Clinical features and etiological characteristics of co-infections in adult patients with rhinovirus pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Lijuan ¹ , LIU Siwei ² , SUN Lingxiao ¹ , WANG Yimin ¹ , LIU Yingmei ¹ , WANG Jinxiang ³ , REN Yali ⁴ , LIU Bo ⁵ , PAN Jianliang ⁶ , LIU Feifei ⁷ , SONG Lisi ⁸ , WANG Chuan ⁹ ,  CAO Bin ¹

1. Department of Respiratory And Critical Care Medicine, National Center for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, P. R. China;
2. School of Science and Engineering, The Chinese University of Hong Kong (Shenzhen), Shenzhen, Guangdong 518172, P. R. China;
3. Beijing Luhe Hospital of Capital Medical University, Beijing 101149, P. R. China;
4. Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050052, P. R. China;
5. Linzi District People’s Hospital of Zibo, Zibo, Shandong 255400, P. R. China;
6. Second People’s Hospital of Weifang, Weifang, Shandong 261041, P. R. China;
7. First Hospital of Qin Huang Dao, Qin Huang Dao, Hebei 066001, P. R. China;
8. Beijing Shijingshan Hospital, Beijing 100043, P. R. China;
9. First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, P. R. China;

Corresponding author：

CAO Bin, Email: caobin_ben@163.com

Keywords：

Rhinovirus; Pneumonia; Coinfections; Prognosis

DOI：

10.7507/1671-6205.201909035

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Objective To explore the clinical features, etiological characteristics of co-infections in adult patients with rhinovirus pneumonia.Methods Fourty-nine patients admitted to hospitals for rhinovirus pneumonia were enrolled from 8 medical centers in mainland China between August 2016 and August 2018. Multiplex real-time polymerase chain reaction assays for viral detection were implemented to all bronchoalveolar lavage fluid specimens obtained from the patients. The patients were divided into two groups depending on the status of other etiology co-infection (simple rhinovirus pneumonia group, n=24; coinfections group, n=25). The general data were collected, age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, whether patients with respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate of the two groups were reviewed and compared in detail.Results Thirteen patients (26.5%) with rhinovirus pneumonia had no underlying diseases, 8 patients (16.3%) with chronic underlying lung diseases, 6 patients (12.2%) with diabetes mellitus, 10 patients (20.4%) were immunocompromised patients, 16 patients (32.7%) with respiratory failure, and the hospital mortality rate was 8.2% (4/49). Cases with coinfection were remarkably correlated with more cerebrovascular diseases and disturbance of consciousness, higher PSI score and higher ratio of CURB-65 score >1, more respiratory failure and hospital mortality than those of simple rhinovirus pneumonia group (P< 0.05). There were 25 cases (51.0%) with mixed infection, including 18 bacteria (36.7%), 12 viruses (24.5%), 12 (24.5%) fungi (pneumocystis, aspergillus). Enterobacter and Pseudomonas aeruginosa were most frequently identified bacteria in the viral-bacterial group. Four patients with coinfections died.Conclusions Rhinovirus pneumonia in adult patients often has underlying diseases, and is prone to coinfections (bacteria, fungi, and other viruses). The outcome of these patients is always poor.

Citation： LI Lijuan, LIU Siwei, SUN Lingxiao, WANG Yimin, LIU Yingmei, WANG Jinxiang, REN Yali, LIU Bo, PAN Jianliang, LIU Feifei, SONG Lisi, WANG Chuan, CAO Bin. Clinical features and etiological characteristics of co-infections in adult patients with rhinovirus pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 451-456. doi: 10.7507/1671-6205.201909035 Copy

1.	Templeton KE, Scheltinga SA, van den Eeden WC, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41(3): 345-351.
2.	Karhu J, Ala-Kokko TI, Vuorinen T, et al. Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia. Clin Infect Dis, 2014, 59(1): 62-70.
3.	Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax, 2008, 63(1): 42-48.
4.	Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis, 2010, 50(2): 202-209.
5.	Lieberman D, Shimoni A, Shemer-Avni Y, et al. Respiratory viruses in adults with community-acquired pneumonia. Chest, 2010, 138(4): 811-816.
6.	Katsurada N, Suzuki M, Aoshima M, et al. The impact of virus infections on pneumonia mortality is complex in adults: a prospective multicentre observational study. BMC Infect Dis, 2017, 17(1): 755.
7.	Wang K, Xi W, Yang D, et al. Rhinovirus is associated with severe adult community-acquired pneumonia in China. J Thorac Dis, 2017, 9(11): 4502-4511.
8.	Jacobs SE, Soave R, Shore TB, et al. Human rhinovirus infections of the lower respiratory tract in hematopoietic stem cell transplant recipients. Transpl Infect Dis, 2013, 15(5): 474-486.
9.	中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南(2006 年版). 中华结核和呼吸杂志, 2006, 29(10): 651-655.
10.	Hohenadel IA, Kiworr M, Genitsariotis R, et al. Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad-spectrum antibiotic and antifungal regimen. Thorax, 2001, 56(2): 115-120.
11.	Rañó A, Agustí C, Benito N, et al. Prognostic factors of non-HIV immunocompromised patients with pulmonary infiltrates. Chest, 2002, 122(1): 253-261.
12.	Sousa D, Justo I, Domínguez A, et al. Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. Clin Microbiol Infect, 2013, 19(2): 187-192.
13.	Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e1-e60.
14.	胡华, 杨燕, 滕隔玲, 等. 支气管肺泡灌洗液半乳甘露聚糖抗原检测在肺曲霉病诊断中的价值. 中华医学杂志, 2012, 92(32): 2268-2270.
15.	奚志敏, 沈军, 王立波, 等. 人鼻病毒感染研究进展. 中华实验和临床病毒学杂志, 2016, 30(3): 333-336.
16.	Seo S, Waghmare A, Scott EM, et al. Human rhinovirus detection in the lower respiratory tract of hematopoietic cell transplant recipients: association with mortality. Haematologica, 2017, 102(6): 1120-1130.
17.	汪志方, 朱晓萍. 人鼻病毒与慢性阻塞性肺疾病急性加重的相关性研究进展. 中华结核和呼吸杂志, 2016, 39(2): 140-142.
18.	杜小兵, 马旭, 高杨, 等. 慢性阻塞性肺疾病急性加重期呼吸道病毒感染检出率及危险因素分析. 中华结核和呼吸杂志, 2017, 40(4): 263-266.
19.	Ishizuka S, Yamaya M, Suzuki T, et al. Effects of rhinovirus infection on the adherence of Streptococcus pneumoniae to cultured human airway epithelial cells. J Infect Dis, 2003, 188(12): 1928-1939.
20.	Qu JX, Gu L, Pu ZH, et al. Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity. BMC Infec Dis, 2015, 15(1): 89.
21.	Hohenthal U, Vainionpää R, Nikoskelainen J, et al. The role of rhinoviruses and enteroviruses in community acquired pneumonia in adults. Thorax, 2008, 63(7): 658-659.
22.	Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med, 2012, 186(4): 325-332.
23.	Hung HM, Yang SL, Chen CJ, et al. Molecular epidemiology and clinical features of rhinovirus infections among hospitalized patients in a medical center in Taiwan. J Microbiol Immunol Infect, 2019, 52(2): 233-241.
24.	Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med, 2018, 6(10): 782-792.
25.	Ivan H, Anna Z, Kelvin T, et al. Unexpectedly higher morbidity and mortality of hospitalized elderly patients associated with rhinovirus compared with influenza virus respiratory tract infection. Int J Mol Sci, 2017, 18(2): piiE259.
26.	Choi SH, Huh JW, Hong SB. Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia. J Clin Virol, 2015, 62: 41-47.
27.	Jacobs SE, Lamson DM, St George K, et al. Human rhinoviruses. Clin Microbiol Rev, 2013, 26(1): 135-162.
28.	Grünewaldt A, Hügel C, Rohde GGU. Rhinoviruses. Internist (Berl), 2019, 60(11): 1151-1154.

1. Templeton KE, Scheltinga SA, van den Eeden WC, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41(3): 345-351.
2. Karhu J, Ala-Kokko TI, Vuorinen T, et al. Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia. Clin Infect Dis, 2014, 59(1): 62-70.
3. Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax, 2008, 63(1): 42-48.
4. Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis, 2010, 50(2): 202-209.
5. Lieberman D, Shimoni A, Shemer-Avni Y, et al. Respiratory viruses in adults with community-acquired pneumonia. Chest, 2010, 138(4): 811-816.
6. Katsurada N, Suzuki M, Aoshima M, et al. The impact of virus infections on pneumonia mortality is complex in adults: a prospective multicentre observational study. BMC Infect Dis, 2017, 17(1): 755.
7. Wang K, Xi W, Yang D, et al. Rhinovirus is associated with severe adult community-acquired pneumonia in China. J Thorac Dis, 2017, 9(11): 4502-4511.
8. Jacobs SE, Soave R, Shore TB, et al. Human rhinovirus infections of the lower respiratory tract in hematopoietic stem cell transplant recipients. Transpl Infect Dis, 2013, 15(5): 474-486.
9. 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南(2006 年版). 中华结核和呼吸杂志, 2006, 29(10): 651-655.
10. Hohenadel IA, Kiworr M, Genitsariotis R, et al. Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad-spectrum antibiotic and antifungal regimen. Thorax, 2001, 56(2): 115-120.
11. Rañó A, Agustí C, Benito N, et al. Prognostic factors of non-HIV immunocompromised patients with pulmonary infiltrates. Chest, 2002, 122(1): 253-261.
12. Sousa D, Justo I, Domínguez A, et al. Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. Clin Microbiol Infect, 2013, 19(2): 187-192.
13. Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e1-e60.
14. 胡华, 杨燕, 滕隔玲, 等. 支气管肺泡灌洗液半乳甘露聚糖抗原检测在肺曲霉病诊断中的价值. 中华医学杂志, 2012, 92(32): 2268-2270.
15. 奚志敏, 沈军, 王立波, 等. 人鼻病毒感染研究进展. 中华实验和临床病毒学杂志, 2016, 30(3): 333-336.
16. Seo S, Waghmare A, Scott EM, et al. Human rhinovirus detection in the lower respiratory tract of hematopoietic cell transplant recipients: association with mortality. Haematologica, 2017, 102(6): 1120-1130.
17. 汪志方, 朱晓萍. 人鼻病毒与慢性阻塞性肺疾病急性加重的相关性研究进展. 中华结核和呼吸杂志, 2016, 39(2): 140-142.
18. 杜小兵, 马旭, 高杨, 等. 慢性阻塞性肺疾病急性加重期呼吸道病毒感染检出率及危险因素分析. 中华结核和呼吸杂志, 2017, 40(4): 263-266.
19. Ishizuka S, Yamaya M, Suzuki T, et al. Effects of rhinovirus infection on the adherence of Streptococcus pneumoniae to cultured human airway epithelial cells. J Infect Dis, 2003, 188(12): 1928-1939.
20. Qu JX, Gu L, Pu ZH, et al. Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity. BMC Infec Dis, 2015, 15(1): 89.
21. Hohenthal U, Vainionpää R, Nikoskelainen J, et al. The role of rhinoviruses and enteroviruses in community acquired pneumonia in adults. Thorax, 2008, 63(7): 658-659.
22. Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med, 2012, 186(4): 325-332.
23. Hung HM, Yang SL, Chen CJ, et al. Molecular epidemiology and clinical features of rhinovirus infections among hospitalized patients in a medical center in Taiwan. J Microbiol Immunol Infect, 2019, 52(2): 233-241.
24. Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med, 2018, 6(10): 782-792.
25. Ivan H, Anna Z, Kelvin T, et al. Unexpectedly higher morbidity and mortality of hospitalized elderly patients associated with rhinovirus compared with influenza virus respiratory tract infection. Int J Mol Sci, 2017, 18(2): piiE259.
26. Choi SH, Huh JW, Hong SB. Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia. J Clin Virol, 2015, 62: 41-47.
27. Jacobs SE, Lamson DM, St George K, et al. Human rhinoviruses. Clin Microbiol Rev, 2013, 26(1): 135-162.
28. Grünewaldt A, Hügel C, Rohde GGU. Rhinoviruses. Internist (Berl), 2019, 60(11): 1151-1154.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical features and etiological characteristics of co-infections in adult patients with rhinovirus pneumonia

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