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Observational Study
. 2021 Jul;93(7):4399-4404.
doi: 10.1002/jmv.26980. Epub 2021 Apr 6.

Viral community acquired pneumonia at the emergency department: Report from the pre COVID-19 age

Ornella Spagnolello  1   2 , Alessandra Pierangeli  3 , Maria Civita Cedrone  2 , Valentina Di Biagio  2 , Massimo Gentile  3 , Annalisa Leonardi  2 , Camilla Valeriano  2 , Giuseppe Pietro Innocenti  1 , Letizia Santinelli  1 , Cristian Borrazzo  1 , Alessandro Russo  4 , Giuseppe Oliveto  3 , Agnese Viscido  3 , Massimo Ciccozzi  5 , Giuliano Bertazzoni  2 , Gabriella d'Ettorre  1 , Giancarlo Ceccarelli  1
Affiliations
Observational Study

Viral community acquired pneumonia at the emergency department: Report from the pre COVID-19 age

Ornella Spagnolello et al. J Med Virol. 2021 Jul.

Abstract

The role of viruses in community acquired pneumonia (CAP) has been largely underestimated in the pre-coronavirus disease 2019 age. However, during flu seasonal early identification of viral infection in CAP is crucial to guide treatment and in-hospital management. Though recommended, the routine use of nasopharyngeal swab (NPS) to detect viral infection has been poorly scaled-up, especially in the emergency department (ED). This study sought to assess the prevalence and associated clinical outcomes of viral infections in patients with CAP during peak flu season. In this retrospective, observational study adults presenting at the ED of our hospital (Rome, Italy) with CAP from January 15th to February 22th, 2019 were enrolled. Each patient was tested on admission with Influenza rapid test and real time multiplex assay. Seventy five consecutive patients were enrolled. 30.7% (n = 23) tested positive for viral infection. Of these, 52.1% (n = 12) were H1N1/FluA. 10 patients had multiple virus co-infections. CAP with viral infection did not differ for any demographic, clinic and laboratory features by the exception of CCI and CURB-65. All intra-ED deaths and mechanical ventilations were recorded among CAP with viral infection. Testing only patients with CURB-65 score ≥2, 10 out of 12 cases of H1N1/FluA would have been detected saving up to 40% tests. Viral infection occurred in one-third of CAP during flu seasonal peak 2019. Since not otherwise distinguishable, NPS is so far the only reliable mean to identify CAP with viral infection. Testing only patients with moderate/severe CAP significantly minimize the number of tests.

Keywords: community acquired pneumonia; emergency department; public health; viral infection.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Flowchart of patient enrollment in final analysis. CAP, community acquired pneumonia; ED, emergency department
Figure 2
Figure 2
Pathogens prevalence in the study population. The number of cases and the percentage for each viral or bacterial pathogen are reported below the graph. FLU A, influenza A any subtype; S. Aur, staphylococcus aureus; S. Pneu, streptococcus pneumoniae
Figure 3
Figure 3
Nontargeted vs targeted screening for viral infection. This plot compares two strategies of screening patients with CAP for viral infection at the ED. Nontargeted test includes all patients presenting with CAP regardless of pneumonia severity. On the contrary, targeted screening involves only moderate to severe CAP (scoring 2 or more at CURB‐65 pneumonia severity score). CAP, community acquired pneumonia; ED, emergency department; NNT, number needed to test
See this image and copyright information in PMC

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