Lower respiratory tract infection in the community: associations between viral aetiology and illness course.,Clinical Microbiology and Infection

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Lower respiratory tract infection in the community: associations between viral aetiology and illness course.
Clinical Microbiology and Infection ( IF 10.9 ) Pub Date : 2020-03-31 , DOI: 10.1016/j.cmi.2020.03.023
L M Vos ₁ , R Bruyndonckx ₂ , N P A Zuithoff ₃ , P Little ₄ , J J Oosterheert ₁ , B D L Broekhuizen ₃ , C Lammens ₅ , K Loens ₅ , M Viveen ₆ , C C Butler ₇ , D Crook ₈ , K Zlateva ₉ , H Goossens ₂ , E C J Claas ₉ , M Ieven ₅ , A M Van Loon ₆ , T J M Verheij ₃ , F E J Coenjaerts ₆ ,

Affiliation

Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (Vaxinfectio), University of Antwerp, Antwerp, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Belgium.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK.
Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (Vaxinfectio), University of Antwerp, Antwerp, Belgium.
Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Medical Microbiology, Leiden University Medical Centre, Leiden University, Leiden, the Netherlands.

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.

中文翻译：

社区下呼吸道感染：病毒病因与病程之间的关联。

目标

这项研究确定了出现急性咳嗽和/或疑似下呼吸道感染的初级保健成年患者的呼吸道病毒与随后的病程之间的关联。

方法

欧洲一项前瞻性前瞻性研究招募了在2007年11月至2010年4月之间患有下呼吸道感染症状的成年人。进行了实时内部聚合酶链反应（PCR），以测试六种常见的呼吸道病毒。在该次要分析中，分别使用回归模型和Cox比例风险模型比较了具有不同病毒病因的组之间的症状严重性（得分1 =没问题，2 =轻度，3 =中度，4 =严重）。此外，评估了基线病毒载量（周期阈值（Ct）值）与疾病进程之间的关联。

结果

在2957年的1354名患者中，PCR检测出了常见的呼吸道病毒阳性（45.8％）。出现时的总体平均症状评分为2.09（95％置信区间（CI）为2.07-2.11），中度直至缓解中度不良或严重症状的中位时间为8.70天（四分位间距4.50-11.00）。流感病毒，人间质肺病毒（hMPV），呼吸道合胞病毒（RSV），冠状病毒（CoV）或鼻病毒的患者的症状评分明显高于未分离病毒的患者（0.07–0.25分或2.3–8.3％的症状评分）。与没有分离出病毒的感染相比，RSV感染（调整后的危险比（AHR）0.80，95％CI 0.65-0.96）和hMPV感染（AHR 0.77，95％CI 0.62-0.94）症状缓解的时间更长。总体，