title: Viruses detected by systematic multiplex polymerase chain reaction in adults with suspected community-acquired pneumonia attending emergency departments in France.
abstract: Infectious agents associated with community-acquired pneumonia (CAP) are under-studied. This study attempted to identify viruses from the upper respiratory tract in adults visiting emergency departments for clinically suspected CAP. Adults with suspected CAP enrolled in the ESCAPED study (impact of computed tomography on CAP diagnosis) had prospective nasopharyngeal (NP) samples studied by multiplex PCR (targeting 15 viruses and four intracellular bacteria). An adjudication committee composed of infectious disease specialists, pneumologists and radiologists blinded to PCR results reviewed patient records, including computed tomography and day 28 follow up, to categorize final diagnostic probability of CAP as definite, probable, possible, or excluded. Among the 254 patients enrolled, 78 (31%) had positive PCR, which detected viruses in 72/254 (28%) and intracellular bacteria in 8 (3%) patients. PCR was positive in 44/125 (35%) patients with definite CAP and 21/83 (25%) patients with excluded CAP. The most frequent organisms were influenza A/B virus in 27 (11%), rhinovirus in 20 (8%), coronavirus in seven (3%), respiratory syncytial virus in seven (3%) and Mycoplasma pneumoniae in eight (3%) of 254 patients. Proportion of rhinovirus was higher in patients with excluded CAP compared with other diagnostic categories (p = 0.01). No such difference was observed for influenza virus. Viruses seem common in adults attending emergency departments with suspected CAP. A concomitant clinical, radiological and biological analysis of the patient's chart can contribute to either confirm their role, or suggest upper respiratory tract infection or shedding. Their imputability and impact in early management of CAP deserve further studies.
  
  
  BACKGROUND
  NCT01574066.
authors.affiliation: IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; UMR 1137, Inserm, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Das
authors.affiliation: Service des Maladies Respiratoires, Hôpital d'Instruction des Armées Percy, Clamart, France.
authors.forename: H
authors.initials: H
authors.lastname: Le Floch
authors.affiliation: Service de Virologie, Hôpital Bichat - Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Houhou
authors.affiliation: Service de Maladies Infectieuses et Tropicales, CHU Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Epelboin
authors.affiliation: Université Pierre et Marie Curie, Paris, France; Centre Pitié, Urgences, CHU Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Hausfater
authors.affiliation: Service de Radiologie, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Centre Tenon, Urgences, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Ray
authors.affiliation: IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; UMR 1137, Inserm, Paris, France; CIC 1425, Inserm, Hôpital Bichat - Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Duval
authors.affiliation: Département de Médecine d'Urgence, Centre Hospitalier Princesse Grace, Monaco.
authors.forename: Y-E
authors.initials: YE
authors.lastname: Claessens
authors.affiliation: IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; UMR 1137, Inserm, Paris, France; Unité de Coordination du Risque Épidémique et Biologique, Assistance Publique - Hôpitaux de Paris, Paris, France. Electronic address: catherine.leport@univ-paris-diderot.fr.
authors.forename: C
authors.initials: C
authors.lastname: Leport
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D009305:Nasopharynx / Q000821:virology; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D011446:Prospective Studies; D014780:Viruses / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
keywords: Adjudication committee; community-acquired pneumonia; emergency departments; multiplex PCR; nasopharyngeal swabs; viruses