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. 2016 Feb 15;213(4):584-91.
doi: 10.1093/infdis/jiv323. Epub 2015 Jul 14.

Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia

Wesley H Self  1 , Derek J Williams  2 , Yuwei Zhu  3 , Krow Ampofo  4 , Andrew T Pavia  5 , James D Chappell  6 , Weston C Hymas  7 , Chris Stockmann  8 , Anna M Bramley  9 , Eileen Schneider  9 , Dean Erdman  9 , Lyn Finelli  9 , Seema Jain  9 , Kathryn M Edwards  2 , Carlos G Grijalva  10
Affiliations

Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia

Wesley H Self et al. J Infect Dis. .

Abstract

Background: The clinical significance of viruses detected in patients with community-acquired pneumonia (CAP) is often unclear.

Methods: We conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. We compared age-stratified prevalence of each virus between patients with CAP and controls and used multivariable logistic regression to calculate attributable fractions (AFs).

Results: We enrolled 1024 patients with CAP and 759 controls. Detections of influenza, respiratory syncytial virus, and human metapneumovirus were substantially more common in patients with CAP of all ages than in controls (AFs near 1.0). Parainfluenza and coronaviruses were also more common among patients with CAP (AF, 0.5-0.75). Rhinovirus was associated with CAP among adults (AF, 0.93) but not children (AF, 0.02). Adenovirus was associated with CAP only among children <2 years old (AF, 0.77).

Conclusions: The probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus. Detections of influenza, respiratory syncytial virus, and human metapneumovirus among patients with CAP of all ages probably indicate an etiologic role, whereas detections of parainfluenza, coronaviruses, rhinovirus, and adenovirus, especially in children, require further scrutiny.

Keywords: asymptomatic infection; attributable fraction; etiology; pneumonia; virus.

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Figures

Figure 1.
Figure 1.
Enrollment of asymptomatic controls.
Figure 2.
Figure 2.
Box and whisker plots of rRT-PCR cycle thresholds among children (age <18 years) positive for each virus, comparing asymptomatic controls and patients with community-acquired pneumonia (CAP): human rhinovirus (A), respiratory syncytial virus (B), human metapneumovirus (C), adenovirus (D), parainfluenza viruses (E), and coronaviruses (F). The center of each box plot represents the median, with the box denoting the interquartile range (IQR), the upper and lower whiskers representing 1.5 times the IQR above and below the 75% and 25% percentile, respectively, and dots showing outliers beyond the whiskers. Abbreviation: rRT-PCR, reverse transcriptase polymerase chain reaction.
See this image and copyright information in PMC

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