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

BMC Infectious Diseases

Chen Wang¹  Bin Cao²  Yi-Min Wang²  Ran Li²  Ying-Mei Liu²  Xiao-Min Yu²  Zeng-Hui Pu³  Li Gu²  Jiu-Xin Qu² 

[1] Department of Respiratory Medicine, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China;Department of Infectious diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, No 8 Gongti Nanlu, ChaoYang District, Beijing 100020, China;Department of Infectious diseases, YanTai Yu Huang-Ding Hospital, Yantai, China

关键词: Human rhinovirus;    Adenovirus;    Influenza virus A;    Adult;    Adolescent;    Pneumonia severity index;    Respiratory viral infection;    Community-acquired pneumonia;   

Others  :  1135703
DOI  :  10.1186/s12879-015-0808-0

 received in 2014-02-26, accepted in 2015-02-06,  发布年份 2015

【 摘 要 】

Background

Better knowledge of distribution of respiratory viruses (RVs) in adolescents and adults with community-acquired pneumonia (CAP) is needed.

Methods

To 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.

Results

Mean (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).

Conclusions

The 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.

【 授权许可】

   
2015 Qu et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Welte T, Torres A, Nathwani D: Clinical and economic burden of community-acquired pneumonia among adults in europe. Thorax 2012, 67:71-9.
• [2]Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C: Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003, 37:1405-33.
• [3]Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al.: Infectious diseases society of america/american thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007, 44(Suppl 2):S27-72.
• [4]Esposito S, Daleno C, Prunotto G, Scala A, Tagliabue C, Borzani I, et al.: Impact of viral infections in children with community-acquired pneumonia: results of a study of 17 respiratory viruses. Influenza Other Respi Viruses 2013, 7:18-26.
• [5]Bezerra PG, Britto MC, Correia JB, Duarte MC, Fonceca AM, Rose K, et al.: Viral and atypical bacterial detection in acute respiratory infection in children under five years. PLoS One 2011, 6:e18928.
• [6]Ruuskanen O, Lahti E, Jennings LC, Murdoch DR: Viral pneumonia. Lancet 2011, 377:1264-75.
• [7]Fouchier RA, Rimmelzwaan GF, Kuiken T, Osterhaus AD: Newer respiratory virus infections: human metapneumovirus, avian influenza virus, and human coronaviruses. Curr Opin Infect Dis 2005, 18:141-6.
• [8]Larcher C, Jeller V, Fischer H, Huemer HP: Prevalence of respiratory viruses, including newly identified viruses, in hospitalised children in austria. Eur J Clin Microbiol Infect Dis 2006, 25:681-6.
• [9]Tiveljung-Lindell A, Rotzen-Ostlund M, Gupta S, Ullstrand R, Grillner L, Zweygberg-Wirgart B, et al.: Development and implementation of a molecular diagnostic platform for daily rapid detection of 15 respiratory viruses. J Med Virol 2009, 81:167-75.
• [10]Arens MQ, Buller RS, Rankin A, Mason S, Whetsell A, Agapov E, et al.: Comparison of the eragen multi-code respiratory virus panel with conventional viral testing and real-time multiplex pcr assays for detection of respiratory viruses. J Clin Microbiol 2010, 48:2387-95.
• [11]Do AH, van Doorn HR, Nghiem MN, Bryant JE, Hoang TH, Do QH, et al.: Viral etiologies of acute respiratory infections among hospitalized vietnamese children in ho chi minh city, 2004–2008. PLoS One 2011, 6:e18176.
• [12]Pavia AT: What is the role of respiratory viruses in community-acquired pneumonia?: what is the best therapy for influenza and other viral causes of community-acquired pneumonia? Infect Dis Clin North Am 2013, 27:157-75.
• [13]Qu J, Gu L, Wu J, Dong J, Pu Z, Gao Y, et al.: Accuracy of igm antibody testing, fq-pcr and culture in laboratory diagnosis of acute infection by mycoplasma pneumoniae in adults and adolescents with community-acquired pneumonia. BMC Infect Dis 2013, 13:172. BioMed Central Full Text
• [14]Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al.: A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997, 336:243-50.
• [15]Waites KB, Nolte FS: Laboratory diagnosis of mycoplasmal infections. ASM Press, Washington, D.C.; 2001.
• [16]Loens K, Van Heirstraeten L, Malhotra-Kumar S, Goossens H, Ieven M: Optimal sampling sites and methods for detection of pathogens possibly causing community-acquired lower respiratory tract infections. J Clin Microbiol 2009, 47:21-31.
• [17]File TM: Community-acquired pneumonia. Lancet 2003, 362:1991-2001.
• [18]Win MK, Chen MI, Barkham T, Lin C, Tan A, Lin R, et al.: Influenza disease burden in adults by subtypes following the initial epidemic of pandemic h1n1 in singapore. Influenza Other Respi Viruses 2011, 5:e563-7.
• [19]Chuang JH, Huang AS, Huang WT, Liu MT, Chou JH, Chang FY, et al.: Nationwide surveillance of influenza during the pandemic (2009–10) and post-pandemic (2010–11) periods in taiwan. PLoS One 2012, 7:e36120.
• [20]Eurosurveillance Editorial Team: World health organization declares post-pandemic phase Euro Surveill 2010, 15(32):pii=19636.
• [21]Riquelme R, Torres A, Rioseco ML, Ewig S, Cillóniz C, Riquelme M, et al.: Influenza pneumonia: a comparison between seasonal influenza virus and the h1n1 pandemic. Eur Respir J 2011, 38:106-11.
• [22]Viasus D, Cordero E, Rodriguez-Bano J, Oteo JA, Fernández-Navarro A, Ortega L, et al.: Changes in epidemiology, clinical features and severity of influenza a (h1n1) 2009 pneumonia in the first post-pandemic influenza season. Clin Microbiol Infect 2012, 18:E55-62.
• [23]Lieberman D, Shimoni A, Shemer-Avni Y, Keren-Naos A, Shtainberg R: Respiratory viruses in adults with community-acquired pneumonia. Chest 2010, 138:811-6.
• [24]Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J: Etiology of community-acquired pneumonia: Increased microbiological yield with new diagnostic methods. Clin Infect Dis 2010, 50:202-9.
• [25]Hohenthal U, Vainionpaa R, Nikoskelainen J, Kotilainen P: The role of rhinoviruses and enteroviruses in community acquired pneumonia in adults. Thorax 2008, 63:658-9.
• [26]Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, et al.: Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008, 63:42-8.
• [27]Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, et al.: Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med 2012, 186:325-32.
• [28]Lauderdale TL, Chang FY, Ben RJ, Yina HC, Nib YH, Tsai JW, et al.: Etiology of community acquired pneumonia among adult patients requiring hospitalization in taiwan. Respir Med 2005, 99:1079-86.
• [29]Cao B, Ren LL, Zhao F, Gonzalez R, Song SF, Bai L, et al.: Viral and mycoplasma pneumoniae community-acquired pneumonia and novel clinical outcome evaluation in ambulatory adult patients in china. Eur J Clin Microbiol Infect Dis 2010, 29:1443-8.
• [30]Hohenthal U, Vainionpaa R, Meurman O, Vahtera A, Katiskalahti T, Nikoskelainen J, et al.: Aetiological diagnosis of community acquired pneumonia: Utility of rapid microbiological methods with respect to disease severity. Scand J Infect Dis 2008, 40:131-8.
• [31]Roson B, Carratala J, Dorca J, Casanova A, Manresa F, Gudiol F: Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis 2001, 33:158-65.
• [32]van der Poll T, Opal SM: Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet 2009, 374:1543-56.