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Clinical Investigations: PNEUMONIA |

Viral Community-Acquired Pneumonia in Nonimmunocompromised Adults*

Andrés de Roux; Maria A. Marcos; Elisa Garcia; Jose Mensa; Santiago Ewig; Hartmut Lode; Antoni Torres
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*From the Servei de Pneumologia (Dr. de Roux and Torres), Institut Clínic de Pneumologia i Cirurgia Toràcica, and the Servei de Microbiologia (Dr. Marcos) and Servei de Malaties Infeccioses (Drs. Garcia and Mensa), Institut Clínic D’Immunologia i Infeccions, Institut d′Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Pneumologische Klinik (Dr. Ewig), Augusta Kranken Anstalt, Bochum, Germany; and the Department Lungenklinik Heckeshorn I (Dr. Lode), Zentralklinik Emil von Behring, Berlin, Germany.

Correspondence to: Antoni Torres, MD, PhD, FCCP, Respiratory Intensive Care Unit, Institut Clinic de Pneumologia i Cirurgia Toracica, escalera 2, planta 3, Hospital Clinic, Villarroel 170, Barcelona, 08036, Spain; e-mail: atorres@medicina. ub.es



Chest. 2004;125(4):1343-1351. doi:10.1378/chest.125.4.1343
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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.

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