Characterizing acute respiratory infections in primary care for better management of viral infections

Abstract

Acute respiratory infections (ARI) are the most common infections in the general population and represent an important socio-economic burden. Characterizing ARIs in primary care in patients of all ages in terms of clinical presentation, and virological results. We conducted a prospective multicenter study in primary care: 36 French general practitioners (GPs) included patients from all ages presenting with symptoms of ARI, and performed a nasopharyngeal swab, which was analyzed by Multiplex RT-PCR. 685 patients of all ages were included in the cohort. We found associations between clinical diagnosis and respiratory viruses: influenza was associated with the diagnosis of flu-like syndrome (p < 0.001), HRV with rhinitis (p < 0.05), and RSV with bronchiolitis (p < 0.001) and bronchitis (p < 0.05). Respiratory distress was associated with RSV (p = 0.002), and a cough at the inclusion was significantly not associated with the influenza virus (p = 0.009). Antibiotic prescriptions were not associated with any specific virus. By day 7, persistent cough was significantly associated with active and passive smoking (respectively p = 0.01 and p < 0.001), influenza and RSV-positive samples (p < 0.05) and an age of less than 2 years (p < 0.01). With this prospective cohort performed in primary care including patients of all ages, we characterized viral respiratory infections, to better understand correlations between clinical data and virological results.

Fig. 1. Clinical characteristics of patients.

Distribution of the age of the patients A, clinical diagnosis according to the age of patients B and viral diagnosis in Multiplex RT-PCR according to the age of patients C. General Practitioners could give several diagnoses for the same patient (e.g.: rhinitis and pharyngitis). Bronchiolitis: viral infection of the lower respiratory tract in infants less than 24 months old. Bronchitis: inflammation of the bronchial tubes caused by infectious agents. Pneumonia: lung inflammation caused by bacterial or viral infection. Flu syndrome: group of symptoms that are similar to those caused by the influenza (flu) virus. These include fever, chills, headache, muscle or body aches, cough, sore throat, runny nose, fatigue, nausea, vomiting and diarrhea.

Fig. 2. Diagnosis and viruses.

A Clinical initial diagnosis according to the viruses found in Multiplex RT-PCR. B Mosaic plot showing the correlation between viruses found in Multiplex PCR and clinical initial diagnosis. The area of the squares is proportional to the number of cases found (diagnosis and virus). The correlation between diagnosis and virus is represented by colors. If the diagnosis is strongly associated with a virus, the square is blue (for example flu-like syndrome and flu); if the diagnosis is strongly not associated with a virus, the square is red (for example flu-like syndrome and HRV). *: p < 0.05, **: p < 0.01.

Fig. 3. Initial respiratory symptoms according to viruses found by Multiplex PCR in the nasopharyngeal swabs.

**: p < 0.01.