TY - JOUR
T1 - Lower respiratory tract infection in the community
T2 - associations between viral aetiology and illness course
AU - Vos, L. M.
AU - Bruyndonckx, R.
AU - Zuithoff, N. P.A.
AU - Little, P.
AU - Oosterheert, J. J.
AU - Broekhuizen, B. D.L.
AU - Lammens, C.
AU - Loens, K.
AU - Viveen, M.
AU - Butler, C. C.
AU - Crook, D.
AU - Zlateva, K.
AU - Goossens, H.
AU - Claas, E. C.J.
AU - Ieven, M.
AU - Van Loon, A. M.
AU - Verheij, T. J.M.
AU - Coenjaerts, F. E.J.
N1 - Funding Information:
The authors declare that they have no conflicts of interest. The study was part of the European Commission Framework Programme 6 (FP6) funded Network of Excellence GRACE, grant number 518226 . Orion Diagnostics provided the QuikRead instruments and kits for this study. The study sponsors played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Funding Information:
The authors declare that they have no conflicts of interest. The study was part of the European Commission Framework Programme 6 (FP6) funded Network of Excellence GRACE, grant number 518226. Orion Diagnostics provided the QuikRead instruments and kits for this study. The study sponsors played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Publisher Copyright:
© 2020
PY - 2021/1
Y1 - 2021/1
N2 - Objectives: This study determined associations between respiratory viruses and subsequent illness course in primary care adult patients presenting with acute cough and/or suspected lower respiratory tract infection. Methods: A prospective European primary care study recruited adults with symptoms of lower respiratory tract infection between November 2007 and April 2010. Real-time in-house polymerase chain reaction (PCR) was performed to test for six common respiratory viruses. In this secondary analysis, symptom severity (scored 1 = no problem, 2 = mild, 3 = moderate, 4 = severe) and symptom duration were compared between groups with different viral aetiologies using regression and Cox proportional hazard models, respectively. Additionally, associations between baseline viral load (cycle threshold (Ct) value) and illness course were assessed. Results: The PCR tested positive for a common respiratory virus in 1354 of the 2957 (45.8%) included patients. The overall mean symptom score at presentation was 2.09 (95% confidence interval (CI) 2.07–2.11) and the median duration until resolution of moderately bad or severe symptoms was 8.70 days (interquartile range 4.50–11.00). Patients with influenza virus, human metapneumovirus (hMPV), respiratory syncytial virus (RSV), coronavirus (CoV) or rhinovirus had a significantly higher symptom score than patients with no virus isolated (0.07–0.25 points or 2.3–8.3% higher symptom score). Time to symptom resolution was longer in RSV infections (adjusted hazard ratio (AHR) 0.80, 95% CI 0.65–0.96) and hMPV infections (AHR 0.77, 95% CI 0.62–0.94) than in infections with no virus isolated. Overall, baseline viral load was associated with symptom severity (difference 0.11, 95% CI 0.06–0.16 per 10 cycles decrease in Ct value), but not with symptom duration. Conclusions: In healthy, working adults from the general community presenting at the general practitioner with acute cough and/or suspected lower respiratory tract infection other than influenza impose an illness burden comparable to influenza. Hence, the public health focus for viral respiratory tract infections should be broadened.
AB - Objectives: This study determined associations between respiratory viruses and subsequent illness course in primary care adult patients presenting with acute cough and/or suspected lower respiratory tract infection. Methods: A prospective European primary care study recruited adults with symptoms of lower respiratory tract infection between November 2007 and April 2010. Real-time in-house polymerase chain reaction (PCR) was performed to test for six common respiratory viruses. In this secondary analysis, symptom severity (scored 1 = no problem, 2 = mild, 3 = moderate, 4 = severe) and symptom duration were compared between groups with different viral aetiologies using regression and Cox proportional hazard models, respectively. Additionally, associations between baseline viral load (cycle threshold (Ct) value) and illness course were assessed. Results: The PCR tested positive for a common respiratory virus in 1354 of the 2957 (45.8%) included patients. The overall mean symptom score at presentation was 2.09 (95% confidence interval (CI) 2.07–2.11) and the median duration until resolution of moderately bad or severe symptoms was 8.70 days (interquartile range 4.50–11.00). Patients with influenza virus, human metapneumovirus (hMPV), respiratory syncytial virus (RSV), coronavirus (CoV) or rhinovirus had a significantly higher symptom score than patients with no virus isolated (0.07–0.25 points or 2.3–8.3% higher symptom score). Time to symptom resolution was longer in RSV infections (adjusted hazard ratio (AHR) 0.80, 95% CI 0.65–0.96) and hMPV infections (AHR 0.77, 95% CI 0.62–0.94) than in infections with no virus isolated. Overall, baseline viral load was associated with symptom severity (difference 0.11, 95% CI 0.06–0.16 per 10 cycles decrease in Ct value), but not with symptom duration. Conclusions: In healthy, working adults from the general community presenting at the general practitioner with acute cough and/or suspected lower respiratory tract infection other than influenza impose an illness burden comparable to influenza. Hence, the public health focus for viral respiratory tract infections should be broadened.
KW - Disease burden
KW - lower respiratory tract infection
KW - primary healthcare
KW - public health
KW - respiratory tract infection
KW - respiratory virus
KW - symptom duration
KW - symptom severity
UR - http://www.scopus.com/inward/record.url?scp=85084140867&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2020.03.023
DO - 10.1016/j.cmi.2020.03.023
M3 - Article
C2 - 32244051
AN - SCOPUS:85084140867
SN - 1198-743X
VL - 27
SP - 96
EP - 104
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 1
ER -