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Review
. 2004 Nov;49(4):262-73.
doi: 10.1016/j.jinf.2004.07.010.

Medical treatment of viral pneumonia including SARS in immunocompetent adult

V C C Cheng  1 , B S F Tang, A K L Wu, C M Chu, K Y Yuen
Affiliations
Review

Medical treatment of viral pneumonia including SARS in immunocompetent adult

V C C Cheng et al. J Infect. 2004 Nov.

Abstract

Since no randomized controlled trials have been conducted on the treatment of viral pneumonia by antivirals or immunomodulators in immunocompetent adults, a review of such anecdotal experience are needed for the more rational use of such agents. Case reports (single or case series) with details on their treatment and outcome in the English literature can be reviewed for pneumonia caused by human or avian influenza A virus (50 patients), varicella zoster virus (120), adenovirus (29), hantavirus (100) and SARS coronavirus (SARS-CoV) (841). Even with steroid therapy alone, the mortality rate appeared to be lower when compared with conservative treatment for pneumonia caused by human influenza virus (12.5% vs. 42.1%) and hantavirus (13.3% vs. 63.4%). Combination of an effective antiviral, acyclovir, with steroid in the treatment of varicella zoster virus may be associated with a lower mortality than acyclovir alone (0% vs. 10.3%). Combination of interferon alfacon-1 plus steroid, or lopinavir/ritonavir, ribavirin plus steroid were associated with a better outcome than ribavirin plus steroid (0% vs. 2.3% vs. 7.7%, respectively). Combination of lopinavir/ritonavir plus ribavirin significantly reduced the virus load of SARS-CoV in nasopharyngeal, serum, stool and urine specimens taken between day 10 and 15 after symptom onset when compared with the historical control group treated with ribavirin. It appears that the combination of an effective antiviral and steroid was associated with a better outcome. Randomized therapeutic trial should be conducted to ascertain the relative usefulness of antiviral alone or in combination with steroid.

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Figures

Figure 1
Figure 1
Sequential quantitative measurements of viral shedding from upper respiratory tract during infections with influenza A virus, respiratory syncytial virus (RSV), and SARS coronavirus (SARS-CoV). Influenza A virus quantitation was performed on throat washings from a naturally occurring case of influenza in a 28-year-old male. Influenza A/Victoria H3N2 virus was isolated using cell cultures. RSV quantitation was done on nasal washings from 12 subjects inoculated nasally with 104.7 TCID50 (50 median tissue culture infectious dose) RSV A2 challenge pool of virus, developed by the National Institute of Allergy and Infectious Diseases. RSV virus load was measured by quantitative RT-PCR using primers based on the nucleotide sequences from the F gene of RSV group A and B viruses. SARS-CoV quantitation was performed on nasopharyngeal specimens from infected patients. SARS-CoV virus load of 12 patients are measured by quantitative RT-PCR of Pol gene from nasopharyngeal specimens.
Figure 2
Figure 2
Changing titers of serum antibody of influenza A virus, nasal IgA of RSV, and IgG of SARS-CoV after onset of symptoms. Serum antibody titer (HAI) of influenza A virus was determined using serial sera from a patient who was naturally infected with influenza A virus (same patient as shown in Fig. 1). Mean RSV nasal IgA titers were obtained from nasal washings of 12 subjects who were inoculated with RSV (same group of patients as shown in Fig. 1). Mean IgG titers of SARS-CoV were obtained using sera from 12 patients who were infected with SARS-CoV (same group of patients as shown in Fig. 1).
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