Viral pneumonia.
Viral pneumonia.
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DOI：
10.1016/s0140-6736(10)61459-6
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发表时间：
2011-04-09
期刊：
影响因子：
--
通讯作者：
Murdoch DR
中科院分区：
文献类型：
--
作者：
Ruuskanen O;Lahti E;Jennings LC;Murdoch DR
每年约有2亿例病毒性社区获得性肺炎病例发生-其中1亿例发生在儿童中，1亿例发生在成人中。分子诊断测试大大增加了我们对病毒在肺炎中的作用的理解，研究结果表明，病毒性肺炎的发病率被低估了。在儿童中，呼吸道合胞病毒、鼻病毒、人偏肺病毒、人博卡病毒和副流感病毒是发达国家和发展中国家最常见的病原体。双重病毒感染很常见，三分之一的儿童有病毒-细菌合并感染的证据。在成人中，病毒是三分之一社区获得性肺炎病例的假定致病因子，特别是流感病毒、鼻病毒和冠状病毒。细菌在成人肺炎中仍然占主导地位。社区中病毒流行的存在、患者的年龄、发病速度、症状、生物标志物、放射学变化和对治疗的反应可以帮助区分病毒性肺炎和细菌性肺炎。然而，没有临床算法存在，将明确区分肺炎的原因。对于明显的病毒性社区获得性肺炎患者是否需要使用抗生素治疗，尚未达成明确的共识。除了神经氨酸酶抑制剂治疗流感病毒引起的肺炎外，使用特异性抗病毒药物治疗病毒性社区获得性肺炎没有明确的作用。流感疫苗是唯一可用的具体预防措施。需要进一步的研究来更好地了解社区获得性肺炎的病因和发病机制。此外，应调查肺炎病因的区域差异，特别是从发展中国家获得更多数据。
About 200 million cases of viral community-acquired pneumonia occur every year—100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection. In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia. Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia. However, no clinical algorithm exists that will distinguish clearly the cause of pneumonia. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Apart from neuraminidase inhibitors for pneumonia caused by influenza viruses, there is no clear role for use of specific antivirals to treat viral community-acquired pneumonia. Influenza vaccines are the only available specific preventive measures. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries.