What are the complications of viral pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Most viral pneumonias in immunocompetent hosts resolve with few sequelae. However, respiratory failure may develop secondary to superimposed bacterial infection.

Secondary bacterial infections are common. Common organisms are Streptococcus pneumoniae, Staphylococcus aureus,Streptococcus pyogenes (group A Streptococcus), and Haemophilus influenzae.

Late sequelae of viral pneumonias include bronchitis and bronchiolitis, especially following infection with RSV and influenza viruses.

Adenovirus serotypes 2, 3, 7, and 21 have been the cause of serious chronic morbidity after acute respiratory illness, including irreversible atelectasis, bronchiectasis, bronchiolitis obliterans, and unilateral hyperlucent lung. An estimated 14-60% of these children will suffer some degree of permanent lung damage. Serious sequelae occurred in patients who survive severe infection with adenovirus 14.

A retrospective cohort study of 100 children with RSV revealed a 79% complication rate. Nearly 24% were considered serious, and 16% of children required mechanical ventilation. The authors concluded that RSV infections in children considerably lengthen their hospital stay and medical costs. In fact, hospital costs approach $1 billion annually in the United States. In addition, 20% of all patients are rehospitalized, and more than 40% develop asthma.

Complications of RSV pneumonia in children are a considerable burden on hospital costs. About 60% of the complications are respiratory and consist of respiratory failure, apnea, stridor, hemoptysis, infiltrates and/or atelectasis, hyperinflation, pneumothorax, or pleural effusions. About 15% of radiographs are described as normal in children with complications. Prematurity and congenital diseases are risk factors for complications.

Viral (mainly PIV) or bacterial (especially S pneumoniae) superinfections, tuberculosis reactivation, and subsequent bronchiectasis are complications of measles pneumonia.

Temporary decreases in the forced expiratory volume in 1 second (FEV1) and/or forced vital capacity (FVC) or a permanent decrease in the lung transfer factor for carbon monoxide (TLCO) are reported in patients with VZV pneumonia. One case of VZV pneumonia complicated by a bacterial lung abscess in a child is reported.

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