市中肺炎で入院した小児および成人におけるパラインフルエンザウイルス1～3型感染

Parainfluenza Virus Types 1-3 Infections Among Children and Adults Hospitalized with Community-Acquired Pneumonia.

• Leigh M Howard
• Kathryn M Edwards
• Yuwei Zhu
• Derek J Williams
• Wesley H Self
• Seema Jain
• Krow Ampofo
• Andrew T Pavia
• Sandra R Arnold
• Jonathan A McCullers
• Evan J Anderson
• Richard G Wunderink
• Carlos G Grijalva

抄録

背景:

パラインフルエンザウイルス（PIV）は下気道感染症の主要な原因である。PIV にはいくつかの明確な血清型がありますが、個々の PIV の血清型間の臨床的特徴と感染の重症度、および市中肺炎患者における PIV と他の病原体との間の比較はほとんど行われていません。

BACKGROUND: Parainfluenza virus (PIV) is a leading cause of lower respiratory tract infections. Although there are several distinct PIV serotypes, few studies have compared the clinical characteristics and severity of infection among the individual PIV serotypes and between PIV and other pathogens in patients with community-acquired pneumonia.

方法:

我々は，米国の 8 つの病院において，小児および成人の市中肺炎入院患者を対象に，臨床データおよび病原体検出のための呼吸器検体，血液検体，血清検体を系統的に収集し，放射線写真で確認された市中肺炎入院患者を対象とした積極的な集団ベースのサーベイランスを実施した．我々は，個々の血清型1，2，3，および他のウイルス性肺炎，非定型肺炎，細菌性肺炎を含むすべてのPIV感染症におけるPIV関連肺炎の臨床的特徴を比較した．また、多変量比例オッズ回帰を用いて、順序尺度（軽度、中等度、重度）を用いたグループ間で院内疾患の重症度を比較した。

METHODS: We conducted active population-based surveillance for radiographically confirmed community-acquired pneumonia hospitalizations among children and adults in eight United States hospitals with systematic collection of clinical data and respiratory, blood, and serological specimens for pathogen detection. We compared clinical features of PIV-associated pneumonia among individual serotypes 1, 2, and 3 and among all PIV infections with other viral, atypical, and bacterial pneumonias. We also compared in-hospital disease severity among groups employing an ordinal scale (mild, moderate, severe) using multivariable proportional odds regression.

結果:

PIVは成人（66/2297［2.9％］）よりも小児（155/2354［6.6％］）でより多く検出された（p＜0.001）。他の病原体はPIV症例の中で共通して共検出された（110/221[50%]）。PIV-1、PIV-2、およびPIV-3感染症の臨床的特徴は、小児と成人の肺炎患者の両方で互いに類似していた。多変量解析では，PIV関連肺炎の小児は他の非細菌性肺炎の小児と同様の重症度を示したが，細菌性肺炎の小児は重症度が上昇した（OR 8.42 [95% CI 1.88, 37.80]）．成人では、PIV関連肺炎は他の肺炎病原体と同様の重症度を示した。

RESULTS: PIV was more commonly detected in children (155/2354 [6.6%]) than in adults (66/2297 [2.9%]) (p<0.001). Other pathogens were commonly co-detected among PIV cases (110/221 [50%]). Clinical features of PIV-1, PIV-2, and PIV-3 infections were similar to one another in both children and adults with pneumonia. In multivariable analysis, children with PIV-associated pneumonia exhibited similar severity to children with other non-bacterial pneumonia; whereas children with bacterial pneumonia, exhibited increased severity (OR 8.42 [95% CI 1.88, 37.80]). In adults, PIV-associated pneumonia exhibited similar severity to other pneumonia pathogens.

結論:

市中後天性肺炎で入院した患者では，臨床的特徴は個々のPIV血清型による感染を区別しなかった．しかし，小児では，PIV 肺炎は細菌性肺炎よりも重症度が低かった．

CONCLUSIONS: Clinical features did not distinguish among infection with individual PIV serotypes in patients hospitalized with community acquired pneumonia. However, in children, PIV pneumonia was less severe than bacterial pneumonia.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.