Medical treatment of viral pneumonia including SARS in immunocompetent adult
Identifieur interne : 005B09 ( Main/Exploration ); précédent : 005B08; suivant : 005B10Medical treatment of viral pneumonia including SARS in immunocompetent adult
Auteurs : V. C. C. Cheng [Hong Kong] ; B. S. F. Tang [Hong Kong] ; A. K. L. Wu [Hong Kong] ; C. M. Chu [Hong Kong] ; K. Y. Yuen [Hong Kong]Source :
- The Journal of infection [ 0163-4453 ] ; 2004.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Antiviraux (usage thérapeutique), Association de médicaments, Femelle, Humains, Immunocompétence, Mâle, Pneumopathie virale (traitement médicamenteux), Pneumopathie virale (étiologie), Résultat thérapeutique, Stéroïdes (usage thérapeutique), Sujet âgé, Syndrome respiratoire aigu sévère (traitement médicamenteux).
- MESH :
- traitement médicamenteux : Pneumopathie virale, Syndrome respiratoire aigu sévère.
- usage thérapeutique : Antiviraux, Stéroïdes.
- étiologie : Pneumopathie virale.
- Pascal (Inist)
- Wicri :
- topic : Adulte.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Antiviral Agents (therapeutic use), Drug Therapy, Combination, Female, Humans, Immunocompetence, Male, Middle Aged, Pneumonia, Pneumonia, Viral (drug therapy), Pneumonia, Viral (etiology), Severe Acute Respiratory Syndrome (drug therapy), Severe acute respiratory syndrome, Steroids (therapeutic use), Treatment, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Antiviral Agents, Steroids.
- drug therapy : Pneumonia, Viral, Severe Acute Respiratory Syndrome.
- etiology : Pneumonia, Viral.
- Adolescent, Adult, Aged, Drug Therapy, Combination, Female, Humans, Immunocompetence, Male, Middle Aged, Treatment Outcome.
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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C. C." last="Cheng">V. C. C. Cheng</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Tang, B S F" sort="Tang, B S F" uniqKey="Tang B" first="B. S. F." last="Tang">B. S. F. Tang</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Wu, A K L" sort="Wu, A K L" uniqKey="Wu A" first="A. K. L." last="Wu">A. K. L. 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Chu</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, United Christian Hospital, Hong Kong Special Administrative Region</s1><s3>HKG</s3><sZ>4 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, United Christian Hospital, Hong Kong Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Yuen, K Y" sort="Yuen, K Y" uniqKey="Yuen K" first="K. Y." last="Yuen">K. Y. Yuen</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">The Journal of infection</title><title level="j" type="abbreviated">J. infect.</title><idno type="ISSN">0163-4453</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The Journal of infection</title><title level="j" type="abbreviated">J. infect.</title><idno type="ISSN">0163-4453</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Antiviral Agents (therapeutic use)</term><term>Drug Therapy, Combination</term><term>Female</term><term>Humans</term><term>Immunocompetence</term><term>Male</term><term>Middle Aged</term><term>Pneumonia</term><term>Pneumonia, Viral (drug therapy)</term><term>Pneumonia, Viral (etiology)</term><term>Severe Acute Respiratory Syndrome (drug therapy)</term><term>Severe acute respiratory syndrome</term><term>Steroids (therapeutic use)</term><term>Treatment</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Antiviraux (usage thérapeutique)</term><term>Association de médicaments</term><term>Femelle</term><term>Humains</term><term>Immunocompétence</term><term>Mâle</term><term>Pneumopathie virale (traitement médicamenteux)</term><term>Pneumopathie virale (étiologie)</term><term>Résultat thérapeutique</term><term>Stéroïdes (usage thérapeutique)</term><term>Sujet âgé</term><term>Syndrome respiratoire aigu sévère (traitement médicamenteux)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term><term>Steroids</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Pneumonia, Viral</term><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Pneumopathie virale</term><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antiviraux</term><term>Stéroïdes</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Drug Therapy, Combination</term><term>Female</term><term>Humans</term><term>Immunocompetence</term><term>Male</term><term>Middle Aged</term><term>Treatment Outcome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Association de médicaments</term><term>Femelle</term><term>Humains</term><term>Immunocompétence</term><term>Mâle</term><term>Pneumonie</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Syndrome respiratoire aigu sévère</term><term>Traitement</term><term>Adulte</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Adulte</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><affiliations><list><country><li>Hong Kong</li></country></list><tree><country name="Hong Kong"><noRegion><name sortKey="Cheng, V C C" sort="Cheng, V C C" uniqKey="Cheng V" first="V. C. C." last="Cheng">V. C. C. Cheng</name></noRegion><name sortKey="Chu, C M" sort="Chu, C M" uniqKey="Chu C" first="C. M." last="Chu">C. M. Chu</name><name sortKey="Tang, B S F" sort="Tang, B S F" uniqKey="Tang B" first="B. S. F." last="Tang">B. S. F. Tang</name><name sortKey="Wu, A K L" sort="Wu, A K L" uniqKey="Wu A" first="A. K. L." last="Wu">A. K. L. Wu</name><name sortKey="Yuen, K Y" sort="Yuen, K Y" uniqKey="Yuen K" first="K. Y." last="Yuen">K. Y. Yuen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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