Viral Community-Acquired Pneumonia in Nonimmunocompromised Adults

doi:10.1378/chest.125.4.1343

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Volume 125, Issue 4, April 2004, Pages 1343-1351

https://doi.org/10.1378/chest.125.4.1343 Get rights and content

Introduction

Viral community-acquired pneumonia (CAP) has been poorly studied and clinically characterized. Using strict criteria for inclusion, we studied this type of infection in a large series of hospitalized adults with CAP.

Materials and methods

All nonimmunocompromised adult patients with a diagnosis of CAP having paired serology for respiratory viruses (RVs) [338 patients] were prospectively included in the study from 1996 to 2001 at our 1,000-bed university teaching hospital, and subsequently were followed up. We compared patients with pure viral (PV), mixed viral (RV + bacteria), and pneumococcal CAP. RVs (ie, influenza, parainfluenza, respiratory syncytial virus, and adenovirus) were diagnosed by means of paired serology.

Results

Sixty-one of 338 patients (18%) with paired serology had an RV detected, and in 31 cases (9%) it was the only pathogen identified. Influenza was the most frequent virus detected (39 patients; 64%). Patients with chronic heart failure (CHF) had an increased risk of acquiring PV CAP (8 of 26 patients; 31%) when compared to a mixed viral/bacterial etiology (2 of 26 patients; 8%; p = 0.035) or CAP caused by Streptococcus pneumoniae (1 of 44 patients; 2%; p = 0.001). Multivariate analysis revealed that CHF (odds ratio [OR], 15.3; 95% confidence interval [CI], 1.4 to 163; p = 0.024) and the absence of expectoration (OR, 0.14; 95% CI, 0.04 to 0.6; p = 0.006) were associated with PV pneumonia compared to pneumococcal CAP.

Conclusion

RVs are frequent etiologies of CAP (single or in combination with bacteria). Patients with CHF have an increased risk of acquiring a viral CAP.

Section snippets

Patients and Methods

From October 1996 to February 2001, consecutive adults (≥ 18 years of age) in whom CAP had been diagnosed and who had been admitted to Hospital Clinic, Institut d'Investigations Biomèdiques August Pi i Sunyer (Universitat de Barcelona, Barcelona, Spain) were prospectively studied. The protocol has been described in detail elsewhere.¹⁰¹¹ In short, CAP was defined by the presence of a new infiltrate seen on a chest radiograph together with clinical symptoms suggestive of a lower respiratory tract

Study Population

Of 1,356 patients (893 men and 463 women; mean age, 68 ± 18 years) with CAP who were admitted at our hospital during the study period, a microbial etiology could be established in 518 patients (38%). Overall, the most commonly identified pathogens were SP (41%), Haemophilus influenzae (14.5%), Pseudomonas aeruginosa (12%), and L pneumophila (10%).

Cohort Analyses

We initially included in the study the 338 patients who had valid paired viral serology findings for viruses. In sixty-one patients (18%), at least

Discussion

The main findings of our study are the following: (1) a viral etiology was detected in 18% of the patients with CAP who had undergone a complete diagnostic evaluation, with half of them having a mixed infection; (2) CHF was an independent risk factor for viral pneumonia compared to patients with SP; and (3) the absence of expectoration was independently associated with a PV CAP.

Viruses are a frequent etiologic finding in patients with CAP. In the present study, RVs were implicated in 18% of all

ACKNOWLEDGMENT

The authors thank Joaquim Angrill, for his help with statistical analysis. Furthermore, we appreciate the critical comments and collaboration of Mauricio Ruiz, Ana Rañó, and Carlos Agustí.

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: Dr. de Roux was supported by a research fellowship grant from the European Respiratory Society (2001). This research was supported by Commisionat per a Universitats i Reserca de la Generalitat de Catalunya 1999 228, Fondo de Investigaciones Sanitarias grant 00/0505, Red Grupo Insuficiencia Respiratoria Aguda, and Red RESPIRA.

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Clinical InvestigationsPNEUMONIAViral Community-Acquired Pneumonia in Nonimmunocompromised Adults

Introduction

Materials and methods

Results

Conclusion

Section snippets

Patients and Methods

Study Population

Cohort Analyses

Discussion

ACKNOWLEDGMENT

Chest

Risk factors for community-acquired pneumonia in adults: a population-based case-control study

Eur Respir J

Informe sobre la vacuna neumocócica

Med Clin (Barc)

Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, initial antimicrobial therapy and prevention

Am J Respir Crit Care Med

Community-acquired pneumonia: epidemiology, risk and prognosis

Severe community-acquired pneumonia in the elderly: epidemiology and prognosis; Study Group for Severe Community-Acquired Pneumonia

Clin Infect Dis

Severe community-acquired pneumonia: risk factors and follow-up epidemiology

Am J Respir Crit Care Med

Recommendations for therapy of community-acquired pneumonia: German Society of Pneumology

Pneumologie

Study of community-acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines

Thorax

Prospective study of the incidence, etiology and outcome of adult lower respiratory tract illness in the community

Thorax

Etiology of community-acquired pneumonia in hospitalized patients: impact of age, comorbidity and severity

Am J Respir Crit Care Med

Severe community-acquired pneumonia: assessment of severity criteria

Am J Respir Crit Care Med

Influenza viruses

Clinical Investigations
PNEUMONIA
Viral Community-Acquired Pneumonia in Nonimmunocompromised Adults