Background: Upper respiratory infections (URIs) are associated with substantial morbidity, mortality, and healthcare costs. Polymerase chain reaction (PCR) testing of nasopharyngeal specimens enables diagnosis of the viral etiology of URIs with near 100% sensitivity and specificity. Few studies have analyzed the distinguishing clinical signs and symptoms of these infections. Our objective was to characterize the clinical signs and symptoms of the most commonly diagnosed respiratory viral infections in patients that presented to the emergency room (ER) or were admitted to a tertiary care hospital between 2012-15.
Methods: Patients presenting to the ER or admitted with signs and symptoms of URIs ,who had undergone a nasopharyngeal swab for respiratory viral panel (RVP) by PCR were asked to complete a brief questionnaire within 24 hours of RVP testing. Patients were excluded if <18 years old, pregnant, or had altered mental status.
Data was collected by reviewing hospital records and questionnaires. Data analysis utilized chi-square testing and multivariate logistic regression with SPSS software. Statistical significance was set at p<.05 with 95% Confidence Interval (CI).
Results: Of 508 patients, 221 (43.5%) tested positive for any viral pathogen (Figure 1). Baseline characteristics were mostly similar between patients in the positive and negative RVP groups. Multivariate analyses indicated that a positive RVP PCR was associated with renal disease (Odds Ratio(OR) 2.22; 95% CI 1.34-3.67), cough (OR 2.78; 95%CI 1.71-4.51) and wheezing (OR 2.00; 95%CI 1.28-3.13). Further analyses indicated that influenza was associated with cough (OR 5.30, 95%CI 2.25-12.48) and joint pain (OR 1.61, 95%CI 1.01-2.58) .Metapneumovirus was associated with wheezing (OR 3.59, 95%CI 1.58-8.16) and age >65 (OR 2.90, 95%CI 1.05-7.96).
Conclusion: There was wide variation among the prevalence of characteristics reported by our study, but as noted above, some signs and symptoms did have significant correlation with certain viruses. As use of RVP-PCR increases, studies like ours may be able to define the clinical presentation more accurately and eventually lead to evidence-based, presentation-guided treatment algorithms for viral URIs.
Figure 1. Incidence of Viruses in Positive RVP-PCR
M. Elfekey, None
C. Mcwilliams, None
A. Luka, None
R. Schwartz, None