Viral Pneumonia/ Flu

Etiologic Agents of Viral pneumonia and Influenza
RSV
Rhinovirus
Influenza A, B, C
Human metapneumovirus
Parainfluenza
Human bocavirus
Coronavirus
Adenovirus
Enteroviruses
Varicella-zoster
Hantavirus
Parechoviruses
EBV
Human herpesvirus
HSV
Mimivirus
CMV
Measles

Major complications
ARDS, bacterial pneumonia, pulmonary fibrosis, respiratory failure

Influenza PPx
Indications:
Contraindications:

Hospitalization for viral pneumonia
-CURB-65 (3-5)
-CRB-65 (1)
3 minor or 1 major Infectious Disease Society of America criteria (based on bacterial)

Rhinovirus
General: common cold, ssRNA
Pathogenesis: droplet, replication in nasopharynx
Symptoms: common cold, pharyngitis, sinusistis, otitis media, COPD exacerbations, Asthma
Complications: fatal in high risk; usually self-limited
Treatment: symptomatic relief(antihistamines, decongetants, NSAIDS)

Respiratory Syncytial Virus (RSV)
*#1 cause of pneumonia in young children (esp. <6 months) -URI symptoms in young adults/ adults; LRI in higher risk patients (infants especiallyw/comorbidity, elderly COPD) -Subtype A and B (A worst) -Symptoms: apnea, URTI (cough, congestion, rhinorrhea, otitis media), LRTI (pneumonia, bronchospasm), sputum production, wheezing Dx: CXR-->patchy bilateral albeolar infiltrates, consolidation; antigen detection tests and cell culture; PCR in older children/ adults; viral culture (higher load lower in respiratory system); rapid detection by EIA (high sensitivity and specificity)
Treatment: supportive therapy, aerosolized ribavirin and RSV Ig (highrisk infants), Palivizumab (reduce hospitalization due to RSV in children; IM injection)

Adenovirus
Serotypes 1&2= infants/ young children
Serotypes 3,4,7= later in life
Serotype 14= high risk patients
*nosocomal outbreaks
Clinical: first recognized as cause of pneumonia in military recuits; DIC and septic shock in some cases; *necrotizing in neonates
Long-Term Sequelae: persistent radiographic abnormalities, abnormal PFT, brochiectasis, hyperlucent lung
Dx: ELISA, PCR, viral culture
CXR: diffuse, bilateral, patchy GROUND GLASS INFILTRATES (usually lower lobes), lobar consolidations, single or multilobar
Treatment: no specific antiviral (ganiciclabir, ribavirin tried), supportive therapy, live oral vaccines (serotypes 4, 7)

Varicella Zoster
-airborne transmission
-2 week incubation; cutaneous lesions following respiratory tract invasion
-latency in dorsal root ganglia (reactivation and spread along sensory nerves in dermatomal pattern)
Clinical: pneumonia in previously healthy adults; cough, dyspnea, pleuritic chest pain, hemoptysis 1-6 days after rash onset
CXR: diffuse, fluffy, reticular, or nodular infiltrates that can rapidl progress; pleural effusion and adenopathy; small, diffuse, punctate lung calcifications may persists in recovered
Diagnosis: rapid diagnosis of herpes group infection–> cytologic exam of lesion scrapings; **direct immunofluorescense for VZV antigen in lesions is most sensistive rapid lab test
Treatment/Prevention: live attenuated vacicne in children, higher dose in adults; Acyclovir treatment

Coronavirus
i.e. SARS
Clinical: cold symptoms, acute otitis media, exacerbations of asthma, exacerbations of bronchitis and pneumonia in adults; fever, chills, myalgias, diarrhea, cough, dyspnea, LDH elevation
CXR: GROUND GLAS OPACITIES AND FOCAL CONSOLIDATIONS (periphery and subpleural regions of lower zones)
Predictive of poor outcome: bilateral disease at presentation, peak level of LDh, older age, comorbid conditions
DX: PCR
Treatment: Chloroquine, protease inhibitors, ribavirin, type I interferons, niclosamide, NSAIDs

Hantavirus
“Navajo Flu”; Zoonosis
Transmission: specific rodent host for each strain
Pathogenesis: 8-20 days incubation, capillary leak syndrome and hyper-immune response implicated in fatal cases
Clinical illness: fever, chills, myalgias, abdominal discomfort, GI symptoms, malaise (URSI initially absent); progresses into mild nonproductive cough and progressive dyspnea; pleural effusion, pulmonary edema, shock-like picture, lactic acidosis
TRIAD: thrombocytopenia, L shift with circulating myeloblasts, and circulating immunoblasts
Dx: serum detection, PCR
Treatment: supportive (fluid status, high dose steroids?, ECMO in severe cases, Ribavirin (?))

Parainfluenza
Type 1–> 6 mos-3 years
Type 3–>bronchiolitis or pneumonia in infants
Clinical: primary infections usually symptomatic; common cold without fever; LESS often–> pharygitis, tracehobronchitis, flu-like illness; ELDERLY/ ADULTS–>pneumonia, COPD exacerbations; LRTI rare (in immunodeficieint)
Dx: PCR, viral culture
Treatment: none proven; Ribavirin+ IVIg in immunodeficient children with severe infections possible

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