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viral pneumonia

Etiology: 1) respiratory syncytial virus (children)* 2) rhinovirus (children)* 3) adenovirus 4) metapneumovirus 5) parainfluenza virus 6) varicella (chickenpox, more common in adults) 7) Herpes virus (including cytomegalovirus) - immunocompromised & patients with burns 8) influenza A & B (see influenza) (uncommon) - bacterial pneumonia as a complication far more common * most common causes of viral pneumonia in children [2] Epidemiology: - > 20% of severe pneumonia with respiratory failure requiring mechanical ventilation due to viral pneumonia [3] Pathology: - Streptococcus pneumoniae may increase susceptibility to viral pneumonia [1] Laboratory: - multiplex PCR assay may be become the new standard Radiology: - chest X-ray: diffuse lung involvement (not lobar) Differential diagnosis: - bacterial pneumonia (may coexist with viral pneumonia) [4] - factors favoring viral pneumonia - rhinorrhea, diarrhea - higher lymphocyte count % in WBC count - lower serum creatinine - ground-glass opacity in chest imaging [4] - factors favoring bacterial pneumonia - acute onset of symptoms - age > 65 years or comorbidity - leukocytosis or leukopenia - fever, headache - cervical painful lymph nodes [4] - serum procalcitonin no helpful [4] Management: 1) see influenza 2) pneumococcal congugate vaccine (Prevnar, PCV7) may reduce incidence of viral pneumonia in infants [1]

Related

influenza

General

pneumonia (PNA) viral infection

References

  1. Journal Watch 24(17):138, 2004 - Madhi SA, Klugman KP, The Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med. 2004 Aug;10(8):811-3. Epub 2004 Jul 11. PMID: 15247911
  2. Jain S, Williams DJ, Arnold SR et al Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children. N Engl J Med 2015; 372:835-845. February 26, 2015 PMID: 25714161 http://www.nejm.org/doi/full/10.1056/NEJMoa1405870
  3. Shorr AF, Fisher K, Micek ST, Kollef MH. The burden of viruses in pneumonia associated with acute respiratory failure: An underappreciated issue. Chest. 2017 Dec 21. pii: S0012-3692(17)33236-1 PMID: 29274318
  4. Heneghan C, Pluddemann A, Mahtani KR Differentiating viral from bacterial pneumonia. Centre for Evidence-Based Medicine. 2020, April 8. Nuffield Department of Primary Care Health Sciences University of Oxford https://www.cebm.net/covid-19/differentiating-viral-from-bacterial-pneumonia/