Viral community-acquired pneumonia in nonimmunocompromised adults
Viral community-acquired pneumonia in nonimmunocompromised adults
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DOI：
10.1378/chest.125.4.1343
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发表时间：
2004-04-01
期刊：
影响因子：
9.6
通讯作者：
Torres, A
中科院分区：
文献类型：
--
作者：
de Roux, AD;Marco, MA;Torres, A
引言：病毒性社区获得性肺炎（CAP）的研究和临床特征很少。使用严格的纳入标准，我们研究了这种类型的感染在一个大系列的住院成人与CAP。材料和方法：1996年至2001年，在我们拥有1,000张床位的大学教学医院，所有诊断为CAP且具有呼吸道病毒（RV）配对血清学的非免疫功能低下的成年患者[338例患者]前瞻性纳入研究，随后进行了随访。我们比较了纯病毒（PV）、混合病毒（RV +细菌）和肺炎球菌CAP患者。RV（即，流感病毒，副流感病毒，呼吸道合胞病毒，腺病毒）的配对血清学诊断的手段。结果：61 338例（18%）与配对血清学RV检测，并在31例（9%），这是唯一的病原体确定。流感是最常见的病毒检测（39例患者; 64%）。与混合病毒/细菌病因（2/26例患者; 8%; p = 0.035）或肺炎链球菌引起的CAP（1/44例患者; 2%; p = 0.001）相比，慢性心力衰竭（CHF）患者发生PV CAP的风险增加（8/26例患者; 31%）。多因素分析显示，CHF（比值比[OR]，15.3; 95%置信区间[CI]，1.4 - 163; p = 0.024）和无咳痰（OR，0.14; 95% CI，0.04至0.6; p = 0.006）与PV肺炎相比，肺炎球菌CAP。RV是CAP的常见病因（单一或与细菌组合）。CHF患者获得病毒性CAP的风险增加。
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.