Lower respiratory tract infection in the community: associations between viral aetiology and illness course

Autor: Jan Jelrik Oosterheert, Robin Bruyndonckx, Paul Little, Christine Lammens, Margareta Ieven, Frank E. J. Coenjaerts, Eric C. J. Claas, Berna D L Broekhuizen, M. Viveen, Derrick W. Crook, Herman Goossens, Christopher C Butler, A. M. van Loon, Laura M. Vos, Katherine Loens, Theo Verheij, Nicolaas P.A. Zuithoff, K. Zlateva
Přispěvatelé: Consortium, GRACE, GRACE Consortium
Rok vydání: 2021
Předmět:
Male
0301 basic medicine
Rhinovirus
viruses
medicine.disease_cause
Severity of Illness Index
0302 clinical medicine
Belgium
Prospective Studies
030212 general & internal medicine
Respiratory Tract Infections
Netherlands
media_common
Respiratory tract infections
biology
Convalescence
public health
Disease burden
General Medicine
Viral Load
Orthomyxoviridae
respiratory virus
symptom severity
Infectious Diseases
Virus Diseases
Respiratory virus
Female
Viral load
Adult
Microbiology (medical)
medicine.medical_specialty
respiratory tract infection
media_common.quotation_subject
030106 microbiology
primary healthcare
03 medical and health sciences
Human metapneumovirus
Internal medicine
Lower respiratory tract infection
Severity of illness
medicine
Humans
Biology
Proportional Hazards Models
Primary Health Care
business.industry
symptom duration
medicine.disease
biology.organism_classification
Coronavirus
Respiratory Syncytial Virus
Human
lower respiratory tract infection
Human medicine
Metapneumovirus
business
Zdroj: Clinical Microbiology and Infection, 27(1), 96-104. ELSEVIER SCI LTD
Clinical microbiology and infection
ISSN: 1198-743X
DOI: 10.1016/j.cmi.2020.03.023
Popis: Objectives: This study determined associations between respiratory viruses and subsequent illness course in primary care adult patients presenting with acute cough and/or suspected lower respiratory tract infection. Methods: A prospective European primary care study recruited adults with symptoms of lower respiratory tract infection between November 2007 and April 2010. Real-time in-house polymerase chain reaction (PCR) was performed to test for six common respiratory viruses. In this secondary analysis, symptom severity (scored 1 = no problem, 2 = mild, 3 = moderate, 4 = severe) and symptom duration were compared between groups with different viral aetiologies using regression and Cox proportional hazard models, respectively. Additionally, associations between baseline viral load (cycle threshold (Ct) value) and illness course were assessed. Results: The PCR tested positive for a common respiratory virus in 1354 of the 2957 (45.8%) included patients. The overall mean symptom score at presentation was 2.09 (95% confidence interval (CI) 2.07-2.11) and the median duration until resolution of moderately bad or severe symptoms was 8.70 days (interquartile range 4.50-11.00). Patients with influenza virus, human metapneumovirus (hMPV), respiratory syncytial virus (RSV), coronavirus (CoV) or rhinovirus had a significantly higher symptom score than patients with no virus isolated (0.07-0.25 points or 2.3-8.3% higher symptom score). Time to symptom resolution was longer in RSV infections (adjusted hazard ratio (AHR) 0.80, 95% CI 0.65-0.96) and hMPV infections (AHR 0.77, 95% CI 0.62-0.94) than in infections with no virus isolated. Overall, baseline viral load was associated with symptom severity (difference 0.11, 95% CI 0.06-0.16 per 10 cycles decrease in Ct value), but not with symptom duration. Conclusions: In healthy, working adults from the general community presenting at the general practitioner with acute cough and/or suspected lower respiratory tract infection other than influenza impose an illness burden comparable to influenza. Hence, the public health focus for viral respiratory tract infections should be broadened. (C) 2020 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
Databáze: OpenAIRE
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