Current status of diagnosis and treatment of viral pneumonia in adults_West China Medical Journal

Authors：

XI Wen ,  GAO Zhancheng

Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, P. R. China;

Corresponding author：

GAO Zhancheng, Email: gaozhancheng5446@163.com

Keywords：

Viral pneumonia; Adults; Diagnosis; Treatment

DOI：

10.7507/1002-0179.201712026

Video：

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Respiratory viruses are important pathogens responsible for community- and hospital-acquired pneumonia in adults. Outbreaks of highly pathogenic viruses in recent years have made us aware of the difficulty and importance of diagnosis and treatment of viral pneumonia. This review summarized the current status of diagnosis and treatment of viral pneumonia in adults so as to improve our understanding of it.

Citation： XI Wen, GAO Zhancheng. Current status of diagnosis and treatment of viral pneumonia in adults. West China Medical Journal, 2018, 33(1): 88-92. doi: 10.7507/1002-0179.201712026 Copy

1.	Johnstone J, Majumdar SR, Fox JD, et al. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest, 2008, 134(6): 1141-1148.
2.	Burk M, El-Kersh K, Saad M, et al. Viral infection in community-acquired pneumonia: a systematic review and meta-analysis. Eur Respir Rev, 2016, 25(140): 178-188.
3.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
4.	Alimi Y, Lim WS, Lansbury L, et al. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol, 2017, 95: 26-35.
5.	Karhu J, Ala-Kokko TI, Vuorinen T, et al. Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia. Clin Infect Dis, 2014, 59(1): 62-70.
6.	Hong HL, Hong SB, Ko GB, et al. Viral infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One, 2014, 9(4): e95865.
7.	Loubet P, Voiriot G, Houhou-Fidouh N, et al. Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: a single-center retrospective study. J Clin Virol, 2017, 91: 52-57.
8.	Mahony J, Chong S, Bulir D, et al. Development of a sensitive loop-mediated isothermal amplification (LAMP) assay providing specimen-to-result diagnosis of RSV infections in thirty minutes. J Clin Microbiol, 2013, 51(8): 2696-2701.
9.	Liu J, Nian QG, Li J, et al. Development of reverse-transcription loop-mediated isothermal amplification assay for rapid detection of novel avian influenza A (H7N9) virus, BMC Microbiol, 2014, 14: 271.
10.	Zhou HY, Zhao MC, Li XN, et al. Clinical evaluation of the isothermal amplification assays for the detection of four common respiratory viruses in children with pneumonia. Arch Virol, 2017, 162(5): 1311-1318.
11.	Prachayangprecha S, Schapendonk CM, Koopmans MP, et al. Exploring the potential of next-generation sequencing in detection of respiratory viruses. J Clin Microbiol, 2014, 52(10): 3722-3730.
12.	Lin Y, Fu Y, Xu M, et al. Evaluation of a PCR/ESI-MS platform to identify respiratory viruses from nasopharyngeal aspirates. J Med Virol, 2015, 87(11): 1867-1871.
13.	Shun-Shin M, Thompson M, Heneghan C, et al. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ, 2009, 339: b3172.
14.	Yu H, Liao Q, Yuan Y, et al. Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China. BMJ, 2010, 341: c4779.
15.	Marcelin JR, Wilson JW, Razonable RR. Oral ribavirin therapy for respiratory syncytial virus infections in moderately to severely immunocompromised patients. Transpl Infect Dis, 2014, 16(2): 242-250.
16.	Wyde PR, Chetty SN, Jewell AM, et al. Comparison of the inhibition of human metapneumovirus and respiratory syncytial virus by ribavirin and immune serum globulin in vitro. Antiviral Res, 2003, 60(1): 51-59.
17.	Shachor-Meyouhas Y, Kassis I, Ben-Barak A. Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child. Pediatr Blood Cancer, 2011, 57(2): 350-351.
18.	Hamelin ME, Prince GA, Boivin G. Effect of ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection. Antimicrob Agents Chemother, 2006, 50(2): 774-777.
19.	Crotty MP, Meyers S, Hampton N, et al. Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship. Crit Care, 2015, 19: 404.
20.	Maximo Quispe-Laime A, Daniel Bracco J, Alejandra Barberio P, et al. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med, 2010, 36(1): 33-41.
21.	Xi X, Xu Y, Jiang L, et al. Hospitalized adult patients with 2009 influenza A (H1N1) in Beijing, China: risk factors for hospital mortality. BMC Infect Dis, 2010, 10: 256.
22.	Kim SH, Hong SB, Yun SC, et al. Corticosteroid treatment in critically ill patients with pandemic influenza a/H1N12009 infection analytic strategy using propensity scores. Am J Respir Crit Care Med, 2011, 183(9): 1207-1214.
23.	Brun-Buisson C, Richard JC, Mercat A, et al. Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med, 2011, 183(9): 1200-1206.
24.	Cao B, Gao HN, Zhou BP, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): E318-E328.
25.	Lee N, Chan PK, Hui DS, et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis, 2009, 200(4): 492-500.
26.	Domachowske JB, Bonville CA, Ali-Ahmad D, et al. Glucocorticoid administration accelerates mortality of pneumovirus-infected mice. J Infect Dis, 2001, 184(12): 1518-1523.
27.	Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids-The Guangzhou experience. Chest, 2006, 129(6): 1441-1452.
28.	Gustafson LM, Proud D, Hendley JO, et al. Oral prednisone therapy in experimental rhinovirus infections. J Allergy Clin Immunol, 1996, 97(4): 1009-1014.
29.	Gordon CL, Johnson PD, Permezel M, et al. Association between severe pandemic 2009 influenza A (H1N1) virus infection and immunoglobulin G(2)subclass deficiency. Clin Infect Dis, 2010, 50(5): 672-678.
30.	Chong JL, Sapari S, Yc K. A case of acute respiratory distress syndrome associated with novel H1N1 treated with intravenous immunoglobulin G. J Microbiol Immunol Infect, 2011, 44(4): 319-322.
31.	Whimbey E, Champlin RE, Couch RB, et al. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients. Clin Infect Dis, 1996, 22(5): 778-782.
32.	Hui DS, Lee N. Adjunctive therapies and immunomodulating agents for severe influenza. Influenza Other Respir Viruses, 2013, 7(Suppl 3): 52-59.
33.	Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis, 2015, 211(1): 80-90.
34.	Murray JL, Mcdonald NJ, Sheng J, et al. Inhibition of influenza A virus replication by antagonism of a PI3K-AKT-mTOR pathway member identified by gene-trap insertional mutagenesis. Antivir Chem Chemother, 2012, 22(5): 205-215.
35.	Wang CH, Chung FT, Lin SM, et al. Adjuvant treatment with a mammalian target of rapamycin inhibitor, sirolimus, and steroids improves outcomes in patients with severe H1N1 pneumonia and acute respiratory failure. Crit Care Med, 2014, 42(2): 313-321.
36.	Hsieh IN, Hartshorn KL. The role of antimicrobial peptides in influenza virus infection and their potential as antiviral and immunomodulatory therapy. Pharmaceuticals (Basel), 2016, 9(3): E53.
37.	Currie SM, Findlay EG, Mcfarlane AJ, et al. Cathelicidins have direct antiviral activity against respiratory syncytial virus in vitro and protective function in vivo in mice and humans. J Immunol, 2016, 196(6): 2699-2710.
38.	Qureshi A, Thakur N, Tandon H, et al. AVPdb: a database of experimentally validated antiviral peptides targeting medically important viruses. Nucleic Acids Res, 2014, 42(D1): D1147-D1153.
39.	Alvarez R, Elbashir S, Borland T, et al. RNA Interference-Mediated silencing of the respiratory syncytial virus nucleocapsid defines a potent antiviral strategy. Antimicrob Agents Chemother, 2009, 53(9): 3952-3962.
40.	Sah DW. Therapeutic potential of RNA interference for neurological disorders. Life Sci, 2006, 79(19): 1773-1780.
41.	Alvarez R, Elbashir S, Borland T, et al. RNA interference-mediated silencing of the respiratory syncytial virus nucleocapsid defines a potent antiviral strategy. Antimicrob Agents Chemother, 2009, 53(9): 3952-3562.
42.	Deffrasnes C, Cavanagh MH, Goyette NA, et al. Inhibition of human metapneumovirus replication by small interfering RNA. Antivir Ther, 2008, 13(6): 821-832.

1. Johnstone J, Majumdar SR, Fox JD, et al. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest, 2008, 134(6): 1141-1148.
2. Burk M, El-Kersh K, Saad M, et al. Viral infection in community-acquired pneumonia: a systematic review and meta-analysis. Eur Respir Rev, 2016, 25(140): 178-188.
3. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
4. Alimi Y, Lim WS, Lansbury L, et al. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol, 2017, 95: 26-35.
5. Karhu J, Ala-Kokko TI, Vuorinen T, et al. Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia. Clin Infect Dis, 2014, 59(1): 62-70.
6. Hong HL, Hong SB, Ko GB, et al. Viral infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One, 2014, 9(4): e95865.
7. Loubet P, Voiriot G, Houhou-Fidouh N, et al. Impact of respiratory viruses in hospital-acquired pneumonia in the intensive care unit: a single-center retrospective study. J Clin Virol, 2017, 91: 52-57.
8. Mahony J, Chong S, Bulir D, et al. Development of a sensitive loop-mediated isothermal amplification (LAMP) assay providing specimen-to-result diagnosis of RSV infections in thirty minutes. J Clin Microbiol, 2013, 51(8): 2696-2701.
9. Liu J, Nian QG, Li J, et al. Development of reverse-transcription loop-mediated isothermal amplification assay for rapid detection of novel avian influenza A (H7N9) virus, BMC Microbiol, 2014, 14: 271.
10. Zhou HY, Zhao MC, Li XN, et al. Clinical evaluation of the isothermal amplification assays for the detection of four common respiratory viruses in children with pneumonia. Arch Virol, 2017, 162(5): 1311-1318.
11. Prachayangprecha S, Schapendonk CM, Koopmans MP, et al. Exploring the potential of next-generation sequencing in detection of respiratory viruses. J Clin Microbiol, 2014, 52(10): 3722-3730.
12. Lin Y, Fu Y, Xu M, et al. Evaluation of a PCR/ESI-MS platform to identify respiratory viruses from nasopharyngeal aspirates. J Med Virol, 2015, 87(11): 1867-1871.
13. Shun-Shin M, Thompson M, Heneghan C, et al. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ, 2009, 339: b3172.
14. Yu H, Liao Q, Yuan Y, et al. Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China. BMJ, 2010, 341: c4779.
15. Marcelin JR, Wilson JW, Razonable RR. Oral ribavirin therapy for respiratory syncytial virus infections in moderately to severely immunocompromised patients. Transpl Infect Dis, 2014, 16(2): 242-250.
16. Wyde PR, Chetty SN, Jewell AM, et al. Comparison of the inhibition of human metapneumovirus and respiratory syncytial virus by ribavirin and immune serum globulin in vitro. Antiviral Res, 2003, 60(1): 51-59.
17. Shachor-Meyouhas Y, Kassis I, Ben-Barak A. Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child. Pediatr Blood Cancer, 2011, 57(2): 350-351.
18. Hamelin ME, Prince GA, Boivin G. Effect of ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection. Antimicrob Agents Chemother, 2006, 50(2): 774-777.
19. Crotty MP, Meyers S, Hampton N, et al. Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship. Crit Care, 2015, 19: 404.
20. Maximo Quispe-Laime A, Daniel Bracco J, Alejandra Barberio P, et al. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med, 2010, 36(1): 33-41.
21. Xi X, Xu Y, Jiang L, et al. Hospitalized adult patients with 2009 influenza A (H1N1) in Beijing, China: risk factors for hospital mortality. BMC Infect Dis, 2010, 10: 256.
22. Kim SH, Hong SB, Yun SC, et al. Corticosteroid treatment in critically ill patients with pandemic influenza a/H1N12009 infection analytic strategy using propensity scores. Am J Respir Crit Care Med, 2011, 183(9): 1207-1214.
23. Brun-Buisson C, Richard JC, Mercat A, et al. Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med, 2011, 183(9): 1200-1206.
24. Cao B, Gao HN, Zhou BP, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): E318-E328.
25. Lee N, Chan PK, Hui DS, et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis, 2009, 200(4): 492-500.
26. Domachowske JB, Bonville CA, Ali-Ahmad D, et al. Glucocorticoid administration accelerates mortality of pneumovirus-infected mice. J Infect Dis, 2001, 184(12): 1518-1523.
27. Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids-The Guangzhou experience. Chest, 2006, 129(6): 1441-1452.
28. Gustafson LM, Proud D, Hendley JO, et al. Oral prednisone therapy in experimental rhinovirus infections. J Allergy Clin Immunol, 1996, 97(4): 1009-1014.
29. Gordon CL, Johnson PD, Permezel M, et al. Association between severe pandemic 2009 influenza A (H1N1) virus infection and immunoglobulin G(2)subclass deficiency. Clin Infect Dis, 2010, 50(5): 672-678.
30. Chong JL, Sapari S, Yc K. A case of acute respiratory distress syndrome associated with novel H1N1 treated with intravenous immunoglobulin G. J Microbiol Immunol Infect, 2011, 44(4): 319-322.
31. Whimbey E, Champlin RE, Couch RB, et al. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients. Clin Infect Dis, 1996, 22(5): 778-782.
32. Hui DS, Lee N. Adjunctive therapies and immunomodulating agents for severe influenza. Influenza Other Respir Viruses, 2013, 7(Suppl 3): 52-59.
33. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis, 2015, 211(1): 80-90.
34. Murray JL, Mcdonald NJ, Sheng J, et al. Inhibition of influenza A virus replication by antagonism of a PI3K-AKT-mTOR pathway member identified by gene-trap insertional mutagenesis. Antivir Chem Chemother, 2012, 22(5): 205-215.
35. Wang CH, Chung FT, Lin SM, et al. Adjuvant treatment with a mammalian target of rapamycin inhibitor, sirolimus, and steroids improves outcomes in patients with severe H1N1 pneumonia and acute respiratory failure. Crit Care Med, 2014, 42(2): 313-321.
36. Hsieh IN, Hartshorn KL. The role of antimicrobial peptides in influenza virus infection and their potential as antiviral and immunomodulatory therapy. Pharmaceuticals (Basel), 2016, 9(3): E53.
37. Currie SM, Findlay EG, Mcfarlane AJ, et al. Cathelicidins have direct antiviral activity against respiratory syncytial virus in vitro and protective function in vivo in mice and humans. J Immunol, 2016, 196(6): 2699-2710.
38. Qureshi A, Thakur N, Tandon H, et al. AVPdb: a database of experimentally validated antiviral peptides targeting medically important viruses. Nucleic Acids Res, 2014, 42(D1): D1147-D1153.
39. Alvarez R, Elbashir S, Borland T, et al. RNA Interference-Mediated silencing of the respiratory syncytial virus nucleocapsid defines a potent antiviral strategy. Antimicrob Agents Chemother, 2009, 53(9): 3952-3962.
40. Sah DW. Therapeutic potential of RNA interference for neurological disorders. Life Sci, 2006, 79(19): 1773-1780.
41. Alvarez R, Elbashir S, Borland T, et al. RNA interference-mediated silencing of the respiratory syncytial virus nucleocapsid defines a potent antiviral strategy. Antimicrob Agents Chemother, 2009, 53(9): 3952-3562.
42. Deffrasnes C, Cavanagh MH, Goyette NA, et al. Inhibition of human metapneumovirus replication by small interfering RNA. Antivir Ther, 2008, 13(6): 821-832.

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