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Pneumonia, Viral

Pneumonia, Viral is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Inflammatory disease of the lungs due to a viral infection
  • Most viral pneumonia result from exposure infection in the form of aerosolized secretions.
  • Hematogenous and direct spread are also possible.

Geriatric Considerations
High rates of morbidity and mortality in the elderly

Pediatric Considerations
  • Adenoviral infections in children are serious.
  • More serious respiratory viral infections are almost always seen in infants and in immunocompromised patients.
Pregnancy Considerations
  • Pregnant patients should avoid contact with anyone who has a viral infection.
  • Influenza vaccination is recommended for all pregnant women during the influenza season.

Epidemiology

Incidence
  • Predominant age: children <5 years
  • Predominant sex: male = female

Prevalence
  • Prevalence is variable with seasonal outbreaks, but the disease is more common during winter months.
  • ~90% of all cases of childhood pneumonias have a viral cause.
  • Between 4% and 39% of pneumonia diagnosed in adults have been attributed to viral causes.

Etiology and Pathophysiology

Overall: Influenza A and respiratory syncytial virus (RSV) are the leading causes followed by adenovirus and the parainfluenza viruses.

  • Adults
    • Influenza A, B, and C
    • Influenza H1N1
    • Adenovirus
    • Parainfluenza
    • Coronavirus/severe acute respiratory syndrome (SARS)
  • Children
    • Influenza A, B, and C
    • Influenza H1N1
    • Rhinovirus
    • Adenovirus
    • Parainfluenza
    • Rubeola (measles)
    • RSV (particularly for those born prematurely)
  • Miscellaneous
    • Cytomegalovirus (CMV) (particularly in immunocompromised patients)
    • Varicella
    • Herpes simplex virus (HSV)
    • Enterovirus
    • Rubeola
    • Epstein-Barr virus
    • Hantavirus
    • Human metapneumovirus

Genetics
No known genetic pattern has been recognized.

Risk Factors

  • Seasonal: epidemic upper respiratory illness
  • Living in close quarters
  • Recent upper respiratory infection
  • Travel to endemic area
  • Nonvaccinated person
  • Age >65 years or <5 years
  • Altered mental status (due to dysphagia)
  • Cardiac disease
  • Chronic pulmonary disease (e.g., COPD, emphysema)
  • Immunocompromised (HIV, transplant recipient, medication-induced)
  • Cystic fibrosis
  • Kartagener syndrome

General Prevention

  • General hand-hygiene techniques are the first-line prevention in transmission of infectious particles.
  • Influenza vaccination: Routine vaccination is now recommended for ALL persons aged ≥6 months.
    • Children who are 6 months to 8 years of age and receiving seasonal vaccination for the first time should receive 2 doses 4 weeks apart.
    • Children who are 6 months to 8 years of age who received 2 doses of the influenza vaccine should receive 1 dose of the seasonal influenza vaccine the following year.
    • See the Centers for Disease Control and Prevention guidelines (1)[A] regarding the use of live attenuated vaccine versus inactivated vaccine.
  • For those patients who are unable to receive influenza vaccine (e.g., with an egg allergy or other) and are at very high risk because of age, comorbid illness, or another risk factor, oseltamivir or zanamivir may be used for the duration of the season, with special recognition for potential viral resistance.
  • For those who did not receive the vaccine and have been exposed to influenza, use of oseltamivir or zanamivir is recommended for up to 10 days following exposure.
  • Palivizumab may be given to children >24 months for RSV prevention.

Commonly Associated Conditions

  • Rate of mixed viral–bacterial coinfection is ~20% and can lead to more severe illness or hospitalization.
  • Fungal infection and Pneumocystis jiroveci pneumonia in immunocompromised patients

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Citation

Stephens, Mark B., et al., editors. "Pneumonia, Viral." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116468/all/Pneumonia__Viral.
Pneumonia, Viral. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116468/all/Pneumonia__Viral. Accessed April 24, 2019.
Pneumonia, Viral. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116468/all/Pneumonia__Viral
Pneumonia, Viral [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116468/all/Pneumonia__Viral.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pneumonia, Viral ID - 116468 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116468/all/Pneumonia__Viral PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -