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Virale Pneumonie

Viral pneumonias

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Zusammenfassung

Viren sind für bis zu 35% der ambulant erworbenen Pneumonien v. a. im frühen Kindesalter verantwortlich. Neben den klassischen Erregern [RS- („respiratory syncytial“), Influenza-A- und -B-, Parainfluenza-, Adeno- und Rhinoviren)] wurden in den letzten 10 Jahren 3 neue Viren beschrieben, humanes Metapneumovirus (hMPV), humanes Bocavirus (hBoV) und H1N1. Klinisch ähnelt die hMPV-Infektion im Verlauf einer RSV-Infektion, bei hospitalisierter hBoV-Pneumonie findet sich häufig eine Sauerstoffpflichtigkeit, H1N1 führt zu einer selbstlimitierenden Krankheit, welche im Verlauf einer saisonalen Influenza ähnelt. Fieber, Tachydyspnoe und feinblasige Rasselgeräusche sind die wegweisenden Symptome. Akute-Phase-Parameter [großes Blutbild, C-reaktives Protein (CRP), Blutsenkungsgeschwindigkeit (BSG) und Prokalzitonin] differenzieren nicht zuverlässig zwischen viraler/bakterieller Genese und sollten schwereren Fällen vorbehalten bleiben. Ein Röntgenbild der Lunge empfiehlt sich bei diagnostisch unklaren Fällen oder beim Verdacht auf Komplikationen. In der Regel sind die Verläufe mild, und eine symptomatische Therapie mit Analgetika, Antipyretika und genügender Flüssigkeitszufuhr reicht aus. Wichtige Komplikationen sind obstruktive Ventilationsstörungen (O2-Monitoring) und Apnoen (v. a. bei Säuglingen <1 Monat).

Abstract

Viral pneumonias account for approximately 35% of community acquired pneumonia, especially in early childhood. In addition to respiratory syncytial virus (RSV), influenza A/B, parainfluenza, adeno- and rhinovirus, three new viruses have been described: human metapneumovirus (hMPV), human bocavirus (hBoV) and H1N1. hMPV shares many characteristics with RSV; oxygen supplementation is often needed in children hospitalized for hBoV pneumonia, while H1N1 pneumonia is a self-limiting disease resembling the course of seasonal influenza. Fever, tachydyspnea und rales are typical clinical symptoms. Acute phase reactants (WBC, CRP, BSR and procalcitonin) do not distinguish between bacterial and viral infections and should not be measured routinely. Chest radiography should be performed if etiology is unclear and if complications (atelectasis etc.) are suspected. In general, the clinical course of viral pneumonia is mild and symptomatic treatment with antipyretics/analgetics and adequate hydration is sufficient. Wheezing (monitoring for oxygen saturation) and apnea (particularly in infants <1 month) represent relevant complications.

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  1. Abteilung Allgemeine Pädiatrie, Zentrum für Kinderheilkunde, Universitätsklinikum Bonn, Adenauerallee 119, 53113, Bonn, Deutschland

    S. Schmitt-Grohé

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Schmitt-Grohé, S. Virale Pneumonie. Monatsschr Kinderheilkd 159, 217–223 (2011). https://doi.org/10.1007/s00112-010-2302-5

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