Current Infectious Disease Reports

, Volume 15, Issue 2, pp 177–183 | Cite as

Viral Infections in Children with Community-Acquired Pneumonia

RESPIRATORY INFECTIONS (F ARNOLD, SECTION EDITOR)

Abstract

Viral pathogens are commonly isolated from children with community-acquired pneumonia (CAP). Viruses like respiratory syncytial virus, human rhinovirus, human metapneumovirus, parainfluenza viruses, and influenza may act as sole pathogens or may predispose to bacterial pneumonia by a variety of mechanisms. New, emerging, or reemerging viral pathogens occasionally cause outbreaks of severe respiratory tract infection in children. The 2009–2010 H1N1 influenza virus pandemic resulted in increased rates of influenza-related hospitalizations and deaths in children. Rapid viral diagnostic tests based on antigen detection or nucleic acid amplification are increasingly available for clinical use and confirm the importance of viral infection in children hospitalized with CAP. Recently published guidelines for the management of CAP in children note that positive viral test results can modify clinical decision making in children with suspected pneumonia by allowing antibacterial therapy to be withheld in the absence of clinical, laboratory, or radiographic findings that suggest bacterial coinfection.

Keywords

Community-acquired pneumonia Bacterial pneumonia Infant Child Adolescent Viral infection Viral respiratory tract infection Streptococcus pneumoniae Staphylococcus aureus Rhinovirus Influenza Metapneumovirus Adenovirus Bocavirus Parainfluenza virus Respiratory syncytial virus Enterovirus 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–61.PubMedCrossRefGoogle Scholar
  2. 2.
    Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bull World Health Org. 2009;86:408–16.CrossRefGoogle Scholar
  3. 3.
    Kronman MP, Hersch AL, Feng R, et al. Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994–2007. Pediatrics. 2011;127:411–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee GE, Lorch SA, Sheffler-Collin S, et al. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics. 2010;126:204–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264–75.PubMedCrossRefGoogle Scholar
  6. 6.
    Juvén T, Mersola J, Waris M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 2000;19:293–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Tsolia MN, Psarras S, Bossios A, et al. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis. 2004;39:681–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Cilla G, Onate E, Perez-Yarza EG, et al. Viruses in community-acquired pneumonia in children aged less than 3 years old: high rates of viral coinfection. J Med Virol. 2008;80:1843–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Nascimento-Carvalho CM, Ribeiro CT, Cardoso MR, et al. The role of respiratory viral infections among children hospitalized for community-acquired pneumonia in a developing country. Pediatr Infect Dis J. 2008;27:939–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Cevey-Macharel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr. 2009;168:1429–36.CrossRefGoogle Scholar
  11. 11.
    •• Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:e25–75. This is the first national U.S. clinical practice guideline for management of children with community-acquired pneumonia. It provides a comprehensive review of diagnostic and treatment issues and identifies gaps in knowledge that need to be addressed by future research.PubMedCrossRefGoogle Scholar
  12. 12.
    Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004;113:701–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Ampofo K, Bender J, Sheng X, et al. Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infections. Pediatrics. 2008;122:229–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Talbot TR, Poehling KA, Hartet TV, et al. Seasonality of invasive pneumococcal disease: temporal relation to document influenza and respiratory syncytial virus circulation. Am J Med. 2005;118:285–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Randolph AG, Reder L, Englund JA. Risk of bacterial infection in previously healthy respiratory syncytial virus-infected young children admitted to the intensive care unit. Pediatr Infect Dis J. 2004;23:990–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Nichol KP, Cherry JD. Bacterial-viral interrelations in respiratory infections of children. N Engl J Med. 1967;277:667–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Levin D, Tribuzio M, Green-Wrzesinki T, et al. Empiric antibiotics are justified for infants with respiratory syncytial virus lower respiratory tract infection presenting with respiratory failure: a prospective study and evidence review. Pediatr Crit Care Med. 2010;11:390–5.PubMedGoogle Scholar
  18. 18.
    Reed C, Kallen A, Patton M, et al. Infection with community-onset staphylococcus aureus and influenza virus in hospitalized children. Pediatr Infect Dis J. 2009;28:572–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Schrag SJ, Shay DK, Gershman K. Emerging infections program respiratory disease activity. Multistate surveillance for laboratory-confirmed influenza-associated hospitalizations in children: 2003–2004. Pediatr Infect Dis J. 2006;25:395–400.PubMedCrossRefGoogle Scholar
  20. 20.
    Louie JK, Schecter R, Honarmand S, et al. Severe pediatric influenza in California, 2003–2005: implications for immunization recommendations. Pediatrics. 2006;117:e610–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase in staphylococcus aureus coinfection. Pediatrics. 2008;122:805–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Thorburn K, Harigopal S, Reddy V, et al. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax. 2008;61:611–5.CrossRefGoogle Scholar
  23. 23.
    Stockman LJ, Reed C, Kallen AJ, et al. Respiratory syncytial virus and Staphylococcus aureus coinfection in children hospitalized with pneumonia. Pediatr Infect Dis J. 2010;29:1048–50.PubMedGoogle Scholar
  24. 24.
    Pittet LA, Hall-Stoodley L, Rutkowski MR, et al. Influenza virus infection decreases tracheal mucociliary velocity and clearance of streptococcus pneumoniae. Am J Respir Cell Mol Biol. 2010;42:450–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Avandhanula V, Rodriguez CA, Devincenzo JP, et al. Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner. J Virol. 2006;80:1629–36.CrossRefGoogle Scholar
  26. 26.
    Wang JH, Kwon HJ, Jang YJ. Rhinovirus enhances various bacterial adhesions to nasal epithelial cells simultaneously. Laryngoscope. 2009;119:1406–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Golda A, Malek N, Dudek B, et al. Infection with human coronavirus NL63 enhances streptococcal adherence to epithelial cells. J Gen Virol. 2011;92:1358–68.PubMedCrossRefGoogle Scholar
  28. 28.
    Halfhide CP, Flanagan BF, Brearey SP, et al. Respiratory syncytial virus binds and undergoes transcription in neutrophils from the blood and airways of infants with severe bronchiolitis. J Infect Dis. 2011;204:451–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Hament J-M, Kimpen JLL, Fleer A, Wolfs TFW. Respiratory viral infection predisposing for bacterial disease: a concise review. FEMS Immunol Med Microbiol. 1999;26:189–96.PubMedCrossRefGoogle Scholar
  30. 30.
    Honkinen M, Lahti E, Osterback R, et al. Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clin Microbiol Infect. 2012;18:300–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Garcia-Garcia ML, Calvo C, Pozo F, et al. Spectrum of respiratory viruses in children with community-aquired pneumonia. Pediatr Infect Dis J. 2012;31:808–13.PubMedCrossRefGoogle Scholar
  32. 32.
    Pretorius MA, Madhi SA, Cohen C, et al. Respiratory viral coinfections identified by a 10-plex real-time reverse-transcription polymerase chain reaction assay in patients hospitalized with severe acute respiratory illness—South Africa, 2009–2010. J Infect Dis. 2012;206:S159–65.PubMedCrossRefGoogle Scholar
  33. 33.
    Hoffman J, Rabezanahary H, Randriamarotia M, et al. Viral and atypical bacterial etiology of acute respiratory infections in children under 5 years old living in a rural tropical area of Madagascar. PLOS. 2012;7:e43666. doi:10.1371/journal/pone.0043666.CrossRefGoogle Scholar
  34. 34.
    Chang ML, Jordan-Villegas A, Evans A, et al. Respiratory viruses identified in an urban children’s hospital emergency department during the 2009 influenza A(H1N1) pandemic. Pediatr Emerg Care. 2012;28:990–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Pavia AT. Viral infections of the lower respiratory tract: old viruses, new viruses, and the role of diagnosis. Clin Infect Dis. 2011;52:S284–9.PubMedCrossRefGoogle Scholar
  36. 36.
    McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006;19:571–82.PubMedCrossRefGoogle Scholar
  37. 37.
    Williams DJ, Hall M, Brogan TV, et al. Influenza coinfection and outcomes in children with complicated pneumonia. Arch Pediatr Adol Med. 2011;165:506–12.CrossRefGoogle Scholar
  38. 38.
    Cox CM, D’Mello T, Perez A, et al. Increase in rates of hospitalization due to laboratory-confirmed influenza among children and adults during the 2009—10 influenza pandemic. J Infect Dis. 2012;206:1350–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Centers for Disease Control and Prevention. Severe illness from 2009 pandemic influenza A (H1N1)—Utah, 2009—10 influenza season. MMWR. 2011;60:1310–4.Google Scholar
  40. 40.
    Weinberger DM, Simonsen L, Jordan R, et al. Impact of the 2009 influenza pandemic on pneumococcal pneumonia hospitalizations in the United States. J Infect Dis. 2012;205:458–68.PubMedCrossRefGoogle Scholar
  41. 41.
    Nelson GE, Gershman K, Swerdlow DL, et al. Invasive pneumococcal disease and pandemic (H1N1) 2009, Denver, Colorado, USA. Emerg Infect Dis. 2012;18:208–16.PubMedCrossRefGoogle Scholar
  42. 42.
    Tran D, Vaudry W, Moore DL, et al. Comparison of children hospitalized with seasonal versus pandemic influenza A, 2004–2009. Pediatrics. 2012;130:397–406.PubMedCrossRefGoogle Scholar
  43. 43.
    Blumental S, Huisman E, Cornet M-C, et al. Pandemic A/H1N1v influenza 2009 in hospitalized children: a multicenter Belgian survey. BMC Infect Dis. 2011;11:313. http://www.biomedcentral.com/1471-2334/11/313.
  44. 44.
    Udompornwattana S, Srajai K, Suwan P, et al. The clinical features, risk of prolonged hospitalization and household infections of hospitalized children for pandemic 2009 influenza A (H1N1) virus infection in Thailand. J Med Assoc Thai. 2012;95:403–11.PubMedGoogle Scholar
  45. 45.
    Lopez-Medina E, Arduara MI, Siegel JD, et al. 2009 influenza A in infants hospitalized at younger than 6 months. J Pediatr. 2012;160:626–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431–41.PubMedCrossRefGoogle Scholar
  47. 47.
    van der Hoek L, Pyrc K, Jebbink MF, et al. Identification of a new human coronarvirus. Nat Med. 2004;10:368–73.PubMedCrossRefGoogle Scholar
  48. 48.
    Allander T. Human bocavirus. J Clin Virol. 2008;41:29–33.PubMedCrossRefGoogle Scholar
  49. 49.
    Centers for Disease Control and Prevention. Clusters of acute respiratory illness associated with human enterovirus 68—Asia, Europe, and United States, 2008–2010. MMWR. 2011;60:1301–4.Google Scholar
  50. 50.
    Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory disease. Am J Epidemiology. 1967;85:297–310.Google Scholar
  51. 51.
    Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shars biologic features with both the enteroviruses and the rhinoviruses. J Gen Virol. 2004;85:2577–84.PubMedCrossRefGoogle Scholar
  52. 52.
    • Centers for Disease Control and Prevention. Update: influenza A (H3N2)v transmission and guidelines—five states, 2011. MMWR. 2012;60:1741–4. This report illustrates the need for ongoing surveillance for new strains of influenza virus, including the recognition that these can arise in the U.S. as well as other parts of the world.Google Scholar
  53. 53.
    Skowronski DM, Janjua NZ, De Serres G, et al. Cross-reactive and vaccine-induced antibody to an emerging swine-origin variant of influenza A virus subtype H3N2 (H3N2v). J Infect Dis. 2012;206:1852–61.PubMedCrossRefGoogle Scholar
  54. 54.
    Grijalva CG, Nuorti JP, Zhu Y, et al. Increasing incidence of empyema complicating childhood community-acquired pneumonia in the United States. Clin Infect Dis. 2010;50:805–13.PubMedCrossRefGoogle Scholar
  55. 55.
    Li S-TT, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal vaccine. Pediatrics. 2010;125:26–33.PubMedCrossRefGoogle Scholar
  56. 56.
    Cohen E, Mahant S, Dell SD, et al. The long-term outcomes of pediatric pleural empyema. Arch Pediatr Adolesc Med. 2012;166:999–1004.PubMedGoogle Scholar
  57. 57.
    •• Brogan TV, Hall M, Williams DJ, et al. Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31:1036–41. This article presents analysis of management of community-acquired pneumonia in children admitted to 29 children’s hospitals in the U.S. in 2009. Substantial variations in diagnostic testing for viral and bacterial etiologies of and types of antimicrobial treatments administered are described and indicate need for more standardized management nationally.PubMedGoogle Scholar
  58. 58.
    Smith MJ, Kong M, Cambon A, et al. Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children. Pediatrics. 2012;129:e1326–33.PubMedCrossRefGoogle Scholar
  59. 59.
    Pierce VM, Elkan M, Leet M, et al. Comparison of the Idaho technology film array system to real-time PCR for detection of respiratory pathogens in children. J Clin Microbiol. 2012;50:364–71.PubMedCrossRefGoogle Scholar
  60. 60.
    Jarti T, Jarti L, Peltola V, et al. Identification of respiratory viruses in asymptomatic subjects: asymptomatic respiratory viral infections. Pediatr Infect Dis J. 2008;27:1103–7.CrossRefGoogle Scholar
  61. 61.
    Bonner AB, Monroe KW, Talley LI, et al. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics. 2003;112:363–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Esposito S, Marchisio P, Moreli P, et al. Effect of a rapid influenza diagnosis. Arch Dis Child. 2003;88:525–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Benito-Fernandez J, Vazquez-Ronco MA, Morteruel-Aizkuren E, et al. Impact of rapid viral testing for influenza A and B viruses on management of febrile infants without signs of focal infection. Pediatr Infect Dis J. 2006;25:1153–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Doan QH, Kissoon N, Dobson S, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr. 2009;154:91–5.PubMedCrossRefGoogle Scholar
  65. 65.
    Byington CL, Castillo H, Gerber K, et al. The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children’s hospital. Arch Pediatr Adol Med. 2002;156:1230–4.Google Scholar
  66. 66.
    Hyvӓrinen MK, Kotaniemi-Syrjӓnen A, Reijonen TM, et al. Lung function and bronchial hyper-responsiveness 11 years after hospitalization for bronchiolitis. Acta Paediatr. 2007;96:1464–9.CrossRefGoogle Scholar
  67. 67.
    Stein RT, Sherrill D, Morgan WJ, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999;354:541–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Martinez FD. Heterogeniety of the association between lower respiratory tract illness in infancy and subsequent asthma. Proc Am Thorac Soc. 2005;2:157–61.PubMedCrossRefGoogle Scholar
  69. 69.
    Murtagh P, Guibergia V, Viale D, et al. Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality. Pediatr Pulmonol. 2009;44:450–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Aguerre V, Castaňos C, Pena HG, et al. Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings. Pediatr Pulmonol. 2010;45:1180–5.PubMedCrossRefGoogle Scholar
  71. 71.
    Koh YY, da Jung E, Koh JY, et al. Bronchoalveolar cellurity and interleukin-8 levels in measles bronchiolitis obliterans. Chest. 2007;131:1454–60.PubMedCrossRefGoogle Scholar
  72. 72.
    Sethi GR, Batra V. Bronchiectasis: causes and management. Indian J Pediatr. 2000;67:133–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Moss RB, Hansen C, Sanders RL, et al. A phase II study of DAS181, a novel host directed antiviral for the treatment of influenza infection. J Infect Dis. 2012;206:1844–51.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Pediatric Infectious DiseasesUniversity of Louisville School of MedicineLouisvilleUSA

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