AUTHOR=Chen Liang , Han Xiudi , Li YanLi , Zhang Chunxiao , Xing Xiqian 

TITLE=The Clinical Characteristics and Outcomes of Adult Patients With Pneumonia Related to Three Paramyxoviruses

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.574128

DOI=10.3389/fmed.2020.574128

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and human parainfluenza virus (hPIV) are paramyxoviruses (PMVs) that are important etiologies of community-acquired pneumonia. However, current knowledge about the clinical features and outcomes of PMV-related pneumonia (PMV-p) is limited. We aimed to investigate the clinical characteristics and disease severity in immunocompetent adults hospitalized with hMPV-related pneumonia (hMPV-p), hPIV-related pneumonia (hPIV-p), or RSV-related pneumonia (RSV-p).</p><p><bold>Methods:</bold> We retrospectively recruited 488 patients with PMV-p (153 with RSV-p, 137 with hMPV-p, and 198 with hPIV-p) from five teaching hospitals in China during 2011–2019. Univariate and multivariate analyses were performed to identify predictors to distinguish hMPV-p/hPIV-p from RSV-p and evaluate the effects of virus types on the clinical outcomes.</p><p><bold>Results:</bold> Compared with RSV-p, sputum production [<italic>odds ratio</italic> (<italic>OR</italic>) 5.029, <italic>95% confidence interval</italic> (<italic>CI</italic>) 2.452–10.312, <italic>P</italic> &lt; 0.001] was positively associated with hMPV-p, while solid malignant tumor (<italic>OR</italic> 0.346, <italic>95% CI</italic> 0.126–0.945, <italic>P</italic> = 0.038), nasal congestion (<italic>OR</italic> 0.102, <italic>95% CI</italic> 0.041–0.251, <italic>P</italic> &lt; 0.001), and respiratory rate ≥ 30 breaths/min (<italic>OR</italic> 0.296, <italic>95% CI</italic> 0.136–0.640, <italic>P</italic> = 0.002) were negatively related to hMPV-p. Sputum production (<italic>OR</italic> 13.418, <italic>95% CI</italic> 6.769–26.598, <italic>P</italic> &lt; 0.001) was positively associated with hPIV-p, while nasal congestion (<italic>OR</italic> 0.194, <italic>95% CI</italic> 0.098–0.387, <italic>P</italic> &lt; 0.001), dyspnea (<italic>OR</italic> 0.469, <italic>95% CI</italic> 0.272–0.809, <italic>P</italic> &lt; 0.001), and respiratory rate ≥30 breaths/min (<italic>OR</italic> 0.090, <italic>95% CI</italic> 0.032–0.257, <italic>P</italic> &lt; 0.001) on admission were negatively related to hPIV-p. After adjustment for confounders, multivariate logistic regression analysis suggested that hMPV-p (<italic>OR</italic> 0.355, <italic>95% CI</italic> 0.135–0.932, <italic>P</italic> = 0.035) and hPIV-p (<italic>OR</italic> 0.311, <italic>95% CI</italic> 0.121–0.784, <italic>P</italic> = 0.013) were associated with decreased 30-day mortality compared with RSV-p. RSV infection (<italic>OR</italic> 4.183, <italic>95% CI</italic> 1.709–10.236, <italic>P</italic> = 0.002) was identified as an independent predictor of 30-day mortality in patients with PMV-p.</p><p><bold>Conclusion:</bold> RSV-p caused more severe disease than hMPV-p and hPIV-p. Although some clinical features are helpful for distinguishing the diseases, etiologic diagnosis is critical in the management of the PMV-p.</p>