Letters Community acquired pneumonia

What about viral community acquired pneumonias?

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a598 (Published 01 July 2008) Cite this as: BMJ 2008;337:a598
  1. G Y Shin, locum consultant virologist
  1. 1Infection and Immunity, 5/F North Wing, St Thomas’ Hospital, London SE1 7EH
  1. gyshin{at}doctors.org.uk

    Although Durrington and Summers mention that viruses are a cause of community acquired pneumonia (CAP), they seem to have disregarded respiratory viruses in their review.1 I was intrigued by the absence of “respiratory viruses” as a cause of CAP in intensive care.

    A quick PubMed review of the literature (limited to articles in English and papers on adult patients in the past three years) confirms that viruses are an important cause of CAP. The frequency of viral aetiologies in a sample of studies of CAP published in this period was 15%, 29%, 32%, 23%, and 56%.2 3 4 5

    Durrington and Summers are not alone in neglecting respiratory viruses during a discussion of CAP. In the most recent update to the British Thoracic Society guidelines on CAP, the word “virus” appears only once in the entire 19 page document.

    The term community acquired pneumonia does not refer to bacterial infections only. Perhaps this is historical. However, as diagnostic techniques improve, in particular with the increasing availability of nucleic acid amplification tests, it is time to challenge this convention.

    If clinicians do not even think of a viral aetiology in patients with CAP, they are unlikely to consider investigations to diagnose respiratory viruses. The costs of not recognising the possibility of viral aetiologies in CAP are clear: inappropriate use of antibiotics for a viral infection, missing the opportunity to consider antiviral treatment in cases of influenza infection, and a failure to institute appropriate infection control measures when CAP is viral in origin.


    Cite this as: BMJ 2008;337:a598


    • Competing interests: None declared.


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