Pneumopathies communautaires d'origine virale en réanimation chez l'adulte immunocompétent

Abstract

There is little data available in the literature on the incidence, etiology and the consequences of community-acquired severe viral pneumonia in the non-immunodeficient adult. In most studies, the viral etiology has not been investigated. The results of studies carried out over the last ten years show a frequency of between 1 and 13.6%. Diagnosis is frequently based on serological testing, but full testing is only carried out in under 50% of cases. In France, respiratory viruses are mainly influenza virus (40–50%), followed by respiratory syncytial virus (RSV: 14%), parainfluenza virus (20–30%), and adenovirus (12–14%). Viruses responsible for pulmonary infection introduced via the hematogenic pathway (varicella-zoster, Epstein-Barr, measles, enterovirus, etc.) are less common, but easier to diagnose. Epidemiological studies should include a thorough investigation of the viral etiology, with for the majority of viruses, viral antigen detection by IF or Elisa, or viral isolation and culture. Serological testing is useful for certain viruses (measles, Epstein-Barr, Hantavirus). Molecular biological techniques are in the process of being assessed. Routinely, the lack of efficient therapeutic agents to treat cases of severe viral pneumonia limits the interest of an etiological approach. RSV infection can be easily and inexpensively diagnosed by viral antigen detection, or viral isolation and culture, but the diagnosis for influenza must be made early after the onset of symptoms, otherwise serological diagnosis may be made a posterior. The aim of such research is to introduce suitable anti-influenza prophylaxis for at-risk subjects, and hygienic measures to limit RSV cross-transmission.