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Original Research: COMMUNITY-ACQUIRED PNEUMONIA |

Viral Infection in Adults Hospitalized With Community-Acquired Pneumonia: Prevalence, Pathogens, and Presentation

Jennie Johnstone, MD; Sumit R. Majumdar, MD, MPH; Julie D. Fox, PhD; Thomas J. Marrie, MD
Author and Funding Information

*From the Department of Medicine (Drs. Johnstone, Majumdar, and Marrie), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; and the Department of Microbiology (Dr. Fox), Provincial Laboratory for Public Health, Calgary, AB, Canada.

Correspondence to: Thomas J. Marrie, MD, Professor, Department of Medicine, Dean, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112th St, Edmonton, AB, Canada T6G 2R7; e-mail: tom.marrie@ualberta.ca


Dr. Majumdar was supported by the Alberta Heritage Foundation for Medical Research (Health Scholar) and the Canadian Institutes of Health Research (New Investigator). This project was funded in part by an establishment grant (to Dr. Marrie) from the Alberta Heritage Foundation for Medical Research.

Funding sources had no role in study design, data collection, data analysis or interpretation, or writing of the report. All authors participated in the study conception, design, analysis, interpretation of results, and revision of the manuscript, and approved the final version of the manuscript. Dr. Johnstone drafted the initial manuscript. Dr. Marrie acquired the data, obtained funding for the study, and will act as guarantor.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(6):1141-1148. doi:10.1378/chest.08-0888
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Background:  The potential role of respiratory viruses in the natural history of community-acquired pneumonia (CAP) in adults has not been well described since the advent of nucleic amplification tests (NATs).

Methods:  From 2004 to 2006, adults with CAP who were admitted to five hospitals were prospectively enrolled in the study, and clinical data, cultures, serology, and nasopharyngeal swabs were obtained. NATs from swabs were tested for influenza, human metapneumovirus (hMPV), respiratory syncytial virus (RSV), rhinovirus, parainfluenza virus 1–4, coronaviruses (OC43, 229E, and NL63), and adenovirus.

Results:  A total of 193 patients were included; the median age was 71 years, 51% of patients were male, and 47% of patients had severe CAP. Overall, 75 patients (39%) had a pathogen identified. Of these pathogens, 29 were viruses (15%), 38 were bacteria (20%), 8 were mixed (4%), and the rest were “unknown.” Influenza (n = 7), hMPV (n = 7), and RSV (n = 5) accounted for most viral infections; other infections included rhinovirus (n = 4), parainfluenza (n = 3), coronavirus (n = 4), and adenovirus (n = 2). Streptococcus pneumoniae was the most common bacterial infection (37%). Compared with bacterial infection, patients with viral infection were older (76 vs 64 years, respectively; p = 0.01), were more likely to have cardiac disease (66% vs 32%, respectively; p = 0.006), and were more frail (eg, 48% with limited ambulation vs 21% of bacterial infections; p = 0.02). There were few clinically meaningful differences in presentation and no differences in outcomes according to the presence or absence of viral infection.

Conclusions:  Viral infections are common in adults with pneumonia. Easily transmissible viruses such as influenza, hMPV, and RSV were the most common, raising concerns about infection control. Routine testing for respiratory viruses may be warranted for adults who have been hospitalized with pneumonia.

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