Respiratory virus is a real pathogen in immunocompetent community-acquired pneumonia: comparing to influenza like illness and volunteer controls

• Published in: BMC pulmonary medicine 2014-09, Vol.14 (1), p.144-144, Article 144
• Main Authors: Zhan, Yangqing, Yang, Zifeng, Chen, Rongchang, Wang, Yutao, Guan, Wenda, Zhao, Suishan
• Format: Article
• Language: English
• Subjects: Adenoviridae - immunology; Adenoviridae Infections - blood; Adenoviridae Infections - virology; Adenovirus; Adenoviruses; Adult; Aged; Antibiotics; Antibodies, Viral - blood; Cell culture; Coinfection - virology; Community-Acquired Infections - blood; Community-Acquired Infections - virology; Confidence intervals; Coronavirus; Coronavirus - immunology; Coronavirus Infections - blood; Coronavirus Infections - virology; Drug resistance; Female; Fever; Healthy Volunteers; Hospitals; Human rhinovirus; Humans; Illnesses; Immunoglobulin G - blood; Infections; Influenza; Influenza A virus; Influenza A virus - immunology; Influenza B virus - immunology; Influenza, Human - blood; Influenza, Human - virology; Laboratories; Male; Middle Aged; Pandemics; Parainfluenza virus; Parainfluenza Virus 1, Human - immunology; Parainfluenza Virus 3, Human - immunology; Picornaviridae Infections - blood; Picornaviridae Infections - virology; Pneumonia; Pneumonia, Viral - blood; Pneumonia, Viral - virology; Polymerase chain reaction; Prospective Studies; Pulmonology; Respiratory diseases; Respirovirus Infections - blood; Respirovirus Infections - virology; Rhinovirus - immunology; RNA Virus Infections - blood; RNA Virus Infections - virology; Statistical analysis; Virology; Viruses
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/1471-2466-14-144

Viral pathogens were more commonly reported than previously estimated in community-acquired pneumonia (CAP) patients. However, the real role of virus was still controversial. Consecutive adult patients with CAP between April and December, 2009 were prospectively enrolled. A four-fold or greater increase of IgG-titres against respiratory viruses in pair sera was tested by means of hemagglutination inhibition assay or indirect immunofluorescence. Swab samples were tested by cell culture and/or nucleic amplification tests. Viral etiology was considered definitive if at least one of the above tests was positive. Viral etiology was established in fifty-two (34.9%) of 149 CAP patients, twenty-two (81.5%) of 27 influenza like illness patients, and none of 75 volunteer controls. Forty-seven CAP patients were infected by a single virus (24 influenza A virus, 5 influenza B, 10 parainfluenza virus type 3 [PIV-3], 2 PIV-1, 2 adenovirus, 2 human rhinovirus and 2 coronavirus OC43), five cases by two or three viruses co-infection. Fever ≥ 39 °C (66.7%), fatigue (64.6%), and purulent sputum (52.1%) was the most common symptoms in viral pneumonia patients. On multivariate analysis, myalgia was included in the model for pneumonia associated with influenza infection. In the CURB-65 model only influenza infection was found independently associated with severe disease (CURB-65 score ≥ 3) out of variables, including age(years), sex, current smoking status, sick contact with febrile patients, numbers of comorbidity, presence of influenza infection, presence of PIV infection, with P = 0.021, OR 7.86 (95% CI 1.37-45.04). Respiratory virus was not a bystander, but pathogenic in pneumonia and was a common cause of CAP.