Clinical features and viral etiology of acute respiratory infection in an outpatient fever clinic during COVID-19 pandemic in a tertiary hospital in Nanjing, China

Abstract

Background: Clinical feature and viral etiology for acute respiratory infection (ARI) in the community was unknown during coronavirus disease 2019 (COVID-19) pandemic.

Objective: In a retrospective study, we aimed to characterize the clinical feature and etiology for the ARI patients admitted to the outpatient fever clinic in Nanjing Drum Tower Hospital between November 2020 and March 2021.

Methods: Fifteen common respiratory pathogens were tested using pharyngeal swabs by multiplex reverse transcriptase-polymerase chain reaction assays.

Results: Of the 242 patients, 56 (23%) were tested positive for at least one viral agent. The predominant viruses included human rhinovirus (HRV) (5.4%), parainfluenza virus type III (PIV-III) (5.0%), and human coronavirus-NL63 (HCoV-NL63) (3.7%). Cough, sputum, nasal obstruction, and rhinorrhea were the most prevalent symptoms in patients with viral infection. Elderly and the patients with underlying diseases were susceptible to pneumonia accompanied with sputum and chest oppression. Three (5.4%) patients in virus infection group, whereas 31 (16.7%) in non-viral infection group (p = 0.033), were empirically prescribed with antiviral agents. Among 149 patients who received antibiotic therapy, 30 (20.1%) patients were later identified with viral infection.

Conclusion: Our study indicated the importance of accurate diagnosis of ARI, especially during the COVID-19 pandemic, which might facilitate appropriate clinical treatment.

Keywords: COVID-19; Viral; acute respiratory infection.

FIGURE 1

Flowchart of the study.

FIGURE 2

Prevalence of viruses in ARIs patients. Among 242 enrolled patients, 1 (0.04%) case was identified as mixed viral infections of both rhinovirus and coronavirus OC43. 13 (5.4%) patients were HRV viruses, 12 (5.0%) were PIV‐III, and 9 (3.7%) were HCoV‐NL63, 6 (2.5%) were HMPV, 4 (1.7%) were PIV‐I, 3 (1.2%) were Influenza A, 3 (1.2%) were AdV, 2 (0.8%) were RSV, and 1 (0.4%) for HCoV‐OC43, HCoV‐HKU1, and HCoV‐229 E. AdV, adenovirus; HCoV, human coronavirus; HMPV, human metapneumovirus; HRV, human rhinovirus; PIV‐I, parainfluenza virus type I; PIV‐III, parainfluenza virus type III; RSV, respiratory syncytial virus.