Respiratory viruses in adults hospitalised with Community-Acquired Pneumonia during the non-winter months in Melbourne: Routine diagnostic practice may miss large numbers of influenza and respiratory syncytial virus infections

Authors

  • Lucy A Desmond Department of Medicine, Melbourne Medical School – Western Health, University of Melbourne
  • Melanie A Lloyd Department of Medicine, Melbourne Medical School – Western Health, University of Melbourne
  • Shelley A Ryan Western Health
  • Edward D Janus Department of Medicine, Melbourne Medical School – Western Health, University of Melbourne General Internal medicine Unit, Western Health, St Albans, Vic
  • Harin A Karunajeewa Department of Medicine, Melbourne Medical School – Western Health, University of Melbourne General Internal medicine Unit, Western Health, St Albans, Vic; The Walter and Eliza Hall Institute of Medical Research, Parkville

DOI:

https://doi.org/10.33321/cdi.2019.43.12

Keywords:

Lower Respiratory Tract Infection (LRTI), Community-Acquired Pneumonia (CAP) Polymerase Chain Reaction (PCR), Influenza, Respiratory Syncytial Virus

Abstract

Background
Community-Acquired Pneumonia (CAP) is one of the highest health burden conditions in Australia. Disease notifications and other data from routine diagnosis suffers from selection bias that may misrepresent the true contribution of various aetiological agents. However existing Australian prospective studies of CAP aetiology have either under-represented elderly patients, not utilised Polymerase Chain Reaction (PCR) diagnostics or been limited to winter months. We therefore sought to re-evaluate CAP aetiology by systematically applying multiplex PCR in a representative cohort of mostly elderly patients hospitalised in Melbourne during non-winter months and compare diagnostic results with those obtained under usual conditions of care.
Methods
Seventy two CAP inpatients were prospectively enrolled over 2 ten-week blocks during non-winter months in Melbourne in 2016-17. Nasopharyngeal and oropharyngeal swabs were obtained at admission and analysed by multiplex-PCR for 7 respiratory viruses and 5 atypical bacteria.
Results
Median age was 74 (interquartile range 67-80) years, with 38 (52.8%) males and 34 (47.2%) females. PCR was positive in 24 (33.3%), including 12 Picornavirus (50.5% of those with a virus), 4 RSV (16.7%) and 4 influenza A (16.7%). CAP-Sym questionnaire responses were similar in those with and without viral infections. Most (80%) pathogens detected by the study, including all 8 cases of influenza and RSV, were not otherwise detected by treating clinicians during hospital admission.
Conclusion
One third of patients admitted with CAP during non-winter months had PCR-detectable respiratory viral infections, including many cases of influenza and RSV that were missed by existing routine clinical diagnostic processes.

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Published

15/04/19

How to Cite

Desmond, Lucy A, Melanie A Lloyd, Shelley A Ryan, Edward D Janus, and Harin A Karunajeewa. 2019. “Respiratory Viruses in Adults Hospitalised With Community-Acquired Pneumonia During the Non-Winter Months in Melbourne: Routine Diagnostic Practice May Miss Large Numbers of Influenza and Respiratory Syncytial Virus Infections”. Communicable Diseases Intelligence 43 (April). https://doi.org/10.33321/cdi.2019.43.12.

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Vol. 43 (2019)

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Original article

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