Medical treatment of viral pneumonia including SARS in immunocompetent adult

Abstract

Since no randomized controlled trials have been conducted on the treatment of viral pneumonia by antivirals or immunomodulators in immunocompetent adults, a review of such anecdotal experience are needed for the more rational use of such agents. Case reports (single or case series) with details on their treatment and outcome in the English literature can be reviewed for pneumonia caused by human or avian influenza A virus (50 patients), varicella zoster virus (120), adenovirus (29), hantavirus (100) and SARS coronavirus (SARS-CoV) (841). Even with steroid therapy alone, the mortality rate appeared to be lower when compared with conservative treatment for pneumonia caused by human influenza virus (12.5% vs. 42.1%) and hantavirus (13.3% vs. 63.4%). Combination of an effective antiviral, acyclovir, with steroid in the treatment of varicella zoster virus may be associated with a lower mortality than acyclovir alone (0% vs. 10.3%). Combination of interferon alfacon-1 plus steroid, or lopinavir/ritonavir, ribavirin plus steroid were associated with a better outcome than ribavirin plus steroid (0% vs. 2.3% vs. 7.7%, respectively). Combination of lopinavir/ritonavir plus ribavirin significantly reduced the virus load of SARS-CoV in nasopharyngeal, serum, stool and urine specimens taken between day 10 and 15 after symptom onset when compared with the historical control group treated with ribavirin. It appears that the combination of an effective antiviral and steroid was associated with a better outcome. Randomized therapeutic trial should be conducted to ascertain the relative usefulness of antiviral alone or in combination with steroid.

Successful treatment of parainfluenza virus 3 pneumonia with oral ribavirin and methylprednisolone in a bone marrow transplant recipient

“…However, in HSCT patients with PIV URTI, corticosteroids are a risk factor for progression to lower respiratory tract infection [1]. On the other hand, some researches of antiviral therapy combined with steroid on viral pneumonia except PIV pneumonia in immunocompetent adults have been reported [28]. According to the study, the only combination of acyclovir and steroid against varicella zoster virus pneumonia was associated with a better outcome; however, the dosage and duration of steroid therapy for all of the viral pneumonia were heterogeneous in the study.…”

Innate Immunity to Influenza A Virus Infection

“…very tentative evidence that corticosteroids may be beneficial in viral pneumonia induced by IAV [240]. As noted, murine studies suggest that in some instances of severe IAV-induced immuno-pathology, inhibition of TNFα may be beneficial.…”

The Role of Corticosteroids in Sepsis and Acute Respiratory Distress Syndrome

“…Unfortunately, human data on the role of corticosteroids in viral pneumonia is limited [65]. A compilation of a large array of reports of the use of corticosteroids for viral pneumonia, including SARS, suggests that corticosteroids may be of benefit, although the authors acknowledge the reporting bias inherent in case series, whereby positive results are more likely to be found in the medical literature [66]. Lew et al reported no significant difference in outcome between 15 SARS patients treated with immunoglobulin and methylprednisolone compared to 30 patients who did not receive these agents [67].…”