Community-acquired viral pneumonia

Abstract

Advanced age often is associated with functional and immunologic decline and chronic cardiopulmonary diseases that predispose to pneumonia when viral infection occurs. Influenza virus remains the primary viral pathogen in the elderly, although the impact of the other respiratory viruses remains to be defined. The clinical syndromes associated with respiratory viruses frequently are indistinguishable from one another or bacterial pathogens; often, viral illness in older adults exacerbates underlying conditions, complicating diagnosis. Antiviral therapy is available for influenza A and B; specific viral diagnosis, particularly with the use of rapid antigen detection, may be useful for clinical management. Treatment for other viruses primarily is supportive.

Fig. 1

Chest radiograph of a 63-year-old woman who had mitral stenosis admitted to the hospital with severe respiratory distress and culture positive influenza A infection. Diffuse pulmonary infiltrates are illustrated.

Fig. 2

Chest radiograph of a 75-year-old man admitted to the hospital with fever, cough, and dyspnea. Influenza A was diagnosed by RT-PCR and confirmed by serology. A patchy opacity is demonstrated in the left lung base.

Fig. 3

Chest radiograph of a 68-year-old man who had a history of emphysema admitted to the hospital with a history of recent “cold,” low-grade fever, wheezing, and dyspnea. RSV infection was documented by viral culture and serology. Patchy airspace disease is seen in the lung bases bilaterally.