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Outbreak of Pneumonia in a Long‐term Care Facility: Antecedent Human Parainfluenza Virus 1 Infection May Predispose to Bacterial Pneumonia
Author(s) -
Fiore Anthony E.,
Iverson Chris,
Messmer Trudy,
Erdman Dean,
Lett Susan M.,
Talkington Deborah F.,
Anderson Larry J.,
Fields Barry,
Carlone George M.,
Breiman Robert F.,
Cetron Martin S.
Publication year - 1998
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1998.tb06649.x
Subject(s) - medicine , pneumonia , streptococcus pneumoniae , outbreak , bacteremia , vaccination , community acquired pneumonia , bacterial pneumonia , pneumococcal pneumonia , immunology , antibiotics , intensive care medicine , virology , microbiology and biotechnology , biology
OBJECTIVES: To determine the causes of an outbreak of lobar pneumonia. DESIGN: Matched (1:2) case‐control study. SETTING: A 70‐bed chronic care facility for older people. PARTICIPANTS: Residents of the facility. RESULTS: Ten residents developed pneumonia over a 10‐day period. Two residents died. One case‐patient had Streptococcus pneumoniae bacteremia; another had polymerase chain reaction evidence of S. pneumoniae infection. No other etiologic agent was identified. Only four of 10 case‐patients had received routine diagnostic cultures of blood or sputum before the administration of antibiotics. Symptoms of upper respiratory illness (URI) among residents before the pneumonia outbreak corresponded with elevation of antibodies to human parainfluenza virus 1 (HPIV1). In a matched case‐control study, six of 10 case‐patients, compared with five of 20 controls, had symptoms of URI during the preceding month (matched odds ratio (MOR) = 4.5, 95% CI = 0.8–33). Nine case‐patients had serum available, and five of these had both serologic evidence of recent HPIV1 infection and recent URI, compared with two of 18 controls (MOR = 9.0, 95% CI = 1.2–208). Only three residents had documentation of pneumococcal vaccination. CONCLUSIONS: Noninfluenza viral infections may play a role in the pathogenesis of some bacterial pneumonias. S. pneumoniae was the cause of at least two pneumonias; lack of preantibiotic cultures may have interfered with isolation of S. pneumoniae in others. Recent HPIV1 infection was epidemiologically linked to subsequently developing pneumonia. Spread of HPIV1 in the facility may have contributed to increased susceptibility to S. pneumoniae and, potentially, to other bacterial pathogens.