Aetiological role of viral and bacterial infections in acute adult lower respiratory tract infection (LRTI) in primary care

Creer, D. D.; Dilworth, J. P.; Gillespie, S. H.; Johnston, A. R.; Johnston, S. L.; Ling, C.; Patel, S.; Sanderson, G.; Wallace, P. G.; McHugh, T. D.
January 2006
Thorax;Jan2006, Vol. 61 Issue 1, p75
Academic Journal
Background: Lower respiratory tract infections (LRTI) are a common reason for consulting general practitioners (GPs). In most cases the aetiology is unknown, yet most result in an antibiotic prescription. The aetiology of LRTI was investigated in a prospective controlled study. Methods: Eighty adults presenting to GPs with acute LRTI were recruited together with 49 controls over 12 months. Throat swabs, nasal aspirates (patients and controls), and sputum (patients) were obtained and polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR) assays were used to detect Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, influenza viruses (AH1, AH3 and B), parainfluenza viruses 1-3, coronaviruses, respiratory syncytial virus, adenoviruses, rhinoviruses, and enteroviruses. Standard sputum bacteriology was also performed. Outcome was recorded at a follow up visit. Results: Potential pathogens were identified in 55 patients with LRTI (69%) and seven controls (14%; p<0.0001). The identification rate was 63% (viruses) and 26% (bacteria) for patients and 12% (p<0.0001) and 6% (p =0.013), respectively, for controls. The most common Organisms identified in the patients were rhinoviruses (33%), influenza viruses (24%), and Streptococcus pneumoniae (19%) compared with 2% (p<0.001), 6% (p=0.013), and 4% (p=0.034), respectively, in controls. Multiple pathogens were identified in 18 of the 80 LRTI patients (22.5%) and in two of the 49 controls (4%; p=0.011). Atypical organisms were rarely identified. Cases with bacterial aetiology were clinically indistinguishable from those with viral aetiology. Conclusion: Patients presenting to GPs with acute adult LRTI predominantly have a viral illness which is most commonly caused by rhinoviruses and influenza viruses.


Related Articles

  • Is Clinical Recognition of Respiratory Syncytial Virus Infection in Hospitalized Elderly and High-Risk Adults Possible? Walsh, Edward E.; Peterson, Derick R.; Falsey, Ann R. // Journal of Infectious Diseases;4/1/2007, Vol. 195 Issue 7, p1046 

    Background. The clinical and radiographic features of respiratory syncytial virus (RSV) infection in elderly hospitalized persons have not been described in detail, to our knowledge, despite its relative frequent occurrence. Methods. Clinical characteristics of 132 RSV infections were compared...

  • The Association of Respiratory Syncytial Virus Infection and Influenza with Emergency Admissions for Respiratory Disease in London: An Analysis of Routine Surveillance Data. Mangtani, Punam; Hajat, Shakoor; Kovats, Sari; Wilkinson, Paul; Armstrong, Ben // Clinical Infectious Diseases;3/1/2006, Vol. 42 Issue 5, p640 

    Background. The importance of respiratory syncytial virus (RSV) infection in adults is not well known, because laboratory testing for RSV infection is not routine. Both RSV infection and influenza are seasonally related, and it is difficult to disentangle one from the other and to disentangle...

  • Etiology and Incidence of Viral and Bacterial Acute Respiratory Illness among Older Children and Adults in Rural Western Kenya, 2007-2010. Feikin, Daniel R.; Njenga, M. Kariuki; Bigogo, Godfrey; Aura, Barrack; Aol, George; Audi, Allan; Jagero, Geoffrey; Muluare, Peter Ochieng; Gikunju, Stella; Nderitu, Leonard; Balish, Amanda; Winchell, Jonas; Schneider, Eileen; Erdman, Dean; Oberste, M. Steven; Katz, Mark A.; Breiman, Robert F.; Halsey, Eric S. // PLoS ONE;Aug2012, Vol. 7 Issue 8, Special section p1 

    Background: Few comprehensive data exist on disease incidence for specific etiologies of acute respiratory illness (ARI) in older children and adults in Africa. Methodology/Principal Findings: From March 1, 2007, to February 28, 2010, among a surveillance population of 21,420 persons .5 years...

  • An epidemiological study of respiratory syncytial virus associated hospitalizations in Denmark. Stensballe, Lone Graff // Respiratory Research;2002 Supplement 1, Vol. 3, pS34 

    Respiratory syncytial virus (RSV) is the most common viral pathogen that causes lower respiratory tract infections in infants. Studies have implicated severe RSV infections early in life as a risk factor for subsequent development of reactive airway disease. We are conducting a study to validate...

  • An epidemiological study of RSV infection in the Gambia. Weber, Martin W.; Milligan, Paul; Sanneh, Mariama; Awemoyi, Agnes; Dakour, Raduwan; Schneider, Gisela; Palmer, Ayo; Jallow, Mariatou; Oparaogu, Anslem; Whittle, Hilton; Mulholland, E. Kim; Greenwood, Brian M. // Bulletin of the World Health Organization;2002, Vol. 80 Issue 7, p562 

    Describes the epidemiology of respiratory syncytial virus (RSV) infection in Gambia. Characteristics of children with acute lower respiratory tract infection (ALRI); Incidence rate of ALRI in children below one year living close to hospitals.

  • Influenzavirus Infection Is a Primary Cause of Febrile Respiratory Illness in HIV-Infected Adults, Despite Vaccination. Klein, Marina B.; Ying Lu; DelBalso, Lina; Coté, Stéphanie; Boivin, Guy // Clinical Infectious Diseases;7/15/2007, Vol. 45 Issue 2, p234 

    Background. There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory...

  • Streptococcus pneumoniae Enhances Human Respiratory Syncytial Virus Infection In Vitro and In Vivo. Nguyen, D. Tien; Louwen, Rogier; Elberse, Karin; van Amerongen, Geert; Yüksel, Selma; Luijendijk, Ad; Osterhaus, Albert D. M. E.; Duprex, W. Paul; de Swart, Rik L. // PLoS ONE;May2015, Vol. 10 Issue 5, p1 

    Human respiratory syncytial virus (HRSV) and Streptococcus pneumoniae are important causative agents of respiratory tract infections. Both pathogens are associated with seasonal disease outbreaks in the pediatric population, and can often be detected simultaneously in infants hospitalized with...

  • The Need for Validation of Statistical Methods for Estimating Respiratory Virus–Attributable Hospitalization. Gilca, Rodica; De Serres, Gaston; Skowronski, Danuta; Boivin, Guy; Buckeridge, David L. // American Journal of Epidemiology;Oct2009, Vol. 170 Issue 7, p925 

    Public policy regarding influenza has been based largely on the burden of hospitalization estimated through ecologic studies applying increasingly sophisticated statistical methods to administrative databases. None are known to have been validated by observational studies. The authors...

  • RSV bigger cause of bronchitis than flu.  // Pulse;5/7/2005, Vol. 65 Issue 18, p16 

    This article cites a study of children in Great Britain, which states that respiratory syncytial virus (RSV) is a more important cause of respiratory infections than infiuenza in children under the age of four. Researchers found RSV was twice as likely as flu to cause acute bronchitis and was...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics