Viral Infections of the Lower Respiratory Tract: Old Viruses, New Viruses, and the Role of Diagnosis

Abstract

Viral infections of the lower respiratory tract cause an enormous disease burden in children, and the role of respiratory viruses in serious lower respiratory tract infections (LRTIs) in older adults is increasingly appreciated. Although viruses are responsible for a large proportion LRTIs, antibiotics are often prescribed. New diagnostic platforms have the potential to detect a wider range of established and newly discovered viruses with greater sensitivity. This will create additional challenges. Although it is clear that influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus are important causes of pneumonia, the role of rhinoviruses and some of the newly described viruses, including human coronaviruses and bocavirus, is harder to determine. Better diagnostic tests that establish the cause of LRTIs in children have the potential to both reduce overall antibiotic use and to improve the targeted use of antibiotics. In addition, rapid identification of viral infections can help control nosocomial transmission.

Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia

“…Stratification of the data on the basis of virus-positive or -negative NPA results indicated a stronger relationship between low vitamin D status and pneumonia outcomes in patients in whom we detected a respiratory virus. However, the interpretation of this finding is limited by a lack of bacterial diagnostics and the relatively low detection rate of virus compared with reports from similar populations (29,30).…”

Clinical predictors of antibiotic prescribing for acutely ill children in primary care: an observational study

“…For examination findings and working diagnosis, missing information was analysed as 'not examined' and 'no diagnosis given', respectively. For the analysis, the clinicians' working diagnoses were further grouped: 'pneumonia', 'chest infection', 'bronchitis', 'bronchiolitis', and 'croup' were grouped with lower respiratory tract infection (LRTI); 34 'throat infection' and 'sore throat' were grouped with 'tonsillitis'; 'coryza' and 'cough' were grouped with URTI; exacerbation of asthma was included in the 'other' category unless URTI or LRTI was also mentioned. For the parent/carer and clinician illness severity measures, scores of 2, 3, and 4 (moderately, very, or severely unwell) were grouped together due to low numbers in these groups compared British Journal of General Practice, September 2015 e586…”

Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

“…Although acute respiratory illness (ARI) in childrenaccountsfora large part ofall visits to pediatric health facilities and is a great economic burden on society, 1,2 our tools to diagnose the etiologic agents have until recently been limited. 3 Treatment with antibiotics induces development of antibiotic resistance in bacteria 4 and has a negligible effect on most ARIs, which generally are of viral origin. 5,6 Nevertheless, antibiotics are frequently prescribed due to lack of clinically valid diagnostic tests verifying a viral etiology.…”

“…3 Treatment with antibiotics induces development of antibiotic resistance in bacteria 4 and has a negligible effect on most ARIs, which generally are of viral origin. 5,6 Nevertheless, antibiotics are frequently prescribed due to lack of clinically valid diagnostic tests verifying a viral etiology.…”