Incidence and Characteristics of Viral Community-Acquired Pneumonia in Adults

Lance C Jennings ^1*, Trevor P Anderson ¹, Kirsten A Beynon ¹, Alvin Chua ¹, Richard TR Laing ², Anja M Werno ¹, Sheryl A Young ¹, Stephen T Chambers ³ and David R Murdoch ³

¹ Canterbury Health Laboratories, New Zealand
² Christchurch Hospital, New Zealand
³ Christchurch School of Medicine & Health Sciences, New Zealand

^* To whom correspondence should be addressed. E-mail: lance.jennings{at}cdhb.govt.nz.

Accepted 22 May 2007

Abstract

Background: In adults, viral causes of community-acquired pneumonia (CAP) are poorly characterised. The aims of this study were to characterise the viral aetiology of CAP in adults by using an extensive array of viral diagnostic tests and to compare the characteristics of viral pneumonia with that of pneumococcal pneumonia.

Methods: Adults admitted to Christchurch Hospital over a 1-year period with CAP were included in the study. Microbiological testing methods included blood and sputum cultures, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, antibody detection in paired sera, and detection of respiratory viruses in nasopharyngeal swabs by immunofluorescence, culture and PCR.

Results: Of 304 patients with CAP, a viral diagnosis was made in 88 (29%), with rhinoviruses and influenza A being the most common. Two or more pathogens were detected in 49 (16%) patients, 45 of whom had mixed viral and bacterial infections. There were no reliable clinical predictors of viral pneumonia, although several variables were independently associated with some aetiologies. The presence of myalgia was associated with pneumonia caused by any respiratory virus (OR 3.62, 95%CI 1.29 to 10.12) and influenza pneumonia (OR 190.72, 95%CI 3.68 to 9891.91). Mixed rhinovirus/pneumococcal infection was associated with severe disease.

Conclusions: Virus-associated CAP is common in adults. Polymicrobial infections involving bacterial and viral pathogens are frequent, and may be associated with severe pneumonia.

Keywords: Streptococcus pneumoniae, influenza, pneumonia, respiratory viruses, rhinovirus

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Murdoch, D. R., O'Brien, K. L., Scott, J. A. G., Karron, R. A., Bhat, N., Driscoll, A. J., Knoll, M. D., Levine, O. S. (2009). Breathing New Life into Pneumonia Diagnostics. J. Clin. Microbiol. 47: 3405-3408 [Full Text]  
• Duncan, A. R., Priest, P. C., Jennings, L. C., Brunton, C. R., Baker, M. G. (2009). Screening for Influenza Infection in International Airline Travelers. AJPH 99: S360-S362 [Abstract] [Full Text]  
• Lahti, E, Peltola, V, Waris, M, Virkki, R, Rantakokko-Jalava, K, Jalava, J, Eerola, E, Ruuskanen, O (2009). Induced sputum in the diagnosis of childhood community-acquired pneumonia. Thorax 64: 252-257 [Abstract] [Full Text]  
• Johnstone, J., Majumdar, S. R., Fox, J. D., Marrie, T. J. (2008). Viral Infection in Adults Hospitalized With Community-Acquired Pneumonia: Prevalence, Pathogens, and Presentation. Chest 134: 1141-1148 [Abstract] [Full Text]  
• Shin, G Y (2008). What about viral community acquired pneumonias?. BMJ 337: a598-a598 [Full Text]  
• Meyerholz, D. K., Edsen-Moore, M., McGill, J., Coleman, R. A., Cook, R. T., Legge, K. L. (2008). Chronic Alcohol Consumption Increases the Severity of Murine Influenza Virus Infections. J. Immunol. 181: 641-648 [Abstract] [Full Text]  
• Hohenthal, U, Vainionpaa, R, Nikoskelainen, J, Kotilainen, P (2008). The role of rhinoviruses and enteroviruses in community acquired pneumonia in adults. Thorax 63: 658-659 [Full Text]  
• Nichols, W. G., Peck Campbell, A. J., Boeckh, M. (2008). Respiratory Viruses Other than Influenza Virus: Impact and Therapeutic Advances. Clin. Microbiol. Rev. 21: 274-290 [Abstract] [Full Text]