title: Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia.
abstract: BACKGROUND
  Rhinoviruses (RVs) may cause pneumonia, but the characteristics of RV-associated pneumonia have not been adequately evaluated.
  
  
  OBJECTIVE
  We aimed to compare characteristics, complications, and outcomes between severe RV- and influenza virus (IFV)-associated pneumonia in adults.
  
  
  METHODS
  We used prospective cohort data of adult patients with severe pneumonia who had been admitted to the medical intensive care unit of a tertiary care hospital over a 4-year period. The clinical features and outcomes of 27 patients with RV-positive bronchoscopic bronchoalveolar lavage (BAL) fluid were compared to those of 51 pneumonia patients with IFV-positive BAL fluid or IFV-positive nasopharyngeal specimens.
  
  
  RESULTS
  Of 356 patients who underwent bronchoscopic BAL and respiratory virus polymerase chain reaction (PCR), RV was the most commonly identified virus (8.1%) from BAL fluid. Patients with RV-associated pneumonia were more likely to be immunocompromised than patients with IFV-associated pneumonia (81.5% vs. 33.3%, p<0.001). Bacterial coinfection tended to be less common in the RV group (18.5% vs. 37.3%, p=0.09). Although septic shock was less common in the RV group (29.6% vs. 54.9%, p=0.03), other clinical manifestations, laboratory findings, and radiologic patterns were similar between the groups. The 28-day mortality of patients with severe RV- and IFV-associated pneumonia was similarly high (29.6% vs. 35.3% respectively, p=0.61).
  
  
  CONCLUSIONS
  Severe RV-associated pneumonia patients were more likely to be immunocompromised and less likely to present septic shock. Overall clinical features were similar and mortalities of both groups were comparably high. Studies of larger cohorts encompassing mild to moderate pneumonia patients are needed.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Heungsup
authors.initials: H
authors.lastname: Sung
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Jeong
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: yskoh@amc.seoul.kr.
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D060085:Coinfection; D015897:Comorbidity; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D063868:Patient Outcome Assessment; D010850:Picornaviridae Infections / Q000150:complications* / Q000453:epidemiology; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012229:Rhinovirus; D012621:Seasons; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: Influenza; Pneumonia; Rhinovirus