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J Infect Dis. 2016 Feb 15;213(4):584-91. doi: 10.1093/infdis/jiv323. Epub 2015 Jul 14.

Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia.

Author information

1
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
2
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
3
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
4
Department of Pediatrics.
5
Departments of Pediatrics and Internal Medicine.
6
Department of Pathology, Microbiology & Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee.
7
ARUP Institute for Clinical and Experimental Pathology.
8
Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City.
9
Centers for Disease Control and Prevention, Atlanta, Georgia.
10
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.

Abstract

BACKGROUND:

The clinical significance of viruses detected in patients with community-acquired pneumonia (CAP) is often unclear.

METHODS:

We conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. We compared age-stratified prevalence of each virus between patients with CAP and controls and used multivariable logistic regression to calculate attributable fractions (AFs).

RESULTS:

We enrolled 1024 patients with CAP and 759 controls. Detections of influenza, respiratory syncytial virus, and human metapneumovirus were substantially more common in patients with CAP of all ages than in controls (AFs near 1.0). Parainfluenza and coronaviruses were also more common among patients with CAP (AF, 0.5-0.75). Rhinovirus was associated with CAP among adults (AF, 0.93) but not children (AF, 0.02). Adenovirus was associated with CAP only among children <2 years old (AF, 0.77).

CONCLUSIONS:

The probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus. Detections of influenza, respiratory syncytial virus, and human metapneumovirus among patients with CAP of all ages probably indicate an etiologic role, whereas detections of parainfluenza, coronaviruses, rhinovirus, and adenovirus, especially in children, require further scrutiny.

KEYWORDS:

asymptomatic infection; attributable fraction; etiology; pneumonia; virus

PMID:
26180044
PMCID:
PMC4721902
DOI:
10.1093/infdis/jiv323
[Indexed for MEDLINE]
Free PMC Article

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