Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein

  • Hakan Cinemre Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Cengiz Karacer Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Murat Yücel Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Aziz Öğütlü Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Fatma Behice Cinemre Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Ali Tamer Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
  • Oguz Karabay Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Keywords: acute respiratory infection, influenza-like illness, viral agents

Abstract

Introduction: Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era.

Methodology: Otherwise healthy 152 patients, presenting to outpatient clinics with ILI/ARI, were included. Patients had history & physical, CRP, hemogram and nasopharyngeal swabs for rhinovirus A/B, influenza A/B, adenovirus A/B/C/D/E, coronavirus 229E/NL63 and OC43, parainfluenza virus 1/2/3, respiratory syncytial virusA/B, metapneumovirus and Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and Bordetella pertussis by PCR and for ABHS culture.

Results: Median (IR) age was 26.5 (16.5). Time to presentation was shorter in men (p = 0.027). Patients with rhinovirus had lower rates (20%) of myalgia (p = 0.043). Patients with influenza virus had higher rates (97%) of elevated CRP (p = 0.016). Logistic regression revealed that patients with ILI/ARI and CRP ≥ 5 mg/L were 60 times more likely to have influenza virus infection than other viral agents (OR = 60.0, 95% CI = 2.65 to 1,358.2, p = 0.010). Rhinovirus predominated in December (54%), March (36%), and April (33%). Influenza virus predominated in January (51%). Fever was most common with adenovirus (p = 0.198). All GABHS cultures were negative. Atypical organisms and Bordetella pertussis were negative in all but one patient.

Conclusions: Influenza virus is the most likely pathogen in ILI/ARI when CRP ≥ 5 mg/L. This might be explained by tissue destruction. Myalgia is rare with rhinovirus probably due to absence of viremia. Negative bacteria by PCR and culture suggest unnecessary antibiotic use in ILI/ARI.

Author Biographies

Hakan Cinemre, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Associate Professor of Medicine
Cengiz Karacer, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
MD, Concultant Doctor of İnternal Medicine
Murat Yücel, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Assistant Professor of Emergency Medicine
Aziz Öğütlü, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Assistant Proffesor of İnfectious Disease
Fatma Behice Cinemre, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Associate Professor of Biochemistry
Ali Tamer, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Professor of İnternal Medicine
Oguz Karabay, Sakarya University School of Medicine, Korucuk, Sakarya, Turkey
Professor of Infectious Disease
Published
2016-08-02
How to Cite
1.
Cinemre H, Karacer C, Yücel M, Öğütlü A, Cinemre FB, Tamer A, Karabay O (2016) Viral etiology in adult influenza-like illness/acute respiratory infection and predictivity of C-reactive protein. J Infect Dev Ctries 10:741-746. doi: 10.3855/jidc.6939
Section
Original Articles