Viral pneumonia

Viral pneumonia is a pneumonia caused by a virus. Viruses are one of the two major causes of pneumonia, the other being bacteria; less common causes are fungi and parasites. Viruses are the most common cause of pneumonia in children, while in adults bacteria are a more common cause.[1]

Viral pneumonia
SpecialtyInfectious disease, respirology

Signs and symptoms

Symptoms of viral pneumonia include fever, non-productive cough, runny nose, and systemic symptoms (e.g. myalgia, headache). Different viruses cause different symptoms.

Cause

Common causes of viral pneumonia are:

Rarer viruses that commonly result in pneumonia include:

Viruses that primarily cause other diseases, but sometimes cause pneumonia include:

The most commonly identified agents in children are respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses.[4]

History

In the pre-antibiotic age, pneumonias had been treated with specific anti-serums of highly variable therapeutic effect and undesirable side-effects (a practice eliminated by the advent of sulfamides in 1936 and the beginning availability of penicillin in the 1940s).

Viral pneumonia was first described by Hobart Reimann in 1938, in an article published by JAMA, An Acute Infection of the Respiratory Tract with Atypical Pneumonia: a disease entity probably caused by a filtrable virus. Reimann, Chairman of the Department of Medicine at Jefferson Medical College, had established the practice of routinely typing the pneumoccocal organism in cases where pneumonia presented. Out of this work, the distinction between viral and bacterial strains was noticed.[7]

Pathophysiology

Viruses must invade cells in order to reproduce. Typically, a virus will reach the lungs by traveling in droplets through the mouth and nose with inhalation. There, the virus invades the cells lining the airways and the alveoli. This invasion often leads to cell death either through direct killing by the virus or by self-destruction through apoptosis.

Further damage to the lungs occurs when the immune system responds to the infection. White blood cells, in particular lymphocytes, are responsible for activating a variety of chemicals (cytokines) which cause leaking of fluid into the alveoli. The combination of cellular destruction and fluid-filled alveoli interrupts the transportation of oxygen into the bloodstream.

In addition to the effects on the lungs, many viruses affect other organs and can lead to illness affecting many different bodily functions. Some viruses also make the body more susceptible to bacterial infection; for this reason, bacterial pneumonia often complicates viral pneumonia.

Prevention

The best prevention against viral pneumonia is vaccination against influenza, adenovirus, chickenpox, herpes zoster, measles, and rubella.

Treatment

In cases of viral pneumonia where influenza A or B are thought to be causative agents, patients who are seen within 48 hours of symptom onset may benefit from treatment with oseltamivir or zanamivir. Respiratory syncytial virus (RSV) has no direct acting treatments, but ribavirin in indicated for severe cases. Herpes simplex virus and varicella-zoster virus infections are usually treated with aciclovir, whilst ganciclovir is used to treat cytomegalovirus. There is no known efficacious treatment for pneumonia caused by SARS coronavirus, MERS coronavirus, adenovirus, hantavirus, or parainfluenza. Care is largely supportive.

Epidemiology

Viral pneumonia occurs in about 200 million people a year which includes about 100 million children and 100 million adults.[4]

References
  1. National Heart, Lung, and Blood Institute, U.S.A. What Causes Pneumonia?
  2. Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology: With STUDENT CONSULT Online Access. Philadelphia: Saunders. ISBN 978-1-4160-2973-1. 8th edition.
  3. Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (15 February 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. PMC 7159299. PMID 31986264.
  4. Ruuskanen, O; Lahti, E; Jennings, LC; Murdoch, DR (2011-04-09). "Viral pneumonia". Lancet. 377 (9773): 1264–75. doi:10.1016/S0140-6736(10)61459-6. PMC 7138033. PMID 21435708.
  5. "SARS Basics Fact Sheet". US Centers for Disease Control and Prevention (CDC). 6 December 2017.
  6. Colby, Thomas V.; Zaki, Sherif R.; Feddersen, Richard M.; Nolte, Kurt B. (October 2000). "Hantavirus Pulmonary Syndrome Is Distinguishable From Acute Interstitial Pneumonia". Archives of Pathology & Laboratory Medicine. 124 (10): 1463–1466. doi:10.1043/0003-9985(2000)124<1463:HPSIDF>2.0.CO;2 (inactive 2020-05-27). PMID 11035576.CS1 maint: date and year (link)
  7. John H, Hodges MD (1989). Wagner, MD, Frederick B (ed.). "Thomas Jefferson University: Tradition and Heritage". Jefferson Digital Commons. Part III, Chapter 9: Department of Medicine. p. 253.
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