaks of RSV infection that were investigated retrospectively after the onset of respiratory illness in a large number of resident~.'~~*''-'~ In general, the diagnosis of RSV was established serologically, and evidence of other respiratory viruses was not detected. Attack rates were high (19 to 43%), and the illnesses were of variable severity. In the most severe outbreak, 40 of 101 residents in a nursing home developed respiratory illness; among those who became ill, 55% developed radiographically proven pneumonia, and 20% died.13 Prospective studies of respiratory illnesses in nursing homes have also detected the presence of RSV infection. In most of these studies, RSV was implicated in a minority of i l l n e s~e s .~~'~~'~ However, one recent study found RSV to be the predominant respiratory virus identified during an influenza season.'' In that study, 149 illnesses were studied in a 591-bed nursing home. Sixty-two illnesses were determined to be of viral etiology, and of these, 40 were attributed to RSV and only two to influenza. The same investigators evaluated acute and convalescent serum obtained from ill residents in two nursing homes." The proportion of ill residents with serologic evidence of RSV infection varied widely, from 3% in one nursing home to 20% in the second facility. Supported by NIH grants AGO9632 (SG), AGO0548 (SG), and SAG00213 (TW)This is GRECC publication number 9406.

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Section: Discussionmentioning

confidence: 99%

Can Respiratory Syncytial Virus and Influenza A be Distinguished Clinically in Institutionalized Older Persons?

Wald

Miller

Shult³

et al. 1995

J American Geriatrics Society

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“…The median age was 75 years, and the incidence of pneumonia was 63%. In two other studies which used viral culture alone for diagnosis, RSV was detected in 2 to 5% of patient samples (109,194). Two more recent, larger studies of hospitalized adults again show RSV to be a common pathogen (27,42).…”

Section: Epidemiology Elderly Adultsmentioning

confidence: 93%

“…Surprisingly, the young adults were otherwise healthy. Lastly, a number of studies evaluating the etiology of community-acquired pneumonia have identified RSV with variable success (Table 3) (27,42,54,96,121,128,159,169,178,194). The variability in infection rates likely reflects the diagnostic tools used and seasons studied but may also reflect some differences in geographic distribution of the virus.…”

Section: Epidemiology Elderly Adultsmentioning

confidence: 99%

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Respiratory Syncytial Virus Infection in Adults

2000

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SUMMARY Respiratory syncytial virus (RSV) is now recognized as a significant problem in certain adult populations. These include the elderly, persons with cardiopulmonary diseases, and immunocompromised hosts. Epidemiological evidence indicates that the impact of RSV in older adults may be similar to that of nonpandemic influenza. In addition, RSV has been found to cause 2 to 5% of adult community-acquired pneumonias. Attack rates in nursing homes are approximately 5 to 10% per year, with significant rates of pneumonia (10 to 20%) and death (2 to 5%). Clinical features may be difficult to distinguish from those of influenza but include nasal congestion, cough, wheezing, and low-grade fever. Bone marrow transplant patients prior to marrow engraftment are at highest risk for pneumonia and death. Diagnosis of RSV infection in adults is difficult because viral culture and antigen detection are insensitive, presumably due to low viral titers in nasal secretions, but early bronchoscopy is valuable in immunosuppressed patients. Treatment of RSV in the elderly is largely supportive, whereas early therapy with ribavirin and intravenous gamma globulin is associated with improved survival in immunocompromised persons. An effective RSV vaccine has not yet been developed, and thus prevention of RSV infection is limited to standard infection control practices such as hand washing and the use of gowns and gloves.

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“…Estimates of RSV infection vary widely (0 to 14%) in CAP studies depending on the diagnostic tools used and the season of study. 2,[41][42][43][44][45][46][47] In a large study of 1200 adults admitted to the hospital with a diagnosis of pneumonia, RSV was identified in 4.4% of cases and was the third most commonly identified pathogen after Streptococcus pneumoniae (6.2%) and influenza types A and B (5.4%). 2 A recent study of CAP from Spain using a combination of diagnostic techniques found RSV to be the cause of 5/198 (3%) of adult patients with CAP.…”

Section: Community-acquired Pneumoniamentioning

confidence: 99%