https://doi.org/10.4081/monaldi.2025.3161
Frequency of viral etiology in community-acquired pneumonia
Submitted: July 31, 2024
Accepted: January 7, 2025
Published: January 17, 2025
Accepted: January 7, 2025
Abstract Views: 61
PDF_EARLY VIEW: 39
SUPPLEMENTARY MATERIAL: 4
SUPPLEMENTARY MATERIAL: 4
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The identification of etiology is very important when managing patients with community-acquired pneumonia (CAP). In Pakistan, studies regarding the viral etiology in CAP are scarce. The main objective of this study was to evaluate the frequency of viral etiology in CAP patients and analyze the clinical features and their impact on prognosis. Medical records of CAP patients admitted to Aga Khan University Hospital (Karachi, Pakistan) from March 2022 to February 2023 were retrospectively reviewed, patients who had microbiological tests performed within 48 hours of the hospital admission were included, and the frequency of viral and bacterial etiology was calculated. Patients who were immunocompromised were excluded. Epidemiological and clinical characteristics were examined, and the impact on prognosis was explored. A total of 166 patients were included; 115 (69.3%) patients were identified as having pneumonia with known causative microorganisms. A total of 83 (72.1%) patients had a viral etiology alone, 18 (15.6%) had only bacterial infection, and 14 (12.2%) had a viral and bacterial co-infection. Influenza A was most frequently detected (n=46/97; 47.4%), followed by Rhinovirus/Enterovirus (n=19/97; 19.6%). Staphylococcus aureus accounted for the majority (n=18; 56.3%) of cases among bacteria. Bacterial and viral-bacterial co-infection was significantly higher among non-survivors (38.1% vs. 16.6%, p=0.034). Confusion-Urea-Respiratory Rate-Blood Pressure-Age of 65 scores of 3-5 [odds ratio (OR) 4.234; 95% confidence interval 1.156-15.501], leukocytosis (OR 0.137; 0.030-0.636), high C-reactive protein (>10mg/L) (OR 1.008; 1.001-1.014), high serum procalcitonin level (≥0.5 ng/mL) (OR 10.731; 3.018-38.153), and mechanical ventilation required (OR 47.104; 13.644-162.625) were associated with mortality. Mechanical ventilation requirement was independently associated with increased odds of mortality (OR 43.407; 8.083-233.085). Of 166 patients, 21 (12.7%) had died, with the highest percentage (28.6%) seen in the viral-bacterial coinfection group (p=0.046). To conclude, respiratory viruses are increasingly being recognized as an important etiology in CAP, with higher mortality seen in bacterial infection, whether alone or with viral co-infection.
Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia 2020;12:11.
DOI: https://doi.org/10.1186/s41479-020-00074-3
WHO. Global health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000-2016.
Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012;67:71-9.
DOI: https://doi.org/10.1136/thx.2009.129502
Musher DM, Abers MS, Bartlett JG. Evolving understanding of the causes of pneumonia in adults, with special attention to the role of pneumococcus. Clin Infect Dis 2017;65:1736-44.
DOI: https://doi.org/10.1093/cid/cix549
Jain S. Epidemiology of viral pneumonia. Clin Chest Med 2017;38:1-9.
DOI: https://doi.org/10.1016/j.ccm.2016.11.012
JHU. COVID-19 dashboard by the center for systems science and engineering (CSSE) at Johns Hopkins University (JHU). Available from: https://coronavirus.jhu.edu/map.html.
Hussain M, Nasir N, Irfan M, Hasan Z. Clinical characteristics and outcomes of patients with H1N1 influenza pneumonia admitted at a tertiary care hospital in Karachi, Pakistan. Pneumonia 2020;12:5.
DOI: https://doi.org/10.1186/s41479-020-00070-7
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44:S27-72.
DOI: https://doi.org/10.1086/511159
Koneman EW, Allen SD, Janda W, et al. Diagnostic microbiology. The nonfermentative gram-negative bacilli. Philedelphia: Lippincott-Raven Publishers; 1997. pp 253-320.
CLSI. Performance standards for antimicrobial susceptibility testing. 2022.
Badar N, Bashir Aamir U, Mehmood MR, et al. Influenza virus surveillance in Pakistan during 2008-2011. PLoS One 2013;8:e79959.
DOI: https://doi.org/10.1371/journal.pone.0079959
Salman M, Badar N, Ikram A, et al. Estimation of seasonal influenza disease burden using sentinel site data in Pakistan 2017–2019: a cross-sectional study. Influenza Other Respir Viruses 2023;17:e13125.
DOI: https://doi.org/10.1111/irv.13125
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015;373:415-27.
DOI: https://doi.org/10.1056/NEJMc1511751
WHO. Influenza (seasonal). 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal).
Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med 1995;333:1618-24.
DOI: https://doi.org/10.1056/NEJM199512143332408
Ullah A, Qasim M, Rahman H, et al. High frequency of methicillin-resistant Staphylococcus aureus in Peshawar Region of Pakistan. Springerplus 2016;5:600.
DOI: https://doi.org/10.1186/s40064-016-2277-3
Anwar MS, Jaffery G, Rehman Bhatti KU, et al. Staphylococcus aureus and MRSA nasal carriage in general population. J Coll Physicians Surg Pak 2004;14:661-4.
Mulcahy ME, McLoughlin RM. Staphylococcus aureus and influenza A virus: partners in coinfection. mBio 2016;7:e02068-16.
DOI: https://doi.org/10.1128/mBio.02068-16
Zaki HA, Hamdi Alkahlout B, Shaban E, et al. The battle of the pneumonia predictors: a comprehensive meta-analysis comparing the pneumonia severity index (PSI) and the CURB-65 score in predicting mortality and the need for ICU support. Cureus 2023;15:e42672.
DOI: https://doi.org/10.7759/cureus.42672
Akram A, Singanayagam A, Choudhury G, et al. Incidence and prognostic implications of acute kidney injury on admission in patients with community-acquired pneumonia. Chest 2010;138:825-32.
DOI: https://doi.org/10.1378/chest.09-3071
Chen D, Yuan H, Cao C, et al. Impact of acute kidney injury on in-hospital outcomes in Chinese patients with community acquired pneumonia. BMC Pulm Med 2021;21:143.
DOI: https://doi.org/10.1186/s12890-021-01511-9
Sarah P, Alexandra B, Jennifer T, Rajesh Y. Community acquired pneumonia and co-existing acute kidney injury have poor clinical outcomes. Eur Respir J 2016;48:PA2587.
DOI: https://doi.org/10.1183/13993003.congress-2016.PA2587
Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008;121:219-25.
DOI: https://doi.org/10.1016/j.amjmed.2007.10.033
Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med 2006;32:469-72.
DOI: https://doi.org/10.1007/s00134-005-0047-8
Keramat F, Ghasemi Basir HR, Abdoli E, et al. Association of serum procalcitonin and C-reactive protein levels with CURB-65 criteria among patients with community-acquired pneumonia. Int J Gen Med 2018;11:217-23.
DOI: https://doi.org/10.2147/IJGM.S165190
Masiá M, Gutiérrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 2005;128:2223-9.
DOI: https://doi.org/10.1378/chest.128.4.2223
Cavallazzi R, Furmanek S, Arnold FW, et al. The burden of community-acquired pneumonia requiring admission to ICU in the United States. Chest 2020;158:1008-16.
DOI: https://doi.org/10.1016/j.chest.2020.03.051
Gearhart AM, Furmanek S, English C, et al. Predicting the need for ICU admission in community-acquired pneumonia. Respir Med 2019;155:61-5.
DOI: https://doi.org/10.1016/j.rmed.2019.07.007
Marrie TJ, Shariatzadeh MR. Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study. Medicine 2007;86:103-11.
DOI: https://doi.org/10.1097/MD.0b013e3180421c16
Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med 2013;369:2126-36.
DOI: https://doi.org/10.1056/NEJMra1208707
Karakuzu Z, Iscimen R, Akalin H, et al. Prognostic risk factors in ventilator-associated pneumonia. Med Sci Monit 2018;24:1321-8.
DOI: https://doi.org/10.12659/MSM.905919
Michael B, Karim EK, Mohamed S, et al. Viral infection in community-acquired pneumonia: a systematic review and meta-analysis. Eur Respir Rev 2016;25:178-88.
DOI: https://doi.org/10.1183/16000617.0076-2015
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;186:325-32.
DOI: https://doi.org/10.1164/rccm.201112-2240OC
Levandowski RA, Gerrity TR, Garrard CS. Modifications of lung clearance mechanisms by acute influenza A infection. J Lab Clin Med 1985;106:428-32.
McCullers JA. The co-pathogenesis of influenza viruses with bacteria in the lung. Nature Rev Microbiol 2014;12:252-62.
DOI: https://doi.org/10.1038/nrmicro3231
Small CL, Shaler CR, McCormick S, et al. Influenza infection leads to increased susceptibility to subsequent bacterial superinfection by impairing NK cell responses in the lung. J Immunol 2010;184:2048-56.
DOI: https://doi.org/10.4049/jimmunol.0902772
Ethics Approval
Given the retrospective chart reviews and lack of direct involvement of patients or other human participants, a waiver of ethics approval and informed consent was obtained from the Ethics Review Committee (ERC) of the Aga Khan University (ERC #2023-8526-24641).How to Cite
Khan, Zain Ahmad, Akbar Shoukat Ali, Imran Ahmed, Joveria Farooqi, and Muhammad Irfan. 2025. “Frequency of Viral Etiology in Community-Acquired Pneumonia”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2025.3161.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Maddalena Modica, Roberta Carabalona, Rosa Spezzaferri, Monica Tavanelli, A. Torri, Vittorino Ripamonti, Paolo Castiglioni, Renata De Maria, Maurizio Ferratini, Psychological profiles derived by cluster analysis of Minnesota Multiphasic Personality Inventory and long term clinical outcome after coronary artery by pass grafting , Monaldi Archives for Chest Disease: Vol. 78 No. 1 (2012): Cardiac series
- Shikha Jain, Puneet Khanna, Soumya Sarkar, Comparative evaluation of ventilator-associated pneumonia in critically ill COVID- 19 and patients infected with other corona viruses: a systematic review and meta-analysis , Monaldi Archives for Chest Disease: Vol. 92 No. 2 (2022)
- Francesco Vetta, Gabriella Locorotondo, Giampaolo Vetta, Maria Mignano, Sonia Bracchitta, Prognostic impact of frailty in elderly cardiac surgery patients , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Debapriya Maji, Upasna Agarwal, Lokender Kumar, Vinay V, Amit Sharma, Clinicodemographic profile and outcome of tuberculosis treatment in TB-HIV co-infected patients receiving daily ATT under a single window TB-HIV services delivery initiative , Monaldi Archives for Chest Disease: Vol. 93 No. 3 (2023)
- Nabila Kanwal, Humza Thobani, Ainan Arshad, Priya Ashok Kumar, Fatima Amjad, Safia Awan, Muhammad Irfan, Factors predicting mortality among patients with COVID-19 associated hospital acquired pneumonia: insights from a tertiary care center , Monaldi Archives for Chest Disease: Vol. 93 No. 4 (2023)
- Antonino Capizzi, Oliviero Sacco, Giovanni A. Rossi, Michela Silvestri, Recurrence of right lower lobe pneumonia 3 years after the first episode in an otherwise healthy 13-year-old girl , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Sara Salim Ali, Imran Ahmed Qureshi, Ahmed Ayaz, Ainan Arshad, Awais Farhad, Bushra Jamil, Muhammad Rizwan Sohail, Etiology, clinical characteristics, and outcome of infective endocarditis: 10-year experience from a tertiary care center in Pakistan , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Raffaele Griffo, Marco Ambrosetti, Giuseppe Furgi, Roberto Carlon, Carmine Chieffo, Giuseppe Favretto, Oreste Febo, Ugo Corrà , Francesco Fattirolli, Pantaleo Giannuzzi, Cesare Greco, Massimo F. Piepoli, Pier Luigi Temporelli, Roberto Tramarin, Stefano Urbinati, Standards and outcome measures in Cardiovascular Rehabilitation. Position Paper GICR/IACPR , Monaldi Archives for Chest Disease: Vol. 78 No. 4 (2012): Cardiac series
- Kiran B, Rupak Singla, Neeta Singla, Vinay V, Kuljeet Singh, Madhumita Paul Choudhury, Nilotpal Bhattacherjee, Factors affecting the treatment outcome of injection based shorter MDR-TB regimen at a referral centre in India , Monaldi Archives for Chest Disease: Vol. 93 No. 3 (2023)
- G. Domenighetti, A. Moccia, R. Gayer, Observational case-control study of non-invasive ventilation in patients with ARDS , Monaldi Archives for Chest Disease: Vol. 69 No. 1 (2008): Pulmonary series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
