Epidemiology, Co-Infections, and Outcomes of Viral Pneumonia in Adults

Abstract

Advanced technologies using polymerase-chain reaction have allowed for increased recognition of viral respiratory infections including pneumonia. Co-infections have been described for several respiratory viruses, especially with influenza. Outcomes of viral pneumonia, including cases with co-infections, have not been well described.This was observational cohort study conducted to describe hospitalized patients with viral pneumonia including co-infections, clinical outcomes, and predictors of mortality. Patients admitted from March 2013 to November 2014 with a positive respiratory virus panel (RVP) and radiographic findings of pneumonia within 48 h of the index RVP were included. Co-respiratory infection (CRI) was defined as any organism identification from a respiratory specimen within 3 days of the index RVP. Predictors of in-hospital mortality on univariate analysis were evaluated in a multivariate model.Of 284 patients with viral pneumonia, a majority (51.8%) were immunocompromised. A total of 84 patients (29.6%) were found to have a CRI with 48 (57.6%) having a bacterial CRI. Viral CRI with HSV, CMV, or both occurred in 28 patients (33.3%). Fungal (16.7%) and other CRIs (7.1%) were less common. Many patients required mechanical ventilation (54%) and vasopressor support (36%). Overall in-hospital mortality was high (23.2%) and readmissions were common with several patients re-hospitalized within 30 (21.1%) and 90 days (36.7%) of discharge. Predictors of in-hospital mortality on multivariate regression included severity of illness factors, stem-cell transplant, and identification of multiple respiratory viruses. In conclusion, hospital mortality is high among adult patients with viral pneumonia and patients with multiple respiratory viruses identified may be at a higher risk.

Viral Respiratory Infections in Patients with Cancer

“…The majority of patients with multiple viral infections had active malignancy. Fifty-eight of malignant patients were admitted to ICU following viral pneumonia (58). In another study, frequency of respiratory viral infections among children suffering from febrile neutropenia caused by cancer chemotherapy was surveyed by in-house real-time PCR.…”

Performance evaluation of direct fluorescent antibody, Focus Diagnostics Simplexa™ Flu A/B & RSV and multi-parameter customized respiratory Taqman® array card in immunocompromised patients

“…Also, in almost one-third of the Simplexa™ positive samples, TAC detected Flu A and the presence of an additional pathogen. Respiratory co-infections, in particular, the association of Flu A with (an)other viral, bacterial or fungal pathogen(s), could be associated with longer hospital stay, a longer ICU stay and even higher mortality (Shah et al, 2016;Echenique et al, 2013;Crotty et al, 2015). Detecting these co-infections could have an important clinical impact.…”

Other Community Respiratory Viruses

“…7 Other investigators have suggested that detection of multiple respiratory viruses portends poor prognosis and may be a marker for occult immuncompromise. 8 Temporal pattern of symptoms Assessing the tempo of disease progression is also key to understanding the significance of a positive RVP. A long duration or interval since onset of URT symptoms followed by new or changed symptoms consistent with LRT or systemic infection suggests a pulmonary infiltrate in a patient with a positive NP or OP swab is more likely bacterial superinfection than primary viral pneumonia.…”

“…Up to 50% of patients with viral pneumonia may be immunocompromised. 8 Disseminated disease, including viremia, is much more likely in the severely immunocompromised.…”

“…Probably the greatest risk is to recent human stem cell and bone marrow transplant patients. 8 Recovery of T-and B-lymphocytes is delayed more than neutrophils and recent hematologic transplant patients may have low immunoglobulin levels. Lung transplant patients are also particularly prone to serious viral pneumonia.…”