The Clinical Characteristics and Outcomes of Adult Patients With Pneumonia Related to Three Paramyxoviruses

Xiqian Xing,Xiudi Han,Yanli Li,Chunxiao Zhang,Liang Chen

doi:10.3389/fmed.2020.574128

Abstract

Background: Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human parainfluenza virus (hPIV) are paramyxoviruses (PMVs) that are important etiologies of community-acquired pneumonia. However, current knowledge about the clinical features and outcomes of PMV-related pneumonia (PMV-p) is limited. We aimed to investigate the clinical characteristics and disease severity in immunocompetent adults hospitalized with hMPV-related pneumonia (hMPV-p), hPIV-related pneumonia (hPIV-p), or RSV-related pneumonia (RSV-p).Methods: We retrospectively recruited 488 patients with PMV-p (153 with RSV-p, 137 with hMPV-p, and 198 with hPIV-p) from five teaching hospitals in China during 2011–2019. Univariate and multivariate analyses were performed to identify predictors to distinguish hMPV-p/hPIV-p from RSV-p and evaluate the effects of virus types on the clinical outcomes.Results: Compared with RSV-p, sputum production [odds ratio (OR) 5.029, 95% confidence interval (CI) 2.452–10.312, P < 0.001] was positively associated with hMPV-p, while solid malignant tumor (OR 0.346, 95% CI 0.126–0.945, P = 0.038), nasal congestion (OR 0.102, 95% CI 0.041–0.251, P < 0.001), and respiratory rate ≥ 30 breaths/min (OR 0.296, 95% CI 0.136–0.640, P = 0.002) were negatively related to hMPV-p. Sputum production (OR 13.418, 95% CI 6.769–26.598, P < 0.001) was positively associated with hPIV-p, while nasal congestion (OR 0.194, 95% CI 0.098–0.387, P < 0.001), dyspnea (OR 0.469, 95% CI 0.272–0.809, P < 0.001), and respiratory rate ≥30 breaths/min (OR 0.090, 95% CI 0.032–0.257, P < 0.001) on admission were negatively related to hPIV-p. After adjustment for confounders, multivariate logistic regression analysis suggested that hMPV-p (OR 0.355, 95% CI 0.135–0.932, P = 0.035) and hPIV-p (OR 0.311, 95% CI 0.121–0.784, P = 0.013) were associated with decreased 30-day mortality compared with RSV-p. RSV infection (OR 4.183, 95% CI 1.709–10.236, P = 0.002) was identified as an independent predictor of 30-day mortality in patients with PMV-p.Conclusion: RSV-p caused more severe disease than hMPV-p and hPIV-p. Although some clinical features are helpful for distinguishing the diseases, etiologic diagnosis is critical in the management of the PMV-p.

Highlights

Despite the current advances in medical technology and the economy, community-acquired pneumonia (CAP) is still a leading cause of death due to infectious diseases globally [1]
A total of 153 Respiratory syncytial virus (RSV)-p patients, 137 human metapneumovirus (hMPV)-p, and 198 human parainfluenza virus (hPIV)-p patients were included in the study; all patients were laboratory and radiologically confirmed (Figure 1)
A multicenter, population-based, prospective surveillance study of nine respiratory viruses among CAP patients in China suggested that RSV and hMPV presented the same seasonality with peaks during the period from winter to spring, while hPIV peaked slightly later in the summer [19]

Summary

Introduction

Despite the current advances in medical technology and the economy, community-acquired pneumonia (CAP) is still a leading cause of death due to infectious diseases globally [1]. Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human parainfluenza virus (hPIV) are singlestranded, negative-sense, and enveloped RNA viruses belonging to the Paramyxoviridae family [2] Each year, these viruses cause upper and lower respiratory tract infections, leading to considerable morbidity and mortality worldwide [3, 4]. In the EPIC (Etiology of Pneumonia in the Community) study, a pathogen was detected in 853 cases among 2,259 adult patients hospitalized with CAP in the United States. Among these cases, hMPV, RSV, and hPIV accounted for 10.3, 8.0, and 7.9% of the pathogens, respectively, ranking the fourth to the sixth most common pathogens, following rhinovirus, influenza virus, and Mycoplasma pneumoniae [7]. We aimed to investigate the clinical characteristics and disease severity in immunocompetent adults hospitalized with hMPV-related pneumonia (hMPV-p), hPIV-related pneumonia (hPIV-p), or RSV-related pneumonia (RSV-p)

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