Die Rolle von Viren bei tiefen Atemwegsinfektionen des Erwachsenen[]

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 Respirationstraktes 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, gelingt ein sicherer und zuverlässiger Nachweis von respiratorischen Viren und somit Aussagen über deren Bedeutung bei Infektionen des tiefen Respirationstraktes. 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. In den beiden vorangegangenen Teilen wurden häufige virale Erreger, Pathogenese und Diagnostik (Teil I) sowie spezifische Krankheitsbilder dargestellt (Teil II). Der aktuelle Teil beschäftigt sich mit Therapie und Prävention bei virusbedingten tiefen Atemwegsinfekten des Erwachsenen.

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 include 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 to prove the presence of respiratory viruses their impact in the pathogenesis of lower respiratory tract infection has probably been underestimated for a long time. Therefore, there might have been many cases of unnecessary antibiotic treatment, especially in cases of acute bronchitis or acute exacerbations of COPD, because of an assumed bacteriological cause. With the introduction of more sensitive investigational procedures, such as polymerase chain reaction, it is possible to sufficiently prove respiratory viruses and therefore illuminate their role in the pathogenesis of lower respiratory tract infections of the adult. We have reviewed the current literature on the impact of viruses in lower respiratory tract infections to elucidate the role of viruses in the pathogenesis of lower respiratory tract infections. The preceding parts of this series provided an introduction to the frequently found viruses, pathogenesis, and diagnostic procedures (part I) as well as common viral infections of the lower respiratory tract (part II). The present 3^rd part deals with therapy for and prevention of viral LRTI.

1 Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

Literatur

• 1 Cheng V C, Tang B S, Wu A K. et al . Medical treatment of viral pneumonia including SARS in immunocompetent adult.  J Infect. 2004;  49 262-273
• 2 Monto A S, Gravenstein S, Elliott M. et al . Clinical signs and symptoms predicting influenza infection.  Arch Intern Med. 2000;  160 3243-3247
• 3 Jefferson T, Demicheli V, Di Pietrantonj C. et al . Amantadine and rimantadine for influenza A in adults.  Cochrane Database Syst Rev. 2006;  2 CD001169
• 4 Centers for disease control and prevention (CDC) . Update: drug susceptibility of swine-origin influenza A (H1N1) viruses, April 2009.  MMWR Morb Mortal Wkly Rep. 2009;  58 433-435
• 5 Diggory P, Fernandez C, Humphrey A. et al . Comparison of elderly people’s technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial.  BMJ. 2001;  322 577-579
• 6 Matheson N J, Symmomds-Abrahams M, Sheikh A. et al . Neuraminidase inhibitors for preventing and treating influenza in children.  Cochrane Database Syst Rev. 2003;  3 CD002744
• 7 Hayden F G, Pavia A T. Antiviral management of seasonal and pandemic influenza.  J Infect Dis. 2006;  194 Suppl 2 119-126
• 8 Jefferson T, Demicheli V, Rivetti D. et al . Antivirals for influenza in healthy adults: systematic review.  Lancet. 2006;  367 303-313
• 9 Gani R, Hughes H, Fleming D. et al . Potential impact of antiviral drug use during influenza pandemic.  Emerg Infect Dis. 2005;  11 1355-1362
• 10 Ferguson N M, Cummings D A, Cauchemez S. et al . Strategies for containing an emerging influenza pandemic in Southeast Asia.  Nature. 2005;  437 209-214
• 11 Longini Jr. I M, Nizam A, Xu S. et al . Containing pandemic influenza at the source.  Science. 2005;  309 1083-1087
• 12 Ferraris O, Kessler N, Valette M. et al . Evolution of the susceptibility to antiviral drugs of A/H3N2 influenza viruses isolated in France from 2002 to 2005.  Vaccine. 2006;  24 6656-6659
• 13 Monto A S, McKimm-Breschkin J L, Macken C. et al . Detection of influenza viruses resistant to neuraminidase inhibitors in global surveillance during the first 3 years of their use.  Antimicrob Agents Chemother. 2006;  50 2395-2402
• 14 Abed Y, Baz M, Boivin G. A novel neuraminidase deletion mutation conferring resistance to oseltamivir in clinical influenza A/H3N2 virus.  J Infect Dis. 2009;  199 180-183
• 15 Kiso M, Mitamura K, Sakai-Tagawa Y. et al . Resistant influenza A viruses in children treated with oseltamivir: descriptive study.  Lancet. 2004;  364 759-765
• 16 Ward P, Small I, Smith J. et al . Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic.  J Antimicrob Chemother. 2005;  55 Suppl 1 i5-i21
• 17 Masihi K N, Schweiger B, Finsterbusch T. et al . Low dose oral combination chemoprophylaxis with oseltamivir and amantadine for influenza A virus infections in mice.  J Chemother. 2007;  19 295-303
• 18 Ilyushina N A, Bovin N V, Webster R G. et al . Combination chemotherapy, a potential strategy for reducing the emergence of drug-resistant influenza A variants.  Antiviral Res. 2006;  70 121-131
• 19 Le Q M, Kiso M, Someya K. et al . Avian flu: isolation of drug-resistant H5N1 virus.  Nature. 2005;  437 1108
• 20 Mishin V P, Hayden F G, Gubareva L V. Susceptibilities of antiviral-resistant influenza viruses to novel neuraminidase inhibitors.  Antimicrob Agents Chemother. 2005;  49 4515-4520
• 21 Wright J J, O’Driscoll G. Treatment of parainfluenza virus 3 pneumonia in a cardiac transplant recipient with intravenous ribavirin and methylprednisolone.  J Heart Lung Transplant. 2005;  24 343-346
• 22 Raza K, Ismailjee S B, Crespo M. et al . Successful outcome of human metapneumovirus (hMPV) pneumonia in a lung transplant recipient treated with intravenous ribavirin.  J Heart Lung Transplant. 2007;  26 862-864
• 23 Gavin P J, Katz B Z. Intravenous ribavirin treatment for severe adenovirus disease in immunocompromised children.  Pediatrics. 2002;  110 e9
• 24 Ventre K, Randolph A. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children.  Cochrane Database Syst Rev. 2004;  (4) CD000181
• 25 Christian M D, Poutanen S M, Loutfy M R. et al . Severe acute respiratory syndrome.  Clin Infect Dis. 2004;  38 1420-1427
• 26 Guerguerian A M, Gauthier M, Lebel M H. et al . Ribavirin in ventilated respiratory syncytial virus bronchiolitis. A randomized, placebo-controlled trial.  Am J Respir Crit Care Med. 1999;  160 829-834
• 27 Centers for disease control and prevention (CDC) . Severe acute respiratory syndrome (SARS) and coronavirus testing – United States, 2003.  MMWR Morb Mortal Wkly Rep. 2003;  52 297-302
• 28 Taber L H, Knight V, Gilbert B E. et al . Ribavirin aerosol treatment of bronchiolitis associated with respiratory syncytial virus infection in infants.  Pediatrics. 1983;  72 613-618
• 29 Moler F W, Steinhart C M, Ohmit S E. et al . Effectiveness of ribavirin in otherwise well infants with respiratory syncytial virus-associated respiratory failure. Pediatric Critical Study GrouS.  J Pediatr. 1996;  128 422-428
• 30 Harrison T W, Oborne J, Newton S. et al . Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial.  Lancet. 2004;  363 271-275
• 31 FitzGerald J M, Becker A, Sears M R. et al . Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations.  Thorax. 2004;  59 550-556
• 32 Patel H, Platt R, Lozano J M. et al . Glucocorticoids for acute viral bronchiolitis in infants and young children.  Cochrane Database Syst Rev. 2004;  (3) CD004878
• 33 Doull I J, Lampe F C, Smith S. et al . Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial.  BMJ. 1997;  315 858-862
• 34 McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood.  Cochrane Database Syst Rev. 2000;  (2) CD001107
• 35 Kellner J D, Ohlsson A, Gadomski A M. et al . Bronchodilators for bronchiolitis.  Cochrane Database Syst Rev. 2000;  (2) CD001266
• 36 American academy of pediatrics subcommitee on diagnosis and management . Diagnosis and management of bronchiolitis.  Pediatrics. 2006;  118 1774-1793
• 37 Singh M. Heated, humidified air for the common cold.  Cochrane Database Syst Rev. 2006;  3 CD001728
• 38 Van Straten M, Josling S. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey.  Adv Ther. 2002;  19 151-159
• 39 Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children.  Cochrane Database Syst Rev. 2005;  (4) CD001479
• 40 Ni J, Wei J, Wu T. Vitamin A for non-measles pneumonia in children.  Cochrane Database Syst Rev. 2005;  (3) CD003700
• 41 Turner R B, Bauer R, Woelkart K. et al . An evaluation of Echinacea angustifolia in experimental rhinovirus infections.  N Engl J Med. 2005;  353 341-348
• 42 Marshall I. Zinc for the common cold.  Cochrane Database Syst Rev. 2000;  (2) CD001364
• 43 Rennard B O, Ertl R F, Gossman G L. et al . Chicken soup inhibits neutrophil chemotaxis in vitro.  Chest. 2000;  118 1150-1157
• 44 Nicas M, Nazaroff W W, Hubbard A. Toward understanding the risk of secondary airborne infection: emission of respirable pathogens.  J Occup Environ Hyg. 2005;  2 143-154
• 45 De Roux A, Marx A, Burkhard O. et al . Impact of corticosteroids on the immune response to a MF59-adjuvanted influenza vaccine in elderly COPD-patients.  Vaccine. 2006;  24 1537-1542
• 46 Belshe R B, Edwards K M, Vesikari T. et al . Live attenuated versus inactivated influenza vaccine in infants and young children.  N Engl J Med. 2007;  356 685-696
• 47 Mutsch M, Zhou W, Rhodes P. et al . Use of the inactivated intranasal influenza vaccine and the risk of Bell’s palsy in Switzerland.  N Engl J Med. 2004;  350 896-903
• 48 Christenson B, Lundbergh P, Hedlund J. et al . Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study.  Lancet. 2001;  357 1008-1011
• 49 Hayward A C, Harling R, Wetten S. et al . Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial.  BMJ. 2006;  333 1241
• 50 Tam C C, O'Brien S J, Petersen I. et al . Guillain-Barre syndrome and preceding infection with campylobacter, influenza and Epstein-Barr virus in the general practice research database.  PLoS One. 2007;  2 e344
• 51 Belshe R B, Newman F K, Tsai T F. et al . Phase 2 evaluation of parainfluenza type 3 cold passage mutant 45 live attenuated vaccine in healthy children 6 – 18 months old.  J Infect Dis. 2004;  189 462-470
• 52 Durbin A P, Karron R A. Progress in the development of respiratory syncytial virus and parainfluenza virus vaccines.  Clin Infect Dis. 2003;  37 1668-1677
• 53 Glezen W P, Taber L H, Frank A L. et al . Risk of primary infection and reinfection with respiratory syncytial virus.  Am J Dis Child. 1986;  140 543-546
• 54 Wright P F, Karron R A, Belshe R B. et al . Evaluation of a live, cold-passaged, temperature-sensitive, respiratory syncytial virus vaccine candidate in infancy.  J Infect Dis. 2000;  182 1331-1342
• 55 Nuijten M J, Wittenberg W, Lebmeier M. Cost effectiveness of palivizumab for respiratory syncytial virus prophylaxis in high-risk children: a UK analysis.  Pharmacoeconomics. 2007;  25 55-71
• 56 Wu H, Pfarr D S, Johnson S. et al . Development of motavizumab, an ultra-potent antibody for the prevention of respiratory syncytial virus infection in the upper and lower respiratory tract.  J Mol Biol. 2007;  368 652-665
• 57 Venkatesh M P, Weisman L E. Prevention and treatment of respiratory syncytial virus infection in infants: an update.  Expert Rev Vaccines. 2006;  5 261-268
• 58 Gray G C, Goswami P R, Malsig M D. et al . Adult adenovirus infections: loss of orphaned vaccines precipitates military respiratory disease epidemics. For the Adenovirus Surveillance GrouS.  Clin Infect Dis. 2000;  31 663-670
• 59 Olsen C W. A review of feline infectious peritonitis virus: molecular biology, immunopathogenesis, clinical aspects, and vaccination.  Vet Microbiol. 1993;  36 1-37
• 60 Martin J E, Louder M K, Holman L A. et al . A SARS DNA vaccine induces neutralizing antibody and cellular immune responses in healthy adults in a Phase I clinical trial.  Vaccine. 2008;  26 6338-6343
• 61 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
• 62 Cheung D, Dick E C, Timmers M C. et al . Rhinovirus inhalation causes long-lasting excessive airway narrowing in response to methacholine in asthmatic subjects in vivo.  Am J Respir Crit Care Med. 1995;  152 1490-1496
• 63 Grunberg K, Smits H H, Timmers M C. et al . Experimental rhinovirus 16 infection. Effects on cell differentials and soluble markers in sputum in asthmatic subjects.  Am J Respir Crit Care Med. 1997;  156 609-616
• 64 Grunberg K, Kuijpers E A, de Klerk E P. et al . Effects of experimental rhinovirus 16 infection on airway hyperresponsiveness to bradykinin in asthmatic subjects in vivo.  Am J Respir Crit Care Med. 1997;  155 833-838
• 65 Mallia P, Massage S D, Kebadze T. et al . An experimental model of rhinovirus induced chronic obstructive pulmonary disease exacerbations: a pilot study.  Respir Res. 2006;  7 116
• 66 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 anderen respiratorischen Virusinfektionen) sowie ambulant erworbener Pneumonie.  Pneumologie. 2005;  59 612-664
• 67 Christ-Crain M, Stolz D, Bingisser R. et al . Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial.  Am J Respir Crit Care Med. 2006;  174 84-93
• 68 Stolz D, Christ-Crain M, Bingisser R. et al . Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy.  Chest. 2007;  131 9-19
• 69 Jefferson T O, Tyrrell D. Antivirals for the common cold.  Cochrane Database Syst Rev. 2001;  (3) CD002743
• 70 Hayden F G, Herrington D T, Coats T L. et al . Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials.  Clin Infect Dis. 2003;  36 1523-1532

1 Gefördert durch die Paul Ehrlich Gesellschaft (PEG).

2 Alle Autoren haben gleichermaßen zur Erstellung des Manuskriptes beigetragen.