title: Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein.
abstract: BACKGROUND
  Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era.
  
  
  METHODS
  Otherwise healthy 152 patients, presenting to outpatient clinics with ILI/ARI, were included. Patients had history & physical, CRP, hemogram and nasopharyngeal swabs for rhinovirus A/B, influenza A/B, adenovirus A/B/C/D/E, coronavirus 229E/NL63 and OC43, parainfluenza virus 1/2/3, respiratory syncytial virusA/B, metapneumovirus and Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Bordetella pertussis by PCR and for ABHS culture.
  
  
  RESULTS
  Median (IR) age was 26.5 (16.5). Time to presentation was shorter in men (p = 0.027). Patients with rhinovirus had lower rates (20%) of myalgia (p = 0.043). Patients with influenza virus had higher rates (97%) of elevated CRP (p = 0.016). Logistic regression revealed that patients with ILI/ARI and CRP ≥ 5 mg/L were 60 times more likely to have influenza virus infection than other viral agents (OR = 60.0, 95% CI = 2.65 to 1,358.2, p = 0.010). Rhinovirus predominated in December (54%), March (36%), and April (33%). Influenza virus predominated in January (51%). Fever was most common with adenovirus (p = 0.198). All GABHS cultures were negative. Atypical organisms and Bordetella pertussis were negative in all but one patient.
  
  
  CONCLUSIONS
  Influenza virus is the most likely pathogen in ILI/ARI when CRP ≥ 5 mg/L. This might be explained by tissue destruction. Myalgia is rare with rhinovirus probably due to absence of viremia. Negative bacteria by PCR and culture suggest unnecessary antibiotic use in ILI/ARI.
authors.affiliation: Sakarya University School of Medicine, Korucuk, Sakarya, Turkey. hakancinemre@sakarya.edu.tr.
authors.forename: Hakan
authors.initials: H
authors.lastname: Cinemre
authors.forename: Cengiz
authors.initials: C
authors.lastname: Karacer
authors.forename: Murat
authors.initials: M
authors.lastname: Yücel
authors.forename: Aziz
authors.initials: A
authors.lastname: Öğütlü
authors.forename: Fatma Behice
authors.initials: FB
authors.lastname: Cinemre
authors.forename: Ali
authors.initials: A
authors.lastname: Tamer
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
mesh_terms: D000293:Adolescent; D000328:Adult; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D002097:C-Reactive Protein / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000209:etiology*; D014777:Virus Diseases / Q000175:diagnosis*; D014780:Viruses / Q000145:classification / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein