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Community-acquired pneumonia in Chile: the clinical relevance in the detection of viruses and atypical bacteria
  1. Vivian Luchsinger1,
  2. Mauricio Ruiz2,
  3. Enna Zunino3,
  4. María Angélica Martínez4,
  5. Clarisse Machado5,
  6. Pedro A Piedra6,
  7. Rodrigo Fasce7,
  8. María Teresa Ulloa4,
  9. Maria Cristina Fink5,
  10. Pamela Lara1,
  11. Mónica Gebauer3,
  12. Fernando Chávez3,
  13. Luis F Avendaño1
  1. 1Programa de Virología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
  2. 2Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
  3. 3Facultad de Medicina, Hospital de Infecciosos Dr. Lucio Córdova, Santiago, Chile
  4. 4Programa de Microbiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
  5. 5Laboratorio de Virología, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
  6. 6Department of Molecular Virology and Microbiology, and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  7. 7Sección Virus Respiratorios y Exantemáticos, Subdepartamento Enfermedades Virales, Instituto de Salud Pública de Chile, Santiago, Chile
  1. Correspondence to Luis F Avendaño, Programa de Virología, Facultad de Medicina, Universidad de Chile, Av. Independencia 1027, Independencia, Santiago 8380453, Chile; lavendan{at}med.uchile.cl

Abstract

Background Adult community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality, however the aetiology often remains uncertain and the therapy is empirical. We applied conventional and molecular diagnostics to identify viruses and atypical bacteria associated with CAP in Chile.

Methods We used sputum and blood cultures, IgG/IgM serology and molecular diagnostic techniques (PCR, reverse transcriptase PCR) for detection of classical and atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumoniae) and respiratory viruses (adenovirus, respiratory syncytial virus (RSV), human metapneumovirus, influenza virus, parainfluenzavirus, rhinovirus, coronavirus) in adults >18 years old presenting with CAP in Santiago from February 2005 to September 2007. Severity was qualified at admission by Fine's pneumonia severity index.

Results Overall detection in 356 enrolled adults were 92 (26%) cases of a single bacterial pathogen, 80 (22%) cases of a single viral pathogen, 60 (17%) cases with mixed bacterial and viral infection and 124 (35%) cases with no identified pathogen. Streptococcus pneumoniae and RSV were the most common bacterial and viral pathogens identified. Infectious agent detection by PCR provided greater sensitivity than conventional techniques. To our surprise, no relationship was observed between clinical severity and sole or coinfections.

Conclusions The use of molecular diagnostics expanded the detection of viruses and atypical bacteria in adults with CAP, as unique or coinfections. Clinical severity and outcome were independent of the aetiological agents detected.

  • Viral infection
  • Bacterial Infection
  • Pneumonia
  • Respiratory Infection

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