Abstract
Especially the role of the newly recognised viruses is not well known in adult lower respiratory tract infections in the community (LRTI). We investigated the role of S. pneumoniae (S.pn), Haemophilus spp (H.spp) and viruses in LRTI in the GRACE primary care network (PCN) using culture and real-time nucleic acid amplification tests (RT-NAATs) From 10/2007-04/2010 3102 patients with LRTI were enrolled in a prospective study in 16 PCNs in 12 EU countries. Nasopharyngeal swabs (NPS) and sputa for culture of S.pn and H.spp were collected and frozen until transport to the central lab for nucleic acid (NA) extraction. Aliquots of NA extracts were sent to the LUMC and UMC-U for detection of influenzaviruses (INF) A/B, parainfluenzavirus (PIV)1-4, human rhinoviruses (HRV), human metapneumovirus (hMPV), respiratory syncytial virus (RSV), adenovirus (HAdV), Bocavirus (BOCA), coronaviruses (HCoV) OC43, NL-63, 229E, polyomaviruses KI and WU by in-house RT-PCR.
In 3082/3102 patients a NPS was collected. An aetiologic agent was detected in 77% of patients: S.pn and H.spp in 9.1% and 14.9% respectively; a respiratory virus in 53.1%: HRV 18.6%, INF 11.1%, HCoV 7.4%, hMPV 4.4%, RSV 4.4%, polyomaviruses 2.8%, PIV 2.5%, HAdV 1.4%, BOCA 0.5%. For most viruses no significant differences were observed in prevalence between the 3 winters. In <5% of patients persistence of respiratory virus was seen in the follow up visit.
This is the largest aetiologic study on LRTI in PCNs: in ±80% of the patients a microbial aetiology was found, over 50% were viral infections: HRV's account for the majority. Use of RT-NAATs results in a significant improvement of the aetiologic diagnosis LRTI.
- © 2011 ERS
