title: Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia.
abstract: BACKGROUND
  The clinical significance of viruses detected in patients with community-acquired pneumonia (CAP) is often unclear.
  
  
  METHODS
  We conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. We compared age-stratified prevalence of each virus between patients with CAP and controls and used multivariable logistic regression to calculate attributable fractions (AFs).
  
  
  RESULTS
  We enrolled 1024 patients with CAP and 759 controls. Detections of influenza, respiratory syncytial virus, and human metapneumovirus were substantially more common in patients with CAP of all ages than in controls (AFs near 1.0). Parainfluenza and coronaviruses were also more common among patients with CAP (AF, 0.5-0.75). Rhinovirus was associated with CAP among adults (AF, 0.93) but not children (AF, 0.02). Adenovirus was associated with CAP only among children <2 years old (AF, 0.77).
  
  
  CONCLUSIONS
  The probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus. Detections of influenza, respiratory syncytial virus, and human metapneumovirus among patients with CAP of all ages probably indicate an etiologic role, whereas detections of parainfluenza, coronaviruses, rhinovirus, and adenovirus, especially in children, require further scrutiny.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Pediatrics.
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.affiliation: Departments of Pediatrics and Internal Medicine.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.affiliation: Department of Pathology, Microbiology & Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: James D
authors.initials: JD
authors.lastname: Chappell
authors.affiliation: ARUP Institute for Clinical and Experimental Pathology.
authors.forename: Weston C
authors.initials: WC
authors.lastname: Hymas
authors.affiliation: Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City.
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bramley
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Eileen
authors.initials: E
authors.lastname: Schneider
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dean
authors.initials: D
authors.lastname: Erdman
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lyn
authors.initials: L
authors.lastname: Finelli
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.affiliation: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000821:virology*; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012136:Respiratory Syncytial Viruses; D012137:Respiratory System / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*
keywords: asymptomatic infection; attributable fraction; etiology; pneumonia; virus