Table 1: Lower Respiratory Tract Viral Infections in Children and Adults. Moreover, rapid diagnosis can lead to early control of potential transmission, thus decreasing overall treatment costs. 3, No. CT: Unifocal GGO (circle). (a) Initial chest radiograph shows multiple irregular nodular peribronchial air spaces or GGO (arrows) in both lungs and a small amount of bilateral pleural effusion. (b, c) Axial chest CT images obtained on the same day at the lower trachea level (b) and the interlobar area level (c) show multiple irregular areas of nodular tree-in-bud opacity and patchy consolidations (arrows) along the bronchovascular bundles and mild bronchial wall thickening. (a) Initial chest radiograph shows increased areas of ill-defined nodular opacity (arrows) in both lower lung zones, especially in the left retrocardiac area. MERS coronavirus is a new member of the β-coronaviruses and is different from SARS and other endemic human β-coronaviruses (eg, OC43, HKU1). 51, No. ... Cavitation is not seen in viral pneumonia, mycoplasma and rarely in streptococcus pneumoniae. 4, 5 June 2020 | RadioGraphics, Vol. HPIV is a single-stranded RNA virus and a member of the family Paramyxoviridae. Initial chest radiographs are normal but soon progress to show multifocal airspace consolidation, predominantly in the lower lung zone. Reverse transcriptase PCR can be used to amplify a much higher number of DNA copies present in bacteria, fungi, virus, or other proteins (10). PCR negative. In immunocompetent adults, RSV infection usually manifests with rhinorrhea, pharyngitis, cough, bronchitis, headache, fatigue, and fever. The incubation period for hantavirus pulmonary syndrome is typically 1–2 weeks but ranges from 1 to 4 weeks. 28, Contemporary Diagnostic Radiology, Vol. Epstein-Barr virus infects B lymphocytes and pharyngeal epithelial cells. Recurrent respiratory papillomatosis is often associated with human papilloma virus types 6 and 11. 6, 23 October 2020 | RadioGraphics, Vol. Computed tomographic (CT) findings of viral pneumonia are diverse and may be affected by the immune status of the host and the underlying pathophysiology of the viral pathogen. The cause of these deaths is not yet known but logically they could be due to severe pulmonary complications such as acute respiratory distress syndrome or secondary pneumonia. HPIV is the second most commonly identified virus (20.8%) in patients admitted to the intensive care unit, and bacterial coinfection is common (40). Measles is a single-stranded RNA enveloped virus belonging to the family Paramyxoviridae that causes a febrile illness with rash in children. 9, No. Pneumonia due to varicella-zoster virus (α Herpesvirinae) in a 53-year-old man who underwent liver transplantation 5 months before contracting the disease. Figure 4c. It is transmitted by sexual contact, by blood transfusion, from mother to child transplacentally, and via breast feeding. Update on emerging infections from the Centers for Disease Control and Prevention. 42, No. (b, c) Axial thin-section (1-mm collimation) CT images obtained on the same day, at the lower trachea level (b) and interlobar area level (c), show ill-defined GGO nodules, interlobular septal thickening (arrowheads), and diffuse GGO (arrows) in both lungs, with a scanty amount of bilateral pleural effusion (* in c). According to World Health Organization statistics, as of June 19, 2008, 385 human infections had been confirmed from 15 countries; of these infections, 243 were fatal. 206, No. Annually, more than 20 000 cases of hantavirus infection are reported globally, the majority of which occur in Asia, but increasing numbers are reported in the Americas and Europe (56,57). 9, American Journal of Obstetrics and Gynecology, Vol. Areas of pulmonary consolidation are most often patchy and poorly defined (consistent with bronchopneumonia) or focal and well-defined (consistent with lobar pneumonia). The test result for hantavirus antibodies was positive, and the titer was increased to 1:512. However, it can cause life-threatening pulmonary infection in immunocompromised patients owing to reactivation of the latent virus or infusion of CMV-seropositive marrow or blood products. The initial chest radiograph may be normal, but several days later, bilateral pulmonary infiltration indicating pulmonary edema develops (55). 4, Clinics in Chest Medicine, Vol. The peripheral pulmonary markings are diminutive as a result of vascular narrowing, and a clear shift of the mediastinum to the left is also seen (arrow). 11, Respiratory Medicine Case Reports, Vol. 27–29 February 2004, Analytic validation of a quantitative real-time PCR assay to measure CMV viral load in whole blood, Pneumonia in solid organ recipients: spectrum of pathogens in 217 episodes, Cytomegalovirus pneumonitis occurring after allogeneic bone marrow transplantation: a study of 106 recipients, Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients, Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS, Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients, Acute respiratory failure and cerebral hemorrhage due to primary Epstein-Barr virus infection, Primary Epstein-Barr virus infection with pneumonia transmitted by allogeneic bone marrow after transplantation, Spectrum of Epstein-Barr virus–associated diseases, Pulmonary manifestations of juvenile laryngotracheal papillomatosis, Laryngeal papillomatosis with pulmonary spread in a 69-year-old man, Virological diagnosis in community-acquired pneumonia in immunocompromised patients, Human parainfluenza virus 4 outbreak and the role of diagnostic tests, Community respiratory virus infections in patients with hematologic malignancies, Community respiratory viruses: organ transplant recipients, Cytomegalovirus infection after bone marrow transplantation in children, Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients, The diagnosis of pneumonia in renal transplant recipients using invasive and noninvasive procedures, Herpes simplex virus lower respiratory tract infection in patients with solid tumors, Community respiratory virus infections among hospitalized adult bone marrow transplant recipients, Epidemiology of seasonal influenza: use of surveillance data and statistical models to estimate the burden of disease, Community-acquired pneumonia: the clinical dilemma, Incidence and characteristics of viral community-acquired pneumonia in adults, Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults, Respiratory syncytial virus infection in adults, The role of viruses in the aetiology of community-acquired pneumonia in adults, Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults, Introduction: infections caused by emerging resistant pathogens. Presented as an education exhibit at the 2016 RSNA Annual Meeting. (a) Initial chest radiograph shows ill-defined diffuse reticular areas of increased opacity (arrows) in both lungs. For this journal-based CME activity, author disclosures are listed at the end of this article. Pathology and emerging infections—quo vadimus? Parenchymal attenuation disturbances.—Patchy inhomogeneities in the attenuation of lung parenchyma (mosaic attenuation pattern) are a recognized finding in some viral infections caused by hypoventilation of alveoli distal to bronchiolar obstruction (inflammation or cicatricial scarring of many bronchioles), which leads to secondary vasoconstriction (and, consequently, underperfused lung) and is seen on CT scans as areas of decreased attenuation (44–46). A “cold” is characterized by upper respiratory tract symptoms and includes tonsillopharyngitis, pharyngitis, epiglottitis, sinusitis, otitis media, and conjunctivitis. Adenovirus is a double-stranded DNA virus with more than 50 identified serotypes that account for 5%–10% of all respiratory tract infections in children (11). Factors that lead to negative laboratory results include poor specimen handling and collection, low viral copy numbers, and inhibitors in the clinical sample (10). (a) Initial chest radiograph shows ill-defined patchy consolidation and GGO (arrows) in the left middle to lower lungs and the right lower lung zone. Viral pneumonia. The CT findings of parainfluenza virus infection are variable, consisting of multiple small peribronchial nodules, ground-glass opacities, and airspace consolidation (94–96) (Fig 15). Respiratory tract infection caused by herpesviridae has been demonstrated after primary infection and reactivation. Branching or centrilobular nodules and mosaic perfusion are seen in patients with viral bronchiolitis (63,64). (e) Pneumonia due to rhinovirus shows multiple ill-defined patchy areas of GGO (arrows) with interlobular septal thickening (arrowheads) in both lungs. (a) Pneumonia due to varicella-zoster virus shows multifocal 1–10-mm well-defined or ill-defined nodular opacity (arrows) with a surrounding halo or patchy GGO (arrowheads) in both lungs. This review focuses on the radiographic and computed tomographic patterns of viral pneumonia caused by different pathogens, including new pathogens. Gasparetto et al (98) reviewed the thin-section CT findings in 20 patients with RSV pneumonitis after hematopoietic stem cell transplantation and found that the predominant patterns of abnormality were small centrilobular nodules (50%), airspace consolidation (35%), ground-glass opacities (30%), and bronchial wall thickening (30%) (Fig 16). Phases initiate with the extent of their participation in the stem cell transplantation population, the specific context coexisting. 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