Etiology and Clinical Outcomes of Acute Respiratory Virus Infection in Hospitalized Adults

Abstract

BackgroundEtiologies and clinical profiles of acute respiratory viral infections need to be clarified to improve preventive and therapeutic strategies.Materials and MethodsA retrospective observational study at a single, university-affiliated center was performed to evaluate the respiratory viral infection etiologies in children compared to that in adults and to document the clinical features of common viral infections for adults from July 2009 to April 2012.ResultsThe common viruses detected from children (2,800 total patients) were human rhinovirus (hRV) (31.8%), adenovirus (AdV) (19.2%), respiratory syncytial virus (RSV) A (17.4%), RSV B (11.7%), and human metapneumovirus (hMPV) (9.8%). In comparison, influenza virus A (IFA) had the highest isolation rate (28.5%), followed by hRV (15.5%), influenza virus B (IFB) (15.0%), and hMPV (14.0%), in adults (763 total patients). Multiple viruses were detected in single specimens from 22.4% of children and 2.0% of adults. IFA/IFB, RSV A/B, and hMPV exhibited strong seasonal detection and similar circulating patterns in children and adults. Adult patients showed different clinical manifestations according to causative viruses; nasal congestion and rhinorrhea were more common in hRV and human coronavirus (hCoV) infection. Patients with RSV B, hRV, or AdV tended to be younger, and those infected with RSV A and hMPV were likely to be older. Those with RSV A infection tended to stay longer in hospital, enter the intensive care unit more frequently, and have a fatal outcome more often. The bacterial co-detection rate was 26.5%, and those cases were more likely to have lower respiratory tract involvement (P = 0.001), longer hospital stay (P = 0.001), and higher mortality (P = 0.001).ConclusionsThe etiologic virus of an acute respiratory infection can be cautiously inferred based on a patient's age and clinical features and concurrent epidemic data. Large-scale prospective surveillance studies are required to provide more accurate information about respiratory viral infection etiology, which could favorably influence clinical outcomes.

Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review

“…The assessment of the unadjusted differences in the frequency of symptoms and signs (Table and Table ) also showed few differences between the influenza viruses. Compared to influenza B, there was some evidence that patients with influenza A (not further specified) less often presented with myalgia (four studies—all focusing on children—of fifteen) were less often sent to the hospital for medical advice and/or further investigation (two studies of fourteen) and more often presented with cough (two studies of nine).…”

“…An overview of the studies (Table and Table ) showed a lot of diversity in the populations that were investigated: Studies are presented in terms of hospitalized patients (n = 22) or cover mainly outpatient settings (n = 19), such as primary care (n = 6) or community‐based (n = 4) settings. Most studies were carried out in Asia (n = 17), Europe (n = 15), or North America (n = 8).…”

Genetic diversity, seasonality and transmission network of human metapneumovirus: identification of a unique sub-lineage of the fusion and attachment genes

“…In temperate countries, a higher prevalence of HMPV has been reported during the months of winter and spring, with a lower seasonality than HRSV213141516. Climate also plays an important role in determining the seasonality of HMPV in tropical countries.…”

Correlation between Infection with Multiple Respiratory Viruses and Length of Hospital Stay in Patients from Cheonan, Korea

“…the LOS for patients infected with INF A was reported to be 6.9 days, whereas LOS for patients infected with ADV or hCoV OC43 was 8.2 days and 8.1 days, respectively [14]. In another study, RSV and hMPV infections reportedly resulted in LOS of 4 days and 3 days, respectively [15].…”