Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity

Abstract

BackgroundBetter knowledge of distribution of respiratory viruses (RVs) in adolescents and adults with community-acquired pneumonia (CAP) is needed.MethodsTo investigate the RVs etiology among adolescents and adults with CAP, according to age and pneumonia severity index (PSI), a multi-center, prospective study was conducted from November 2010 to April 2012. Fifteen RVs were tested by polymerase chain reaction (PCR). Bacteria were detected by urinary antigen, conventional culture and PCR.ResultsMean (SD) age and median (IQR) PSI score of 954 patients enrolled was 45.2 (19.5) years (range 14–94) and 42 (36). RVs were found in 262 patients (27.5%): influenza virus A (IFV A, 9.9%) comprised of pandemic H1N1 (6.7%) and seasonal H3N2 (3.5%), human rhinovirus (4.3%), adenovirus (4.2%), human metapneumovirus (1.8%), parainfluenza virus 1, 3 and 2 (1.7%, 1.5% and 1.2%). Influenza virus B, enterovirus, respiratory syncytial virus, human coronavirus and parainfluenza virus 4 were rarely detected (<1%). Frequency of IFV A was highest among patients aged between 45–64 years (p < 0.001), while adenovirus among patients aged 14–17 years (p < 0.001), no differences was found in other RVs. The proportion of pandemic H1N1 increased with severity of pneumonia evaluated by PSI (P < 0.05).ConclusionsThe proportion of RVs in CAP is higher than previously reported. IFV A pneumonia are usually found in patients older than 45 years, while, adenovirus pneumonia are common in adolescents and young adults. Pandemic H1N1 virus is still recognized by PSI as a high-severity pathogen. The findings contribute baseline data on viral CAP study in China.

Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

“…We felt that our systematic review would still be representative of an adult population with the inclusion of the latter two studies, given the mean/median age of their sample. The patient population consisted of inpatients in 25 studies [1-3, 5-12, 17, 18, 20, 21, 23-28, 30, 33-35], outpatients in one study [36], and both inpatients and outpatients in five studies [19,22,29,31,32].…”

“…They were published between 2005 and 2015 and carried out in Europe (n=14) [1, 3, 5, 18-24, 26, 28, 33, 35], Asia (n=9) [2, 6, 10, 29-32, 34, 36], North America (n=4) [11,12,25,27], Oceania (n=3) [7,8,17] and South America (n=1) [9]. These studies enrolled a predominantly adult population although two of them used a cut-off of age >14 years for inclusion [3,31]. Our original protocol anticipated the exclusion of studies with paediatric populations.…”

“…=83.2%) in studies with mixed inpatients and outpatients [19,22,29,31,32]. In the two studies that obtained lower respiratory samples in >50% of the patients [2,28], it was 44.2% …”

“…For the outcome short-term mortality, we pooled data from 13 studies [2,3,6,7,24,26,28,29,[31][32][33][34][35]. The odds of death were higher in patients with viral infection, but there was no statistical significance (OR 1.3, 95% CI 0.8-2.16; p=0.283; I 2 =44.1%) (figure 3).…”

“…In patients with dual bacterial and viral infection (10 studies), the odds of death were significantly higher compared with patients without dual infection (OR 2. [3] SAITO [32] HOLM [22] JENNINGS [8] HOHENTHAL [21] CHARLES [17] JOHNSTONE [27] DIEDEREN [20] MERMOND [7] SHIBLI [34] JOHANSSON [26] LIEBERMAN [30] HARA [6] CILLÓNIZ [18] CHOI [2] SANGIL [33] YIN [36] VAN GAGELDONK-LAFEBER [5] LUCHSINGER [9] TAKAHASHI [10] WIEMKEN [11] MUSHER [12] VIASUS [35] HUIJSKENS [24] KIM [29] KARHU [28] HOLTER [23] QU [31] DAS [19] JAIN [25] …”