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Wednesday, 27 November 2013

Lower respiratory tract infection (Respiratory Disease)– Viral causes of Pneumonia

Lower respiratory tract infection
The lower respiratory tract infection are the infection consisting of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs, including the bronchitis and pneumonia. According to  The World Health Report 2004 – Changing History(1), in 2002 lower respiratory track infection were still the leading cause of deaths among all infectious diseases, and accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.
Pneumonia is defined as a condition of the inflammation of the lung as a result of infection, caused by bacteria, such as bacteria Streptococcus pneumoniae or influenza viruses in most cases. Fungi, such as Pneumocystis jiroveci, certain medication such as PPI Stomach Acid Drugs and other conditions such as impaired immune systems can also induced the disease.
A.1. Causes
A.1.1. Viral causes of Pneumonia
1. Human bocavirus (HBoV)
According to the study of the clinical characteristics of human bocavirus (HBoV) infection in children, found that Among 843 cases, 90 were HboV positive (10.7%), 131 were respiratory syncytial virus (RSV) positive (15.5%), 117 were influenza virus positive (13.9%), 84 were parainfluenza virus positive (10.0%), 55 were rhinovirus positive (6.5%), 48 were coronavirus positive (5.7%), and 33 were human metapneumovirus positive (3.7%). Of the 90 HBoV infected patients, 45 (50%) showed a co-infection with other respiratory tract viruses. Among them, 33 were infected with one other type of virus (37%), 11 (12%) were infected with two other types of virus, and 1 case (1%) was infected with other three viruses. The HBoV positive rate in children with wheezing was significantly higher than those without wheezing (17.0% vs 9.2%; P<0.01)(8).
2. Legionnaires’ disease or HPIV 3
According to the study by Infectious Disease Division, Winthrop-University Hospital, the most common mimics of H1N1 pneumonia are Legionnaires’ disease or HPIV 3 in adults, and metapneumovirus or respiratory syncytial virus in children(9).
3. Human metapneumovirus
Human metapneumovirus (hMPV) is a newly identified paramyxovirus causing lower respiratory tract infections (LRTI). According to the strudy by School of Medicine, DPMSC, University of Udine, Italy, during a 15-month study period, 124 children were admitted due to presumptive CAP and, in 116 of them, CAP was radiologically confirmed that hMPV caused 0% to 17.5% of LRTI cases in children in the mini-review. The figure was about 5% in the present and in the only earlier paediatric CAP study. Thus, hMPV is a real but rare cause of paediatric CAP, although seroconversion to hMPV in most children takes place in early childhood(10).
4. Adenovirus
Adenovirus is a frequent cause of mild self-limiting upper respiratory tract infection, gastroenteritis, and conjunctivitis in infants and young children. There is a report of  a case of severe adenovirus pneumonia in a young immunocompetent male who presented with sudden onset respiratory distress that progressed rapidly to respiratory failure and made a successful recovery on supportive measures. Systematic review of the literature identified 14 cases of severe adenovirus pneumonia (defined as respiratory failure requiring ventilatory support at any point during the course of illness) in otherwise healthy immunocompetent adults both in epidemic and community settings(11).
5. Acute respiratory distress syndrome (ARDS)
According to the study by Department of Medicine, University of Manitoba, H1N1 2009 has emerged as an important cause of ARDS in 2009-2010(12).
6. Other virus
Pleural effusion (PE), a complication of community-acquired pneumonia (CAP), is usually attributed to a bacterial infection. According to the study by Federal University of Bahia School of Medicine, found that  in the study bacterial and viral infections among 277 children hospitalized with CAP,  among these children 206 (74%) had radiographic confirmation, of whom 25 (12%) had PE. The aetiology was established in 18 (72%) PE cases: bacterial (n = 5; 28%), viral (n = 9; 50%), and viral-bacterial (n = 4; 22%) infections were found. Infection by rhinovirus (n = 3), enterovirus, Streptococcus pneumoniae (n = 2 each), Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, influenza A virus, and respiratory syncytial virus (RSV) (n = 1 each) were detected as probable sole infections. Parainfluenza virus 1/3 + influenza A virus and RSV + influenza A virus (n = 1 each) were identified as mixed viral-viral infections(13).
5. Etc.

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Sources 
(1) http://www.who.int/whr/2004/en/
(8) http://www.ncbi.nlm.nih.gov/pubmed/7839256
(9) http://www.ncbi.nlm.nih.gov/pubmed/20888645
(10) http://www.ncbi.nlm.nih.gov/pubmed/18618373
(11) http://www.ncbi.nlm.nih.gov/pubmed/18030505
(12) http://www.ncbi.nlm.nih.gov/pubmed/21157318
(13) http://www.ncbi.nlm.nih.gov/pubmed/23286738