eMedicine Specialties > Emergency Medicine > Pulmonary

Pneumonia, Viral: Follow-up

Author: Gloria J Kuhn, DO, PhD, FACEP, Professor, Vice-Chair of Academic Affairs, Dept of Emergency Medicine, Wayne State University School of Medicine; Professor, Department of Internal Medicine, Section of Emergency Medicine, Michigan State University College of Osteopathic Medicine
Contributor Information and Disclosures

Updated: Jun 11, 2009

Follow-up

Further Inpatient Care

  • Immunocompromised or severely ill patients should be hospitalized.
  • Respiratory failure should be considered in any severely ill patient.
  • Obtain samples for laboratory testing to aid in diagnosis and therapy for both outpatients and hospitalized patients. Testing can aid in giving prophylaxis to contacts of sick patients sent home and for isolation of hospitalized patients to prevent nosocomial spread of disease.

Further Outpatient Care

  • Patients well enough for discharge should undergo follow-up with their physician in 1-2 days.
  • Chest radiographs may not show complete resolution for 1-2 weeks.

Inpatient & Outpatient Medications

  • Beta-agonists
  • Nonaspirin antipyretics

Deterrence/Prevention

  • Vaccination is not as effective in elderly people as in young healthy people perhaps due to decreased immune response in older patients. The effectiveness/efficacy of widespread vaccination of elderly persons has been called into question. Only elderly patients residing in assisted living conditions showed a clear benefit from vaccination.19 Still, influenza A and B vaccination are recommended by the CDC for the following populations20 :
    • Children aged 6-23 months
    • Children with chronic illnesses
    • Adults aged 50 years and older
    • People 2 years old or older who have an underlying, long-term illness (heart or lung disease, metabolic disease [eg, diabetes], kidney disease, a blood disorder, or a weakened immune system [including people with HIV/AIDS])
    • Women who will be pregnant this season
    • People who live in nursing homes or other long-term care facilities
    • Persons aged 6 months to 18 years and take aspirin daily (to prevent Reye syndrome as a complication of influenza)
    • Health care workers
    • People who have or take care of an infant younger than 6 months (Do not give a flu shot to infants younger than 6 months.)
  • Measles vaccine
  • Varicella vaccine

Complications

  • Respiratory failure
  • Pulmonary fibrosis
  • Superimposed bacterial infection
  • Adult respiratory distress syndrome
  • Reye syndrome

Prognosis

  • The prognosis is good in the vast majority of patients, but it is guarded in elderly or immunocompromised patients. Patients with SARS and avian influenza have a high mortality rate, and about 25% of patients with SARS have residual pulmonary pathology.24
  • Some healthy patients may have severe disease with increased morbidity and mortality.
  • Chronic asthma is more common in children with severe lower lung infection due to RSV than in the general population.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Distinguishing viral pneumonia (for which no specific treatment, other than ganciclovir and acyclovir, exists) from bacterial pneumonias (for which antibiotics should be used) is impossible, and patients may have coexisting viral and bacterial pneumonias. Therefore, patients with evidence of acute pneumonia should be treated with antibiotics. Patients coming from home should receive antibiotics recommended for community-acquired pneumonia, and patients who are institutionalized should receive antibiotics recommended for nosocomial infections.
  • Failure to administer antibiotics in a timely fashion may result in increased morbidity and mortality. All admitted patients should receive antibiotics in the ED after appropriate laboratory tests have been performed.
  • Not all patients with pneumonia have auscultatory changes. Pneumonia is a common cause for change in mental status or decrease in functional status in elderly patients.
  • Pulse oximetric findings should be checked and documented in patients who are being discharged.
  • Patients who do not improve with outpatient therapy are candidates for admission.

Special Concerns

  • Pregnant patients often have more severe disease.
  • Any adult with varicella pneumonia is at risk for severe disease and respiratory failure.
  • Elderly persons are more at risk for severe disease.
  • Immunocompromised patients have more severe disease.
  • Patients with other cardiovascular and pulmonary diseases have more severe disease.
  • Consider respiratory isolation for patients with pneumonia during influenza epidemics or those suspected of having SARS based on travel history.
  • Smokers are more at risk for severe illness and complications.
 


More on Pneumonia, Viral

Overview: Pneumonia, Viral
Differential Diagnoses & Workup: Pneumonia, Viral
Treatment & Medication: Pneumonia, Viral
Follow-up: Pneumonia, Viral
References
Further Reading
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References

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  2. Falsey AR, Walsh EE. Viral pneumonia in older adults. Clin Infect Dis. Feb 15 2006;42(4):518-24. [Medline].

  3. HHS Declares Public Health Emergency for Swine Flu. US Department of Health and Human Resources. Available at http://www.hhs.gov/news/press/2009pres/04/20090426a.html. Accessed April 27, 2009.

  4. Swine Influenza (Flu). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu. Accessed April 27, 2009.

  5. WHO. Influenza A (H1N1): Special Highlights. World Health Organization. Available at http://www.who.int/en/. Accessed June 11, 2009.

  6. Guidance for Clinicians and Public Health Professionals. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/swineflu/guidance. Accessed April 27, 2009.

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  8. Varia M, Wilson S, Sarwal S, et al. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. Aug 19 2003;169(4):285-92. [Medline].

  9. Ng WF, To KF, Lam WW, et al. The comparative pathology of severe acute respiratory syndrome and avian influenza A subtype H5N1--a review. Hum Pathol. Apr 2006;37(4):381-90. [Medline].

  10. Centers for Disease Control and Prevention. Acute respiratory disease associated with adenovirus serotype 14--four states, 2006-2007. MMWR Morb Mortal Wkly Rep. Nov 16 2007;56(45):1181-4. [Medline].

  11. Louie JK, Kajon AE, Holodniy M, et al. Severe pneumonia due to adenovirus serotype 14: a new respiratory threat?. Clin Infect Dis. Feb 1 2008;46(3):421-5. [Medline].

  12. Metzgar D, Osuna M, Kajon AE, et al. Abrupt emergence of diverse species B adenoviruses at US military recruit training centers. J Infect Dis. Nov 15 2007;196(10):1465-73. [Medline].

  13. Legg JP, Hussain IR, Warner JA, et al. Type 1 and type 2 cytokine imbalance in acute respiratory syncytial virus bronchiolitis. Am J Respir Crit Care Med. Sep 15 2003;168(6):633-9. [Medline].

  14. Levy MM, Baylor MS, Bernard GR, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med. Mar 1 2005;171(5):518-26. [Medline].

  15. Singh AM, Moore PE, Gern JE, et al. Bronchiolitis to asthma: a review and call for studies of gene-virus interactions in asthma causation. Am J Respir Crit Care Med. Jan 15 2007;175(2):108-19. [Medline].

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  18. Thompson WW, Shay DK, Weintraub E, et al. Influenza-associated hospitalizations in the United States. JAMA. Sep 15 2004;292(11):1333-40. [Medline].

  19. [Best Evidence] Rivetti D, Jefferson T, Thomas R, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2006;3:CD004876. [Medline].

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  23. Choi KW, Chau TN, Tsang O, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. Nov 4 2003;139(9):715-23. [Medline].

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  32. Metzgar D, Osuna M, Kajon AE, et al. Abrupt emergence of diverse species B adenoviruses at US military recruit training centers. J Infect Dis. Nov 15 2007;196(10):1465-73. [Medline].

  33. Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. Apr 2004;113(4):701-7. [Medline].

  34. Oliveira EC, Lee B, Colice GL. Influenza in the intensive care unit. J Intensive Care Med. Mar-Apr 2003;18(2):80-91. [Medline].

  35. Smith NM, Bresee JS, Shay DK, et al. Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jul 28 2006;55:1-42. [Medline].

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Further Reading

Clinical guidelines

Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007 Mar 1;44 Suppl 2:S27-72. [335 references] PubMed

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Keywords

viral pneumonia, pneumonia influenza, severe acute respiratory syndrome, SARS, coronavirus, CoV, RSV, respiratory syncytial virus, influenza virus, influenza A, parainfluenza 1, parainfluenza 2, parainfluenza 3, adenovirus, parainfluenza virus, rhinovirus, Hantavirus, cytomegalovirus, CMV, Paramyxovirus species, measles, varicella-zoster virus, Epstein-Barr virus, herpes simplex virus, community-acquired pneumonia, Sin Nombre virus, respiratory illness, pneumococcal vaccines

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Contributor Information and Disclosures

Author

Gloria J Kuhn, DO, PhD, FACEP, Professor, Vice-Chair of Academic Affairs, Dept of Emergency Medicine, Wayne State University School of Medicine; Professor, Department of Internal Medicine, Section of Emergency Medicine, Michigan State University College of Osteopathic Medicine
Gloria J Kuhn, DO, PhD, FACEP is a member of the following medical societies: American College of Emergency Physicians and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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