Clinical Characteristics of Adult COVID-19 Pneumonia and Other Viral Pneumonias: Comparisons of Imaging Findings

Main Article Content

Daishi Shimada Masafumi Seki


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.

Keywords: Cytomegalovirus, human etapneumovirus, Influenza virus, Measles virus, Respiratory syncytial virus, SARS-CoV-2

Article Details

How to Cite
SHIMADA, Daishi; SEKI, Masafumi. Clinical Characteristics of Adult COVID-19 Pneumonia and Other Viral Pneumonias: Comparisons of Imaging Findings. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1.Seki M.Lessons from the Nationwide Surveillance of SARS-CoV-2 Surges in Japan. JMA J 2021; 4: 302-3.
2. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9.
3. Louria DB, Blumenfeld H, Ellis JT, Kilborne ED, Rodgers DE Studies on influenza in the pandemic of 1957-1958. II. Pulmonary complications of influenza. J Clin Invest 1959; 21: 213-65.
4. Seki M. Trends in the management of infectious disease under SARS-CoV-2 era: From pathophysiological comparison of COVID-19 and influenza. World J Virol 2021; 10(2): 62-8.
5. Varga Z, Flammer A, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395: 1417-8.
6. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377: 1264-75.
7. Mandell LA, Wunderink R, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
8. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA 2020; 180: 934-43.
9. Yamagishi T, Ohnishi M, Matsunaga N, et al.. Environmental Sampling for Severe Acute Respiratory Syndrome Coronavirus 2 During a COVID-19 Outbreak on the Diamond Princess Cruise Ship. J Infect Dis 2020; 222: 1098-102.
10. Sugano N, Ando W, Fukushima W. Cluster of Severe Acute Respiratory Syndrome Coronavirus 2 Infections Linked to Music Clubs in Osaka, Japan. J Infect Dis 2020; 222: 1635-40.
11. Kuzmina A, KKhalaila Y, Voloshin O, et al. SARS-CoV-2 spike variants exhibit differential infectivity and neutralization resistance to convalescent or post-vaccination sera. Cell Host Microbe 2021; 29: 522-8.
12. Matthay MA, Leligdowicz A, Liu KD. Biological Mechanisms of COVID-19 Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2020; 202: 1489-91.
13. Takano K, Watanabe Y, Hariu M, Seki M. Detection of Representative Mutant Strains and a Case of Prolonged Infection by SARS-CoV-2 with Spike 69/70 Deletion in Japan. Infect Drug Resist 2021; 6: 2579-81.
14. Lin HC, Liu Y, Hsing TY, et al. RSV pneumonia with or without bacterial co-infection among healthy children. J Formos Med Assoc 2022; 121: 687-93.
15. Seki M, Yoshida H, Gotoh K, et al. Severe respiratory failure due to co-infection with human metapneumovirus and Streptococcus pneumoniae. Respir Med Case Rep 2014; 15: 13-5.
16. Watanabe Y, Kamioka Y, Seki M. Rhinovirus-Infected Patients in the COVID-19 Pandemic Period. Infect Drug Resist 2021; 14: 609-11.
17. Hübschen JM, Gouandjika-VasilacheI I, Dina J. Measles. Lancet 2022; 399: 678-90.
18. Fonseca Brito L, Brune W, Stahl FR. Cytomegalovirus (CMV) Pneumonitis: Cell Tropism, Inflammation, and Immunity. Int J Mol Sci 2019; 20: 3865.
19. Cunba BA. Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin North Am 2010; 24: 147-58.
20. Ison MG, Fishman J. Cytomegalovirus pneumonia in transplant recipients. Clin Chest Med 2005; 26: 691-705.
21. Doesch AO, Repp J, Hofmann N, et al. Effects of oral valganciclovir prophylaxis for cytomegalovirus infection in heart transplant patients. Drug Des Devel Ther 2012; 6: 289-95.
22. Metlay JP, Waterer G, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-e67.
23. Kohno S, Seki M, Watanabe A; CAP Study Group. Evaluation of an assessment system for the JRS 2005: A-DROP for the management of CAP in adults. Intern Med 2011; 50: 1183-91.
24. Metlay JP, Waterer G. Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic. Ann Intern Med 2020; 173: 304-5.
25. Seki M, Yanagihara K, Higashiyama Y, et al. Immunokinetics in severe pneumonia due to influenza virus and bacteria coinfection in mice. Eur Respir J 2004; 24: 143-9.
26. Seki M, Fuke R, Oikawa N, Hariu M, Watanabe Y. Association of influenza with severe pneumonia/empyema in the community, hospital, and healthcare-associated setting. Respir Med Case Rep 2016; 24.
27. Seki M. COVID-19 related secondary bacterial pneumonia -Comparisons with influenza- Medical Research Archives, 2022; 10: 2678-85.
28. Seki M, Kosai K, Yanagihara K et al. Disease severity in patients with simultaneous influenza and bacterial pneumonia. Intern Med 2007; 46: 953-8.
29. Seki M, Suyama N, Hashiguchi K, et al. A patient with fulminant influenza-related bacterial pneumonia due to Streptococcus pneumoniae followed by Mycobacterium tuberculosis infection. Intern Med 2008; 47: 2043-7.
30. Suzuki J, Endo S, Mizuno T, et al. Use of a multiplex polymerase chain reaction assay for the early detection of an outbreak of human parainfluenza virus type 3 infection in a nursery school during the COVID-19 pandemic. Infect Prev Pract 2022; 4: 100221.