Rhinovirus is associated with severe adult community-acquired pneumonia in China

Abstract

Background: Human rhinovirus (HRV) is one of the most common viral etiologies detected in community-acquired pneumonia (CAP) adult cases. However, few is known about the characteristics of HRV-associated CAP. To describe the clinical features of HRV-associated CAP in immunocompetent adults admitted to multiple medical centers in mainland China over a 2-year period.

Methods: A total of 383 patients admitted to hospitals for CAP were enrolled from 46 medical centers in mainland China between January 2013 and December 2014. Multiplex real-time polymerase chain reaction (RT-PCR) assays for viral detection and DNA-based quantitative loop-mediated isothermal amplification (qLAMP) assays for bacterial detection were implemented to all lower respiratory tract specimens obtained from the patients. Twenty-eight cases (28/383, 7.3%) revealed HRV-positive PCR results. Patients with bronchoalveolar lavage (BAL) HRV-positive PCR results (n=20) were further enrolled and divided into two groups depending on the status of bacterial co-infection (viral group, n=12; viral-Bacterial group, n=8). Demographic, clinical and microbiological data were reviewed and compared in detail.

Results: Cases with HRV-infection were remarkably correlated with respiratory failure (14/20) and most of them (13/14) received mechanical ventilation. Fever (17/20), productive cough (15/20) and dyspnea (6/20) were common symptoms while flu-like symptoms were rarely observed in the cohort. Streptococcus pneumoniae (3/8), Klebsiella pneumoniae (3/8) and Mycoplasma pneumoniae (2/8) were most frequently identified bacterium in the viral-bacterial group. Compared with the viral group, higher incidence of septic shock (3/8 vs. 1/12, P=0.255), longer ICU length of stay (LOS) (10.0 vs. 6.5 days, P=0.686), longer hospital LOS (18.5 vs. 13.0 days, P=0.208) and higher 28-day mortality (2/8 vs. 2/12, P=1) were observed in the Viral-Bacterial group, although without statistically significant difference.

Conclusions: HRV is a common etiology in CAP among China adults, especially in severe CAP. Clinicians should be vigilant considering of the poor outcome. Highly qualified multiplex PCR techniques with invasive sampling are needed to increase the detection rate.

Keywords: Human rhinovirus (HRV); bronchoalveolar lavage (BAL); community-acquired pneumonia (CAP); immunocompetent; loop-mediated isothermal amplification (LAMP); pathogen.

Figure 1

Flow chart of study inclusion process. CAP, community-acquired pneumonia; PCR, polymerase chain reaction; BAL, bronchoalveolar lavage; HRV, human rhinovirus; LAMP, loop-mediated isothermal amplification.

Figure 2

Distribution time of HRV detections. HRV, human rhinovirus; HRV-POS-CP, non-severe pneumonia with HRV positive detection; HRV-POS-SP, severe pneumonia with HRV positive detection; HRV-NEG-CP, non-severe pneumonia without HRV positive detection; HRV-NEG-SP, severe pneumonia without HRV positive detection.

Figure 3

Chest CT images of HRV-CAP. (A,B) M/50 years old, SCAP, HRV-detected only. Diffuse patchy infiltrations, lobar consolidation, companied with bilateral pleural effusions were observed in his chest CT; (C) M/66 years old, CAP, HRV-detected only. CT showed bilateral diffuse ground grass opacities; (D) M/35 years old, SCAP, HRV-Streptococcus pneumoniae co-infection. CT revealed bilateral lobar consolidations. CAP, community-acquired pneumonia; SCAP, severe community-acquired pneumonia; CT, computed tomography; HRV, human rhinovirus.