viral pneumonia
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Etiology
- respiratory syncytial virus (children)*
- rhinovirus (children)*
- adenovirus
- metapneumovirus
- parainfluenza virus
- varicella (chickenpox, more common in adults)
- Herpes virus (including cytomegalovirus)
- immunocompromised & patients with burns
- influenza A & B (see influenza) (uncommon)
- bacterial pneumonia as a complication far more common
* most common causes of viral pneumonia in children[2]
Epidemiology
- > 20% of severe pneumonia with respiratory failure requiring mechanical ventilation due to viral pneumonia[3]
Pathology
- Streptococcus pneumoniae may increase susceptibility viral pneumonia[1]
Clinical manifestations
Laboratory
- multiplex PCR assay may be become the new standard
Radiology
- chest X-ray:
- diffuse lung involvement (not lobar)
- ground-glass opacity (bibasilar opacities)
Differential diagnosis
- bacterial pneumonia (may coexist with viral pneumonia)[4]
- factors favoring viral pneumonia
- rhinorrhea, diarrhea
- higher lymphocyte count % in WBC count
- lower serum creatinine
- ground-glass opacity in chest imaging[4]
- factors favoring bacterial pneumonia
- acute onset of symptoms
- age > 65 years or comorbidity
- leukocytosis or leukopenia
- fever, headache
- cervical painful lymph nodes[4]
- factors favoring viral pneumonia
- serum procalcitonin no helpful[4]
Management
- see influenza*
- pneumococcal congugate vaccine (Prevnar, PCV7) may reduce incidence of viral pneumonia in infants[1]
* a negative rapid antigen test & influenza vaccine 5 months prior does not rule out influenza in elderly person residing in a skilled nursing facility[5]
More general terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Journal Watch 24(17):138, 2004
Madhi SA, Klugman KP, The Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med. 2004 Aug;10(8):811-3. Epub 2004 Jul 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15247911 - ↑ Jump up to: 2.0 2.1 Jain S, Williams DJ, Arnold SR et al Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children. N Engl J Med 2015; 372:835-845. February 26, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25714161 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1405870
- ↑ Jump up to: 3.0 3.1 Shorr AF, Fisher K, Micek ST, Kollef MH. The burden of viruses in pneumonia associated with acute respiratory failure: An underappreciated issue. Chest. 2017 Dec 21. pii: S0012-3692(17)33236-1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29274318
- ↑ Jump up to: 4.0 4.1 4.2 4.3 4.4 Heneghan C, Pluddemann A, Mahtani KR Differentiating viral from bacterial pneumonia. Centre for Evidence-Based Medicine. 2020, April 8. Nuffield Department of Primary Care Health Sciences University of Oxford https://www.cebm.net/covid-19/differentiating-viral-from-bacterial-pneumonia/
- ↑ Jump up to: 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025