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

Severe Parainfluenza Viral Infection-A Retrospective Study of Adult Intensive Care Patients

There is little known about parainfluenza virus (PIV) infection in adult intensive care unit (ICU) patients. Here, we aim to describe the characteristics, clinical course and outcomes of PIV infection in adults requiring intensive care. In this retrospective study of consecutive patients admitted to our ICU with confirmed PIV infection over a 7-year period, we report the patient characteristics, laboratory tests and prognostic scores on ICU admission. The main outcomes reported are 30-day mortality and organ support required. We included 50 patients (52% male, mean age 67.6 years). The mean PaO2/FiO2 and neutrophil/lymphocyte ratios on ICU admission were 198 ± 82 mmHg and 15.7 ± 12.5. Overall, 98% of patients required respiratory support and 24% required cardiovascular support. The median length of ICU stay was 5.9 days (IQR 3.7-9.1) with a 30-day mortality of 40%. In conclusion, PIV infection in adult ICU patients is associated with significant mortality and morbidity. There were significant differences between patients who presented with primary hypoxemic respiratory failure and hypercapnic respiratory failure.

Severe community-acquired pneumonia in the post COVID-19 era

PURPOSE OF REVIEW

The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines.

RECENT FINDINGS

Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence.Viruses have an increasing role as sCAP etiology with an impact on mortality. Accordingly, it is imperative to strengthen the demand for vaccines and newer antivirals. Considering an early monitoring of the immune response in patients with severe Influenza, may help to evaluate a personalized immunomodulatory strategy. Despite growing evidence, the use of corticosteroids as an adjunctive therapy in bacterial sCAP continues to be controversial.

SUMMARY

Mortality due to sCAP still remains undesirably high. This fact strengthens the need for more high-quality research to increase evidence. It also highlights the need for clinicians to be aware of the level of evidence of the stated recommendations, taking this into consideration before decision making.

Predictors of hospitalization and superinfection in viral respiratory tract infections between influenza and paramyxoviruses: the SUPERFLUOUS study

BACKGROUND

Viral respiratory tract infections (VRTIs) are one of the most common diseases, but the risk of superinfection has never been compared depending on virus species.

METHODS

Multicenter retrospective study conducted amongst adults tested positive to VRTIs by RT-PCR. We compared characteristics between influenza (A-B) and paramyxoviruses (RSV,PIV1,PIV3 and hMPV) and identified predictors of superinfection and hospitalization.

RESULTS

590 patients had a VRTI, including 347 (59%) influenza and 243 paramyxoviruses with comparable superinfections between groups (53% vs 60%). In multivariate analyses, predictors of superinfections were: age>75 years-old (aOR=2.37, 95%CI [1.65-3.40]), chronic respiratory disease (aOR=1.79, 95%CI [1.20-2.67]) and biological abnormalities (neutrophils>7000/mm 3, aOR=1.98, 95%CI [1.34-2.91]; eosinophils<50/mm 3, aOR=2.53, 95%CI [1.61-3.98]; PCT>0.25ng/mL, aOR=2.8, 95%CI [1.65-4.73]). Predictors of hospitalisation were: age>75 years-old (aOR=3.49, 95%CI [2.17-5.63]), paramyxovirus infection (aOR=2.28, 95%CI [1.39-3.75]), long-term use of inhaled corticosteroids (aOR=2.49, 95%CI [1.13-5.49]) and biological abnormalities (neutrophils>7000/mm 3, aOR=2.38, 95%CI [1.37-4.12]; PCT>0.25ng/mL, aOR=2.49, 95%CI [1.23-5.02]). Kaplan-Meier survival curves showed that influenza-infected patients experienced a higher mortality than paramyxoviruses (8.9% versus 4.5% respectively, p=0.017).

CONCLUSION

Our study revealed a high rate of superinfection (56%), not related to viral species. However influenza was associated with a poorer prognosis than paramyxoviruses, pleading for a broader and large-scale vaccination of individual at risk of VRTIs.