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Lower respiratory tract infection in the community: associations between viral aetiology and illness course

Lower respiratory tract infection in the community: associations between viral aetiology and illness course
Lower respiratory tract infection in the community: associations between viral aetiology and illness course

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.

Disease burden, lower respiratory tract infection, primary healthcare, public health, respiratory tract infection, respiratory virus, symptom duration, symptom severity
1198-743X
96-104
Vos, L. M.
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Bruyndonckx, R.
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Zuithoff, N. P.A.
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Little, P.
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Oosterheert, J. J.
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Broekhuizen, B. D.L.
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Lammens, C.
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Loens, K.
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Viveen, M.
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Butler, C. C.
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Crook, D.
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Zlateva, K.
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Goossens, H.
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Claas, E. C.J.
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Ieven, M.
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Van Loon, A. M.
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Verheij, T. J.M.
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Coenjaerts, F. E.J.
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GRACE Consortium
Vos, L. M.
5d861f05-adf8-462c-86a3-961d1cea873c
Bruyndonckx, R.
f4de37c8-5255-4d22-936b-62a7c900c81a
Zuithoff, N. P.A.
1b152e26-e7c7-4b88-b231-26c410726393
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Oosterheert, J. J.
00e62a0e-0862-4b98-b9d4-90bbd9fce29c
Broekhuizen, B. D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Lammens, C.
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Loens, K.
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Viveen, M.
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Butler, C. C.
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Crook, D.
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Zlateva, K.
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Goossens, H.
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Claas, E. C.J.
ac1a6cfa-813e-4304-9bf8-082a4d85eec5
Ieven, M.
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Van Loon, A. M.
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Verheij, T. J.M.
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Coenjaerts, F. E.J.
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GRACE Consortium (2021) Lower respiratory tract infection in the community: associations between viral aetiology and illness course. Clinical Microbiology and Infection, 27 (1), 96-104. (doi:10.1016/j.cmi.2020.03.023).

Record type: Article

Abstract

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.

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Manuscript LM Vos et al - revised 13-3-2020 - Accepted Manuscript
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More information

Accepted/In Press date: 21 March 2020
Published date: January 2021
Additional Information: Copyright © 2020. Published by Elsevier Ltd.
Keywords: Disease burden, lower respiratory tract infection, primary healthcare, public health, respiratory tract infection, respiratory virus, symptom duration, symptom severity

Identifiers

Local EPrints ID: 441181
URI: http://eprints.soton.ac.uk/id/eprint/441181
ISSN: 1198-743X
PURE UUID: 809b6165-9513-4f72-8915-1b17387f172e
ORCID for P. Little: ORCID iD orcid.org/0000-0003-3664-1873

Catalogue record

Date deposited: 04 Jun 2020 16:30
Last modified: 12 Jul 2024 04:07

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Contributors

Author: L. M. Vos
Author: R. Bruyndonckx
Author: N. P.A. Zuithoff
Author: P. Little ORCID iD
Author: J. J. Oosterheert
Author: B. D.L. Broekhuizen
Author: C. Lammens
Author: K. Loens
Author: M. Viveen
Author: C. C. Butler
Author: D. Crook
Author: K. Zlateva
Author: H. Goossens
Author: E. C.J. Claas
Author: M. Ieven
Author: A. M. Van Loon
Author: T. J.M. Verheij
Author: F. E.J. Coenjaerts
Corporate Author: GRACE Consortium

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