Die Rolle von Viren bei tiefen Atemwegsinfektionen des Erwachsenen[]

 

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Zusammenfassung

Infektionen des Respirationstrakts sind in industrialisierten Ländern eine der häufigsten Ursachen für ärztliche Konsultationen, wobei rund ein Drittel dieser Erkrankungen die tiefen Atemwege betreffen. Hierzu zählen neben der akuten Bronchitis auch die akute Exazerbation einer chronisch obstruktiven Lungenerkrankung (COPD), die ambulant oder nosokomial erworbene Pneumonie und als besondere Entität die Influenza, die sämtliche Abschnitte des Respirationstrakt betreffen kann. Über lange Zeit wurde aus Mangel an geeigneten Untersuchungsmethoden die Bedeutung von respiratorischen Viren bei der Genese dieser Infektionen wahrscheinlich unterschätzt. Da bislang oft eine bakterielle Genese vermutet wurde, erfolgte im klinischen Alltag, insbesondere bei der akuten Bronchitis oder der exazerbierten COPD, in vielen Fällen eine antibiotische Behandlung, die wahrscheinlich nicht erforderlich ist und das Risiko einer Resistenzentwicklung beinhaltet. Erst mit der Einführung von sensitiveren Nachweisverfahren für Viren, wie zum Beispiel der Polymerasekettenreaktion (PCR), gelingt ein sicherer und zuverlässiger Nachweis von respiratorischen Viren, der Aussagen über deren Bedeutung bei Infektionen des tiefen Respirationstrakts erlaubt. Im Rahmen dieser dreiteiligen Serie soll deshalb anhand der aktuellen Literatur ein Überblick über den derzeitigen Kenntnisstand zur Bedeutung von respiratorischen Viren bei tiefen Atemwegsinfektionen des Erwachsenen gegeben werden. Der erste Teil befasste sich mit spezifischen Erregern, Pathogenese und Diagnostik. Im aktuellen Teil wird auf die Rolle von Viren bei den häufigsten Formen der tiefen Atemwegsinfekte (s. o.) eingegangen, und der dritte und letzte Teil behandelt Therapie und Prävention.

Abstract

In industrialized countries respiratory tract infections are one of the most common reasons for medical consultations. It is assumed that almost one third of these infections affect the lower respiratory tract (LRTI), e. g. acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), community- or hospital-acquired pneumonia and influenza. Due to a lack of sufficient and valid investigations on the epidemiology of respiratory viruses, their impact on the pathogenesis of LRTI has probably been underestimated for a long time. Therefore, there might have been many cases of needless antibiotic treatment, particularly in cases of acute bronchitis or acute exacerbations of COPD, because of an assumed bacteriological aetiology. Following the introduction of diagnostic procedures with increased sensitivity, such as polymerase chain reaction, it is possible to reliably detect respiratory viruses and to illuminate their role in the pathogenesis of LRTI of the adult. We have reviewed the current literature to elucidate the role of viruses in the pathogenesis of LRTI. The first part of this series described frequent viral pathogens, pathogenesis of viral LRTI, and diagnostic procedures. In this 2^nd part the aetiological role of viruses in the most frequent forms of LRTI will be highlighted, and the third and last part will provide an overview of therapeutic and preventive options.

1 Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

Literatur

• 1 Holmes W F, Macfarlane J T, Macfarlane R M. et al . Symptoms, signs, and prescribing for acute lower respiratory tract illness.  Br J Gen Pract. 2001;  51 177-181
  PubMedGoogle Scholar
• 2 Gonzales R, Sande M A. Uncomplicated acute bronchitis.  Ann Intern Med. 2000;  133 981-991
  PubMedGoogle Scholar
• 3 Braman S S. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.  Chest. 2006;  129 (Suppl 1) 95S-103S
  CrossrefPubMedGoogle Scholar
• 4 Thiadens H A, Postma D S, de Bock G H. et al . Asthma in adult patients presenting with symptoms of acute bronchitis in general practice.  Scand J Prim Health Care. 2000;  18 188-192
  CrossrefPubMedGoogle Scholar
• 5 Höffken G, Lorenz J, Kern W. et al . S3-Leitlinie zur Epidemiologie, Diagnostik, antimikrobieller Therapie und Management von erwachsenen Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen (akute Bronchitis, akute Exazerbation einer chronischen Bronchitis, Influenza und andere respiratorische Virusinfektionen) sowie ambulant erworbene Pneumonie.  Pneumologie. 2005;  59 612-664
  PubMedGoogle Scholar
• 6 Techniker Krankenkasse .Gesundheitsreport 2006. 2006
  PubMedGoogle Scholar
• 7 Cate T R, Couch R B, Fleet W F. et al . Production of Tracheobronchitis in Volunteers with Rhinovirus in a Small-Particle Aerosol.  Am J Epidemiol. 1965;  81 95-105
  PubMedGoogle Scholar
• 8 Jonsson J S, Sigurdsson J A, Kristinsson K G. et al . Acute bronchitis in adults. How close do we come to its aetiology in general practice?.  Scand J Prim Health Care. 1997;  15 156-160
  CrossrefPubMedGoogle Scholar
• 9 Boldy D A, Skidmore S J, Ayres J G. Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine.  Respir Med. 1990;  84 377-385
  CrossrefPubMedGoogle Scholar
• 10 Macfarlane J, Holmes W, Gard P. et al . Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community.  Thorax. 2001;  56 109-114
  CrossrefPubMedGoogle Scholar
• 11 Freymuth F, Vabret A, Gouarin S. et al . Epidemiology and diagnosis of respiratory syncytial virus in adults.  Rev Mal Respir. 2004;  21 35-42
  PubMedGoogle Scholar
• 12 Nicholson K G, Kent J, Hammersley V. et al . Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study.  BMJ. 1996;  313 1119-1123
  PubMedGoogle Scholar
• 13 Smucny J, Fahey T, Becker L. et al . Antibiotics for acute bronchitis.  Cochrane Database Syst Rev. 2004;  4 CD000245
  PubMedGoogle Scholar
• 14 Evans A T, Husain S, Durairaj L. et al . Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial.  Lancet. 2002;  359 1648-1654
  CrossrefPubMedGoogle Scholar
• 15 Van den Hoogen B G, Osterhaus D M, Fouchier R A. Clinical impact and diagnosis of human metapneumovirus infection.  Pediatr Infect Dis J. 2004;  23 (Suppl 1) 25-32
  PubMedGoogle Scholar
• 16 Prins J M, Wolthers K C. Human metapneumovirus: a new pathogen in children and adults.  Neth J Med. 2004;  62 177-179
  PubMedGoogle Scholar
• 17 Kaye M, Skidmore S, Osman H. et al . Surveillance of respiratory virus infections in adult hospital admissions using rapid methods.  Epidemiol Infect. 2006;  134 792-798
  CrossrefPubMedGoogle Scholar
• 18 Vabret A, Mourez T, Gouarin S. et al . An outbreak of coronavirus OC43 respiratory infection in Normandy, France.  Clin Infect Dis. 2003;  36 985-989
  CrossrefPubMedGoogle Scholar
• 19 Knutson D, Braun C. Diagnosis and management of acute bronchitis.  Am Fam Physician. 2002;  65 2039-2044
  PubMedGoogle Scholar
• 20 Kardos P, Cegla U, Gillissen A. et al . Leitlinie der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von Patienten mit akutem und chronischem Husten.  Pneumologie. 2004;  58 570-602
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Melbye H, Kongerud J, Vorland L. Reversible airflow limitation in adults with respiratory infection.  Eur Respir J. 1994;  7 1239-1245
  CrossrefPubMedGoogle Scholar
• 22 Macfarlane J, Holmes W, Gard P. et al . Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet.  BMJ. 2002;  324 91-94
  CrossrefPubMedGoogle Scholar
• 23 Rabe K F, Beghe B, Luppi F. et al . Update in chronic obstructive pulmonary disease 2006.  Am J Respir Crit Care Med. 2007;  175 1222-1232
  CrossrefPubMedGoogle Scholar
• 24 Seemungal T A, Donaldson G C, Paul E A. et al . Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1418-1422
  CrossrefPubMedGoogle Scholar
• 25 Burge S, Wedzicha J A. COPD exacerbations: definitions and classifications.  Eur Respir J Suppl. 2003;  41 46s-53s
  PubMedGoogle Scholar
• 26 Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations.  Chest. 2000;  117 (Suppl 2) 398S-401S
  CrossrefPubMedGoogle Scholar
• 27 Anthonisen N R, Manfreda J, Warren C P. et al . Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.  Ann Intern Med. 1987;  106 196-204
  CrossrefPubMedGoogle Scholar
• 28 WHO .World Health Report 2008. 2008
  PubMedGoogle Scholar
• 29 Connors A F, Dawson N V, Thomas C. et al . Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).  Am J Respir Crit Care Med. 1996;  154 959-967
  CrossrefPubMedGoogle Scholar
• 30 Groenewegen K H, Schols A M, Wouters E F. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD.  Chest. 2003;  124 459-467
  CrossrefPubMedGoogle Scholar
• 31 Kanner R E, Anthonisen N R, Connett J E. Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: results from the lung health study.  Am J Respir Crit Care Med. 2001;  164 358-364
  CrossrefPubMedGoogle Scholar
• 32 Donaldson G C, Seemungal T A, Bhowmik A. et al . Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
  CrossrefPubMedGoogle Scholar
• 33 Murphy T F, Sethi S, Niederman M. The role of bacteria in exacerbations of COPD. A constructive view.  Chest. 2000;  118 204-209
  CrossrefPubMedGoogle Scholar
• 34 Greenberg S B, Allen M, Wilson J. et al . Respiratory viral infections in adults with and without chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  162 167-173
  CrossrefPubMedGoogle Scholar
• 35 Bandi V, Apicella M A, Mason E. et al . Nontypeable Haemophilus influenzae in the lower respiratory tract of patients with chronic bronchitis.  Am J Respir Crit Care Med. 2001;  164 2114-2119
  PubMedGoogle Scholar
• 36 Patel I S, Seemungal T A, Wilks . et al . Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations.  Thorax. 2002;  57 759-764
  CrossrefPubMedGoogle Scholar
• 37 Saint S, Bent S, Vittinghoff E. et al . Antibiotics in chronic obstructive pulmonary disease exacerbations. A meta-analysis.  Jama. 1995;  273 957-960
  CrossrefPubMedGoogle Scholar
• 38 MacNee W, Calverley S M. Chronic obstructive pulmonary disease. 7: Management of COPD.  Thorax. 2003;  58 261-265
  CrossrefPubMedGoogle Scholar
• 39 Wedzicha J A. Role of viruses in exacerbations of chronic obstructive pulmonary disease.  Proc Am Thorac Soc. 2004;  1 115-120
  CrossrefPubMedGoogle Scholar
• 40 Seemungal T, Harper-Owen R, Bhowmik A. et al . Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  164 1618-1623
  CrossrefPubMedGoogle Scholar
• 41 Seemungal T A, Donaldson G C, Bhowmik A. et al . Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  161 1608-1613
  CrossrefPubMedGoogle Scholar
• 42 Tan W C, Xiang X, Qui D. et al . Epidemiology of respiratory viruses in patients hospitalized with near-fatal asthma, acute exacerbations of asthma, or chronic obstructive pulmonary disease.  Am J Med. 2003;  115 272-277
  CrossrefPubMedGoogle Scholar
• 43 Rohde G, Wiethege A, Borg I. et al . Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study.  Thorax. 2003;  58 37-42
  CrossrefPubMedGoogle Scholar
• 44 Papi A, Bellettato C M, Braccioni F. et al . Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.  Am J Respir Crit Care Med. 2006;  173 1114-1121
  CrossrefPubMedGoogle Scholar
• 45 Wilkinson T M, Hurst J R, Perera W R. et al . Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD.  Chest. 2006;  129 317-324
  CrossrefPubMedGoogle Scholar
• 46 Barnes P J. Chronic obstructive pulmonary disease.  N Engl J Med. 2000;  343 269-280
  CrossrefPubMedGoogle Scholar
• 47 Rohde G, Borg I, Wiethege A. et al . Inflammatory response in acute viral exacerbations of COPD.  Infection. 2008;  36 427-433
  CrossrefPubMedGoogle Scholar
• 48 Hogg J C, Chu F, Utokaparch S. et al . The nature of small-airway obstruction in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 2645-2653
  CrossrefPubMedGoogle Scholar
• 49 Rohde G, Schlosser B, Arinir U. et al . The role of respiratory infections in chronic obstructive pulmonary disease.  Med Klin (München). 2007;  102 893-898
  CrossrefPubMedGoogle Scholar
• 50 Borg I, Rohde G, Loseke S. et al . Evaluation of a quantitative real-time PCR for the detection of respiratory syncytial virus in pulmonary diseases.  Eur Respir J. 2003;  21 944-951
  CrossrefPubMedGoogle Scholar
• 51 Rohde G, Wiethege A, Borg I. et al . Influenza A virus in Exacerbation of chronic obstruktive pulmonary disease.  Eur Respir J Suppl. 2001;  18 (Suppl 33) 152
  PubMedGoogle Scholar
• 52 Worth H, Buhl R, Cegla U. et al . Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).  Pneumologie. 2002;  56 704-738
  Article in Thieme ConnectPubMedGoogle Scholar
• 53 Ruiz M, Ewig S, Marcos M A. et al . Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.  Am J Respir Crit Care Med. 1999;  160 397-405
  PubMedGoogle Scholar
• 54 Lim W S, Macfarlane J T, Boswell T C. et al . Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines.  Thorax. 2001;  56 296-301
  CrossrefPubMedGoogle Scholar
• 55 Welte T, Kohnlein T. Global and local epidemiology of community-acquired pneumonia: the experience of the CAPNETZ Network.  Semin Respir Crit Care Med. 2009;  30 127-135
  Article in Thieme ConnectPubMedGoogle Scholar
• 56 Fang G D, Fine M, Orloff J. et al . New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.  Medicine (Baltimore). 1990;  69 307-316
  PubMedGoogle Scholar
• 57 Dowell S F, Anderson L J, Gary Jr. H E. et al . Respiratory syncytial virus is an important cause of community-acquired lower respiratory infection among hospitalized adults.  J Infect Dis. 1996;  174 456-462
  CrossrefPubMedGoogle Scholar
• 58 Almirall J, Bolibar I, Vidal J. et al . Epidemiology of community-acquired pneumonia in adults: a population-based study.  Eur Respir J. 2000;  15 757-763
  CrossrefPubMedGoogle Scholar
• 59 Woodhead M. Community-acquired pneumonia guidelines – an international comparison: a view from Europe.  Chest. 1998;  113 (Suppl) 183S-187S
  CrossrefPubMedGoogle Scholar
• 60 De Roux A, Marcos M A, Garcia E. et al . Viral community-acquired pneumonia in nonimmunocompromised adults.  Chest. 2004;  125 1343-1351
  CrossrefPubMedGoogle Scholar
• 61 Angeles Marcos M, Camps M, Pumarola T. et al . The role of viruses in the aetiology of community-acquired pneumonia in adults.  Antivir Ther. 2006;  11 351-359
  PubMedGoogle Scholar
• 62 Ewig S. Community-acquired pneumonia: definition, epidemiology, and outcome.  Semin Respir Infect. 1999;  14 94-102
  PubMedGoogle Scholar
• 63 Krech T, Wegmann T, Martin H. et al . Etiology of atypical pneumonias. A serological study on 1494 patients.  Schweiz Med Wochenschr. 1986;  116 2-7
  PubMedGoogle Scholar
• 64 Farr B M, Kaiser D L, Harrison B D. et al . Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee.  Thorax. 1989;  44 1031-1035
  CrossrefPubMedGoogle Scholar
• 65 Dahmash N S, Chowdhury M N. Re-evaluation of pneumonia requiring admission to an intensive care unit: a prospective study.  Thorax. 1994;  49 71-76
  CrossrefPubMedGoogle Scholar
• 66 Bohte R, van Furth R, van den Broek P F. Aetiology of community-acquired pneumonia: a prospective study among adults requiring admission to hospital.  Thorax. 1995;  50 543-547
  CrossrefPubMedGoogle Scholar
• 67 Socan M, Marinic-Fiser N, Kraigher A. et al . Microbial aetiology of community-acquired pneumonia in hospitalised patients.  Eur J Clin Microbiol Infect Dis. 1999;  18 777-782
  CrossrefPubMedGoogle Scholar
• 68 Hamelin M E, Cote S, Laforge J. et al . Human metapneumovirus infection in adults with community-acquired pneumonia and exacerbation of chronic obstructive pulmonary disease.  Clin Infect Dis. 2005;  41 498-502
  CrossrefPubMedGoogle Scholar
• 69 La Scola B, Marrie T J, Auffray J P. et al . Mimivirus in pneumonia patients.  Emerg Infect Dis. 2005;  11 449-452
  CrossrefPubMedGoogle Scholar
• 70 Johnstone J, Majumdar S R, Fox J D. et al . Human metapneumovirus pneumonia in adults: results of a prospective study.  Clin Infect Dis. 2008;  46 571-574
  CrossrefPubMedGoogle Scholar
• 71 Cebular S, Lee S, Tolaney P. et al . Community-acquired pneumonia in immunocompromised patients. Opportunistic infections to consider in differential diagnosis.  Postgrad Med. 2003;  113 65-66, 69 – 70, 73 – 74
  CrossrefPubMedGoogle Scholar
• 72 Duffau P, Moiton M P, Lafon M E. et al . A case of severe community acquired pneumonia and non-respiratory illness induced by Influenza A.  Med Mal Infect. 2006;  36 473-475
  CrossrefPubMedGoogle Scholar
• 73 Lee D G, Yoo J H, Choi J H. et al . A fatal case of measles pneumonia complicating an adult recipient of hemopoietic stem cell transplantation during the nationwide epidemic in Korea.  Int J Infect Dis. 2006;  10 410-411
  CrossrefPubMedGoogle Scholar
• 74 Kobashi Y, Okimoto N, Matsushima T. et al . Clinical analysis of community-acquired pneumonia in the elderly.  Intern Med. 2001;  40 703-707
  CrossrefPubMedGoogle Scholar
• 75 Gutierrez F, Masia M, Mirete C. et al . The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens.  J Infect. 2006;  53 166-174
  CrossrefPubMedGoogle Scholar
• 76 Johnstone J, Majumdar S R, Fox J D. et al . Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation.  Chest. 2008;  134 1141-1148
  CrossrefPubMedGoogle Scholar
• 77 Jennings L C, Anderson T P, Beynon K A. et al . Incidence and characteristics of viral community-acquired pneumonia in adults.  Thorax. 2008;  63 42-48
  CrossrefPubMedGoogle Scholar
• 78 Ruiz-Gonzalez A, Falguera M, Nogues A. et al . Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.  Am J Med. 1999;  106 385-390
  CrossrefPubMedGoogle Scholar
• 79 Ishida T, Hasimoto T, Arita M. et al . Efficacy of transthoracic needle aspiration in community-acquired pneumonia.  Intern Med. 2001;  40 873-877
  CrossrefPubMedGoogle Scholar
• 80 Nseir S, Di Pompeo C, Pronnier P. et al . Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome.  Eur Respir J. 2002;  20 1483-1489
  CrossrefPubMedGoogle Scholar
• 81 ATS/IDSA . Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.  Am J Respir Crit Care Med. 2005;  171 388-416
  CrossrefPubMedGoogle Scholar
• 82 Louie M, Dyck B, Parker S. et al . Nosocomial pneumonia in a Canadian tertiary care center: a prospective surveillance study.  Infect Control Hosp Epidemiol. 1991;  12 356-363
  CrossrefPubMedGoogle Scholar
• 83 Daubin C, Parienti J J, Vincent S. et al . Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study.  Crit Care. 2006;  10 R142
  CrossrefPubMedGoogle Scholar
• 84 Ong G M, Lowry K, Mahajan S. et al . Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit.  J Med Virol. 2004;  72 121-125
  CrossrefPubMedGoogle Scholar
• 85 Camps K, Jorens P G, Demey H E. et al . Clinical significance of herpes simplex virus in the lower respiratory tract of critically ill patients.  Eur J Clin Microbiol Infect Dis. 2002;  21 758-759
  CrossrefPubMedGoogle Scholar
• 86 De Vos N, Van Hoovels L, Vankeerberghen A. et al . Monitoring of herpes simplex virus in the lower respiratory tract of critically ill patients using real-time PCR: a prospective study.  Clin Microbiol Infect. 2009;  15 358-363
  CrossrefPubMedGoogle Scholar
• 87 Daubin C, Vincent S, Vabret A. et al . Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study.  Intensive Care Med. 2005;  31 1116-1122
  CrossrefPubMedGoogle Scholar
• 88 Porteous C, Bradley J A, Hamilton D N. et al . Herpes simplex virus reactivation in surgical patients.  Crit Care Med. 1984;  12 626-628
  CrossrefPubMedGoogle Scholar
• 89 Hanley P J, Conaway M M, Halstead D C. et al . Nosocomial herpes simplex virus infection associated with oral endotracheal intubation.  Am J Infect Control. 199;  21 310-316
  PubMedGoogle Scholar
• 90 Byers R J, Hasleton P S, Quigley A. et al . Pulmonary herpes simplex in burns patients.  Eur Respir J. 1996;  9 2313-2317
  CrossrefPubMedGoogle Scholar
• 91 Bruynseels P, Jorens P G, Demey H E. et al . Herpes simplex virus in the respiratory tract of critical care patients: a prospective study.  Lancet. 2003;  362 1536-1541
  CrossrefPubMedGoogle Scholar
• 92 Luyt C E, Combea A, Deback C. et al . Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation.  Am J Respir Crit Care Med. 2007;  175 935-942
  CrossrefPubMedGoogle Scholar
• 93 Schuller D, Spessert C, Fraser V J. et al . Herpes simplex virus from respiratory tract secretions: epidemiology, clinical characteristics, and outcome in immunocompromised and nonimmunocompromised hosts.  Am J Med. 1993;  94 29-33
  CrossrefPubMedGoogle Scholar
• 94 Engelmann I, Gottlieb J, Meier A. et al . Clinical relevance of and risk factors for HSV-related tracheobronchitis or pneumonia: results of an outbreak investigation.  Crit Care. 2007;  11 R119
  CrossrefPubMedGoogle Scholar
• 95 Tuxen D V, Wilson J W, Cade J F. Prevention of lower respiratory herpes simplex virus infection with acyclovir in patients with the adult respiratory distress syndrome.  Am Rev Respir Dis. 1987;  136 402-405
  PubMedGoogle Scholar
• 96 Van den Brink J W, Simoons-Smit A M, Beihuizen A. et al . Respiratory herpes simplex virus type 1 infection/colonisation in the critically ill: marker or mediator?.  J Clin Virol. 2004;  30 68-72
  CrossrefPubMedGoogle Scholar
• 97 Ziemann M, Sedemund-Adib B, Reiland P. et al . Increased mortality in long-term intensive care patients with active cytomegalovirus infection.  Crit Care Med. 2008;  36 3145-3150
  CrossrefPubMedGoogle Scholar
• 98 Heininger A, Jahn G, Engel C. et al . Human cytomegalovirus infections in nonimmunosuppressed critically ill patients.  Crit Care Med. 2001;  29 541-547
  CrossrefPubMedGoogle Scholar
• 99 Jaber S, Chanques G, Borry J. et al . Cytomegalovirus infection in critically ill patients: associated factors and consequences.  Chest. 2005;  127 233-241
  CrossrefPubMedGoogle Scholar
• 100 Guidry G G, Black-Payne C A, Payne D K. et al . Respiratory syncytial virus infection among intubated adults in a university medical intensive care unit.  Chest. 1991;  100 1377-1384
  CrossrefPubMedGoogle Scholar
• 101 Oliveira E C, Lee B, Colice G L. Influenza in the intensive care unit.  J Intensive Care Med. 2003;  18 80-91
  CrossrefPubMedGoogle Scholar
• 102 Malcolm E, Arruda E, Hayden F G. et al . Clinical features of patients with acute respiratory illness and rhinovirus in their bronchoalveolar lavages.  J Clin Virol. 2001;  21 9-16
  CrossrefPubMedGoogle Scholar
• 103 Stollenwerk N, Harper R W, Sandrock C E. Bench-to-bedside review: rare and common viral infections in the intensive care unit – linking pathophysiology to clinical presentation.  Crit Care. 2008;  12 219
  CrossrefPubMedGoogle Scholar
• 104 Tellier R. Review of aerosol transmission of influenza A virus.  Emerg Infect Dis. 2006;  12 1657-1662
  PubMedGoogle Scholar
• 105 Brundage J F. Cases and deaths during influenza pandemics in the United States.  Am J Prev Med. 2006;  31 252-256
  CrossrefPubMedGoogle Scholar
• 106 Jamieson D J, Honein M A, Rasmussen S A. et al . H1N1 2009 influenza virus infection during pregnancy in the USA.  Lancet. 2009;  374 451-458
  CrossrefPubMedGoogle Scholar
• 107 Boivin G, Hardy I, Tellier G. et al . Predicting influenza infections during epidemics with use of a clinical case definition.  Clin Infect Dis. 2000;  31 1166-1169
  CrossrefPubMedGoogle Scholar
• 108 Lieberman D, Schlaeffer F, Boldur I. et al . Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients.  Thorax. 1996;  51 179-184
  CrossrefPubMedGoogle Scholar

1 Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

2 Alle Autoren haben gleichermaßen zur Erstellung des Manuskriptes beigetragen.

Dr. Sebastian R. Ott

Universitätsklinik für Pneumologie
Universitätsspital Bern (Inselspital)

3010 Bern
Schweiz

Email: sebastian.ott@insel.ch