Clinical Relevance of Multiple Respiratory Virus Detection in Adult Patients with Acute Respiratory Illness

ABSTRACT Because increasing numbers of nasopharyngeal swab specimens from adult patients with acute respiratory illness (ARI) are being tested by respiratory virus (RV) multiplex reverse transcriptase PCR (RVM-RT-PCR), multiple RV detection (MRVD) is being encountered more frequently. However, the clinical relevance of MRVD in adult patients has rarely been evaluated. The clinical characteristics of hospitalized adult patients with ARI and MRVD by RVM-RT-PCR tests were compared to those of patients with single RV detection (SRVD) during a single year at a tertiary care center. MRVD was observed in 26 of the 190 adult patients (13.7%). The patients with MRVD had a higher incidence of chronic lung disease than the patients with SRVD (34.6% versus 15.9%, crude odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.13 to 6.98, P = 0.03). Although the former were more likely than the latter to receive mechanical ventilation (19.2% versus 6.7%, crude OR = 3.31, 95% CI = 1.05 to 10.47, P = 0.049), the length of hospital stay (median, 7 versus 6.5 days; P = 0.66), and the in-hospital mortality rate (7.7% versus 4.3%, crude OR = 1.87, 95% CI = 0.37 to 9.53, P = 0.35) were not different between the two groups. In multivariate analysis, chronic lung disease was associated with MRVD (adjusted OR = 3.08, 95% CI = 1.12 to 8.46, P = 0.03). In summary, it was not uncommon to encounter adult patients with ARI and MRVD by RVM-RT-PCR tests of nasopharyngeal swab specimens. MRVD was associated with chronic lung disease rather than the severity of the ARI.

[1]  Seong-Ho Choi,et al.  Utilization of the respiratory virus multiplex reverse transcription-polymerase chain reaction test for adult patients at a Korean tertiary care center , 2014, The Korean journal of internal medicine.

[2]  Arnaud Merglen,et al.  Clinical Disease Severity of Respiratory Viral Co-Infection versus Single Viral Infection: A Systematic Review and Meta-Analysis , 2014, PloS one.

[3]  P. Klapper,et al.  Single and multiple respiratory virus infections and severity of respiratory disease: A systematic review , 2013, Paediatric Respiratory Reviews.

[4]  C. Renaud,et al.  Clinical and economical impact of multiplex respiratory virus assays , 2013, Diagnostic Microbiology and Infectious Disease.

[5]  K. Chapin,et al.  Clinical Characteristics and Outcomes in Hospitalized Patients with Respiratory Viral Co-Infection during the 2009 H1N1 Influenza Pandemic , 2013, PloS one.

[6]  U. Sajjan.  Susceptibility to viral infections in chronic obstructive pulmonary disease: role of epithelial cells , 2013, Current opinion in pulmonary medicine.

[7]  H. Park,et al.  Viral infection in patients with severe pneumonia requiring intensive care unit admission. , 2012, American journal of respiratory and critical care medicine.

[8]  P. Klapper,et al.  Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality , 2012, Influenza and other respiratory viruses.

[9]  M. Theodoridou,et al.  Evaluation of viral co‐infections in hospitalized and non‐hospitalized children with respiratory infections using microarrays , 2012, Clinical Microbiology and Infection.

[10]  D. Skowronski,et al.  Community‐acquired respiratory viruses and co‐infection among patients of Ontario sentinel practices, April 2009 to February 2010 , 2012, Influenza and other respiratory viruses.

[11]  S. Johnston,et al.  Viruses exacerbating chronic pulmonary disease: the role of immune modulation , 2012, BMC Medicine.

[12]  N. Bellei,et al.  Respiratory viral coinfection among hospitalized patients with H1N1 2009 during the first pandemic wave in Brazil , 2012, The Brazilian Journal of Infectious Diseases.

[13]  R. Lu,et al.  Etiology and Clinical Characterization of Respiratory Virus Infections in Adult Patients Attending an Emergency Department in Beijing , 2012, PloS one.

[14]  M. Smieja,et al.  Molecular diagnosis of respiratory virus infections , 2011, Critical reviews in clinical laboratory sciences.

[15]  T. Pumarola,et al.  Clinical relevance of mixed respiratory viral infections in adults with influenza A H1N1 , 2011, European Respiratory Journal.

[16]  F. Esper,et al.  Rate and influence of respiratory virus co-infection on pandemic (H1N1) influenza disease , 2011, Journal of Infection.

[17]  N. Lévêque,et al.  Rapid Detection of Respiratory Tract Viral Infections and Coinfections in Patients with Influenza-Like Illnesses by Use of Reverse Transcription-PCR DNA Microarray Systems , 2010, Journal of Clinical Microbiology.

[18]  R. Willers,et al.  Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection , 2010, Journal of Clinical Virology.

[19]  J. Dorca,et al.  Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. , 2007, Archives of internal medicine.

[20]  J. Petitjean,et al.  Comparison of multiplex PCR assays and conventional techniques for the diagnostic of respiratory virus infections in children admitted to hospital with an acute respiratory illness , 2006, Journal of medical virology.

[21]  V. Foulongne,et al.  Human Metapneumovirus Infection in Young Children Hospitalized With Respiratory Tract Disease , 2006, The Pediatric infectious disease journal.

[22]  H. Hutter,et al.  Single Versus Dual Respiratory Virus Infections in Hospitalized Infants: Impact on Clinical Course of Disease and Interferon-γ Response , 2005, The Pediatric infectious disease journal.

[23]  T. Shim,et al.  The prognosis of respiratory failure in patients with tuberculous destroyed lung. , 2001, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[24]  P. Piedra,et al.  Dual Respiratory Virus Infections , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.