人偏肺病毒相关性社区获得性肺炎住院患者的临床特征。
Clinical Features of Human Metapneumovirus-Associated Community-acquired Pneumonia Hospitalizations.
机构信息
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
Clin Infect Dis. 2021 Jan 23;72(1):108-117. doi: 10.1093/cid/ciaa088.
BACKGROUND
Human metapneumovirus (HMPV) is a leading cause of respiratory tract infections. Few studies have compared the clinical characteristics and severity of HMPV-associated pneumonia with other pathogens.
METHODS
Active, population-based surveillance was previously conducted for radiographically confirmed, community-acquired pneumonia hospitalizations among children and adults in 8 United States hospitals. Clinical data and specimens for pathogen detection were systematically collected. We described clinical features of all HMPV-associated pneumonia and, after excluding codetections with other pathogen types, we compared features of HMPV-associated pneumonia with other viral, atypical, and bacterial pneumonia and modeled the severity (mild, moderate, and severe) and length of stay using multivariable proportional odds regression.
RESULTS
HMPV was detected in 298/2358 (12.6%) children and 88/2320 (3.8%) adults hospitalized with pneumonia and was commonly codetected with other pathogens (125/298 [42%] children and 21/88 [24%] adults). Fever and cough were the most common presenting symptoms of HMPV-associated pneumonia and were also common symptoms of other pathogens. After excluding codetections in children (n = 1778), compared to HMPV (reference), bacterial pneumonia exhibited increased severity (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.43-9.40), respiratory syncytial virus (RSV; OR, 0.76; 95% CI, .59-.99) and atypical (OR, 0.39; 95% CI, .19-.81) infections exhibited decreased severity, and other viral pneumonia exhibited similar severity (OR, 0.88; 95% CI, .55-1.39). In adults (n = 2145), bacterial (OR, 3.74; 95% CI, 1.87-7.47) and RSV pneumonia (OR, 1.82; 95% CI, 1.32-2.50) were more severe than HMPV (reference), but all other pathogens had similar severity.
CONCLUSIONS
Clinical features did not reliably distinguish HMPV-associated pneumonia from other pathogens. HMPV-associated pneumonia was less severe than bacterial and adult RSV pneumonia, but was otherwise as or more severe than other common pathogens.
背景
人偏肺病毒（HMPV）是呼吸道感染的主要病原体。很少有研究比较 HMPV 相关肺炎与其他病原体引起的肺炎的临床特征和严重程度。
方法
先前在美国 8 家医院对放射学确诊的社区获得性肺炎住院患者进行了主动、基于人群的监测。系统收集了临床数据和病原体检测标本。我们描述了所有 HMPV 相关肺炎的临床特征，并在排除与其他病原体类型的合并检测后，比较了 HMPV 相关肺炎与其他病毒、非典型和细菌肺炎的特征，并使用多变量比例优势回归模型对严重程度（轻度、中度和重度）和住院时间进行建模。
结果
在因肺炎住院的 2358 例儿童（298 例）和 2320 例成人（88 例）中检测到 HMPV，且 HMPV 常与其他病原体合并检测（儿童 125/298 [42%]，成人 21/88 [24%]）。发热和咳嗽是 HMPV 相关肺炎最常见的首发症状，也是其他病原体的常见症状。在排除儿童（n=1778）的合并检测后，与 HMPV（参考）相比，细菌性肺炎的严重程度增加（优势比[OR]，3.66；95%置信区间[CI]，1.43-9.40），呼吸道合胞病毒（RSV；OR，0.76；95%CI，0.59-0.99）和非典型（OR，0.39；95%CI，0.19-0.81）感染的严重程度降低，而其他病毒性肺炎的严重程度相似（OR，0.88；95%CI，0.55-1.39）。在成人（n=2145）中，细菌性（OR，3.74；95%CI，1.87-7.47）和 RSV 肺炎（OR，1.82；95%CI，1.32-2.50）比 HMPV（参考）更严重，但所有其他病原体的严重程度相似。
结论
临床特征不能可靠地区分 HMPV 相关肺炎与其他病原体。HMPV 相关肺炎的严重程度低于细菌性和成人 RSV 肺炎，但与其他常见病原体一样严重或更严重。
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