Viral pneumonia.

Department of Paediatrics, Turku University Hospitals, Turku, Finland.
The Lancet (Impact Factor: 39.21). 03/2011; 377(9773):1264-75. DOI: 10.1016/S0140-6736(10)61459-6
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: The role of mixed pneumonia (virus + bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP.
    BMC Pulmonary Medicine 07/2014; 14(1):123. · 2.49 Impact Factor
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    ABSTRACT: Introducción. Identifcar inicialmente los niños con neumonía bacteriana puede reducir el uso inadecuado de antibióticos. El puntaje BPS (Bacterial Pneumonia Score) es un modelo de predicción clínica que alcanzó adecuada precisión diagnóstica en la predicción de niños con neumonía bacteriana. Sin embargo, como la interpretación de la radiografía de tórax que incluye este modelo es algo compleja, se desarrolló una versión simplifcada, cuya validación en otra población aún no se ha realizado.Objetivo. Validar una regla de predicción clínica simplifcada para identifcar niños con riesgo de presentar neumonía bacteriana. Métodos. Se estudiaron niños <5 años internados por neumonía con etiología confirmada (viral o bacteriana), y se registraron componentes de la regla de predicción clínica simplifcada (temperatura axilar, edad, neutróflos totales, neutróflos inmaduros y radiografía de tórax). Resultados. Se incorporaron 168 pacientes (23 presentaron neumonía bacteriana y 145 viral). Aquellos con neumonía bacteriana presentaron un valor de la escala mayor que los de etiología viral (5,3 ± 2,5 contra 2,6 ± 2,02; p <0,001). Un puntaje ≥3 fue identifcado como el mejor punto de corte para predecir neumonía bacteriana (área bajo la curva de predicción relativa [aucROC]= 0,79; IC95%: 0,68-0,90), y fue signifcativamente más frecuente en pacientes con neumonía bacteriana que viral (19/23 contra 72/145, p= 0,003; OR= 4,8; IC95%: 1,4-17,6). La predicción de neumonía bacteriana mostró una sensibilidad de 82,6%, especifcidad 50,3%, valor predictivo positivo 20,9%, valor predictivo negativo 94,8%, razón de verosimilitud positiva 1,66 y razón de verosimilitud negativa 0,35. Conclusiones. La regla de predicción clínica simplifcada evaluada mostró una limitada capacidad diagnóstica para identifcar a niños con neumonía bacteriana y resultó inferior al BPS.
    Archivos argentinos de pediatría 12/2011; 109(6):499-503. · 0.29 Impact Factor
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    ABSTRACT: Objectives Data on prognostic factors among children with severe pneumonia are scarce in middle-income countries. We investigated prognostic factors for an adverse outcome among children admitted to the Hôpital d’Enfants de Rabat, Morocco with World Health Organization-defined clinically severe pneumonia (CSP). Methods Children aged 2–59 months admitted to the hospital and fulfilling the CSP definition were recruited into this 13-month prospective study. A poor prognosis was defined as death, a need for intensive care, or a Respiratory Index of Severity in Children (RISC) score ≥3. Multivariate logistic regression was performed to ascertain independent predictive factors for a poor prognosis. Results Of the 689 children included in this analysis, 55 (8.0%) required intensive care and 28 died (4.0%). Five hundred and two (72.8%) children were classified as having a good prognosis and 187 (27.2%) as having a poor prognosis. A history of prematurity (odds ratio (OR) 2.50, 95% confidence interval (CI) 1.24–5.04), of fever (OR 2.25, 95% CI 1.32–3.83), living in a house with smokers (OR 1.79, 95% CI 1.18–2.72), impaired consciousness (OR 10.96, 95% CI 2.88–41.73), cyanosis (OR 2.09, 95% CI 1.05–4.15), pallor (OR 2.27, 95% CI 1.34–3.84), having rhonchi on auscultation (OR 2.45, 95% CI 1.58–3.79), and human metapneumovirus infection (OR 2.13, 95% CI 1.13–4.02) were all independent risk factors for an adverse outcome, whereas a history of asthma (OR 0.46, 95% CI 0.25–0.84) was the only independent risk factor for a positive outcome. Conclusions The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of Moroccan children with severe pneumonia.
    International Journal of Infectious Diseases 10/2014; · 2.33 Impact Factor

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