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Different viral infections show characteristic imaging findings based on their particular pathophysiology. SARS-COV-2 shows characteristically high transmissibility and virulence, and it can evade the human immune system. COVID-19 patients frequently develop severe illness involving cytokine storm leading to acute respiratory distress syndrome (ARDS), as well as alveolar flood and severe vascular damage resulting in sepsis and organ damage. These basically develop from bilateral ground-glass infiltrations that are also found in the adult viral pneumonias, such as measles, respiratory syncytial virus, human metapneumovirus, and cytomegalovirus pneumonias. Secondary bacterial pneumonia due to co-infection with bacteria is a major issue in viral pneumonia, especially in influenza pneumonia, but patients with adult viral pneumonias are very different from bacterial pneumonia patients, and they are usually young, produce less sputum, and sometimes show characteristic skin lesions, including rash and vesicular lesions. Accurate diagnosis of the specific pathogen of viral pneumonia is important to perform the appropriate treatment and prevent infection, and it can recently be performed by multiplex PCR.
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