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

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BMC Pulmonary Medicine

, 14:144

Infectious, Rare and Idiopathic Pulmonary Diseases


BackgroundViral pathogens were more commonly reported than previously estimated in community-acquired pneumonia CAP patients. However, the real role of virus was still controversial.

MethodsConsecutive 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.

ResultsViral 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 ageyears, 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.

ConclusionRespiratory virus was not a bystander, but pathogenic in pneumonia and was a common cause of CAP.

KeywordsCell culture Clinical feature Community-acquired pneumonia Seroconversion Viral disease AbbreviationsCAPCommunity-acquired pneumonia

NATsNucleic amplification tests

HCoVHuman coronavirus

HRVHuman Rhinovirus

hMPVHuman metapneumovirus

HBoVHuman bocavirus

ILIInfluenza like illness

Flu AInfluenza virus type A

AH1N1pdm09Pandemic H1N1 2009 influenza A virus

PIVParainfluenza virus


RSVRespiratory syncytial virus

RT-PCRReverse transcription polymerase chain reaction

rRT-PCRReal-time reverse transcription polymerase chain reaction

IQRInterquartile range

OROdds ratio

CIConfidence interval.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2466-14-144 contains supplementary material, which is available to authorized users.

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Autor: Yangqing Zhan - Zifeng Yang - Rongchang Chen - Yutao Wang - Wenda Guan - Suishan Zhao


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