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Menezes RC, Ferreira IBB, Sobral L, Garcia SL, Pustilnik HN, Araújo-Pereira M, Andrade BB. Severe viral lower respiratory tract infections in Brazilian children: Clinical features of a national cohort. J Infect Public Health 2024; 17:1-9. [PMID: 37988811 DOI: 10.1016/j.jiph.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/28/2023] [Accepted: 09/25/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The accurate etiological diagnosis of lower respiratory tract infections (LRTI) is essential for their effective clinical management. The extensive use of molecular methods during the COVID-19 pandemic has enabled massive data acquisition on viral lower respiratory tract infections. The current study aims to identify clinical features associated with eight viral agents among children presenting severe LRTI. METHODS retrospective cohort study of data from the Brazilian Influenza Epidemiological Surveillance Information System. Patients under 20 years-old who had severe LRTI with etiological confirmation through RT-PCR between 2020 and 2022 were included. Binary logistic regressions were used to examine associations between pathogens and symptoms. RESULTS 60,657 cases were assessed. The main viral agents detected were Sars-CoV-2 (COV2) (41.2%), Respiratory Syncytial Virus (29.1%), Human Rhinovirus (HRV) (12.1%), and Influenza (FLU) (5.5%). A general mortality rate of 4.3% was observed. The multivariate analysis evidenced that COV2 less likely presented with cough (OR: 0.34; 95%CI: 0.32-0.36), respiratory discomfort (Adjusted Odds Ratio (aOR): 0.61; 95%Confidence Interval (CI): 0.59-0.64), and desaturation (aOR: 0.71; 95%CI: 0.69-0.75). RSV strongly associated with cough (aOR: 2.59; 95%CI: 2.45-2.75) and respiratory discomfort (aOR: 1.54; 95%CI: 1.46-1.62), whereas FLU was linked to fever (aOR: 2.27; 95%CI: 2.06-2.50) and sore throat (aOR: 1.48; 95%CI: 1.34-1.64). CONCLUSIONS The viral agents responsible for severe LRTI have distinct associations with clinical features in children.
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Affiliation(s)
- Rodrigo C Menezes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Bahia, Brazil; Universidade Federal da Bahia (UFBA), Bahia, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Bahia, Brazil
| | - Isabella B B Ferreira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Bahia, Brazil
| | - Luciana Sobral
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública (EBMSP), Bahia, Brazil
| | - Stefania L Garcia
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Universidade Salvador, Bahia, Brazil
| | - Hugo N Pustilnik
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Universidade Salvador, Bahia, Brazil
| | - Mariana Araújo-Pereira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Bahia, Brazil; Universidade Federal da Bahia (UFBA), Bahia, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Bahia, Brazil
| | - Bruno B Andrade
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Brazil; Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Bahia, Brazil; Universidade Federal da Bahia (UFBA), Bahia, Brazil; Fundação Oswaldo Cruz (FIOCRUZ), Bahia, Brazil; Universidade Salvador, Bahia, Brazil.
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Little P, Francis NA, Stuart B, O'Reilly G, Thompson N, Becque T, Hay AD, Wang K, Sharland M, Harnden A, Yao G, Raftery J, Zhu S, Little J, Hookham C, Rowley K, Euden J, Harman K, Coenen S, Read RC, Woods C, Butler CC, Faust SN, Leydon G, Wan M, Hood K, Whitehurst J, Richards-Hall S, Smith P, Thomas M, Moore M, Verheij T. Antibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT. Health Technol Assess 2023; 27:1-90. [PMID: 37436003 DOI: 10.3310/dgbv3199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Background Antimicrobial resistance is a global health threat. Antibiotics are commonly prescribed for children with uncomplicated lower respiratory tract infections, but there is little randomised evidence to support the effectiveness of antibiotics in treating these infections, either overall or relating to key clinical subgroups in which antibiotic prescribing is common (chest signs; fever; physician rating of unwell; sputum/rattly chest; shortness of breath). Objectives To estimate the clinical effectiveness and cost-effectiveness of amoxicillin for uncomplicated lower respiratory tract infections in children both overall and in clinical subgroups. Design Placebo-controlled trial with qualitative, observational and cost-effectiveness studies. Setting UK general practices. Participants Children aged 1-12 years with acute uncomplicated lower respiratory tract infections. Outcomes The primary outcome was the duration in days of symptoms rated moderately bad or worse (measured using a validated diary). Secondary outcomes were symptom severity on days 2-4 (0 = no problem to 6 = as bad as it could be); symptom duration until very little/no problem; reconsultations for new or worsening symptoms; complications; side effects; and resource use. Methods Children were randomised to receive 50 mg/kg/day of oral amoxicillin in divided doses for 7 days, or placebo using pre-prepared packs, using computer-generated random numbers by an independent statistician. Children who were not randomised could participate in a parallel observational study. Semistructured telephone interviews explored the views of 16 parents and 14 clinicians, and the data were analysed using thematic analysis. Throat swabs were analysed using multiplex polymerase chain reaction. Results A total of 432 children were randomised (antibiotics, n = 221; placebo, n = 211). The primary analysis imputed missing data for 115 children. The duration of moderately bad symptoms was similar in the antibiotic and placebo groups overall (median of 5 and 6 days, respectively; hazard ratio 1.13, 95% confidence interval 0.90 to 1.42), with similar results for subgroups, and when including antibiotic prescription data from the 326 children in the observational study. Reconsultations for new or worsening symptoms (29.7% and 38.2%, respectively; risk ratio 0.80, 95% confidence interval 0.58 to 1.05), illness progression requiring hospital assessment or admission (2.4% vs. 2.0%) and side effects (38% vs. 34%) were similar in the two groups. Complete-case (n = 317) and per-protocol (n = 185) analyses were similar, and the presence of bacteria did not mediate antibiotic effectiveness. NHS costs per child were slightly higher (antibiotics, £29; placebo, £26), with no difference in non-NHS costs (antibiotics, £33; placebo, £33). A model predicting complications (with seven variables: baseline severity, difference in respiratory rate from normal for age, duration of prior illness, oxygen saturation, sputum/rattly chest, passing urine less often, and diarrhoea) had good discrimination (bootstrapped area under the receiver operator curve 0.83) and calibration. Parents found it difficult to interpret symptoms and signs, used the sounds of the child's cough to judge the severity of illness, and commonly consulted to receive a clinical examination and reassurance. Parents acknowledged that antibiotics should be used only when 'necessary', and clinicians noted a reduction in parents' expectations for antibiotics. Limitations The study was underpowered to detect small benefits in key subgroups. Conclusion Amoxicillin for uncomplicated lower respiratory tract infections in children is unlikely to be clinically effective or to reduce health or societal costs. Parents need better access to information, as well as clear communication about the self-management of their child's illness and safety-netting. Future work The data can be incorporated in the Cochrane review and individual patient data meta-analysis. Trial registration This trial is registered as ISRCTN79914298. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Little
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Nick A Francis
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Gilly O'Reilly
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Natalie Thompson
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Sharland
- Institute of Infection and Immunity, St George's University, London, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Guiqing Yao
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - James Raftery
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Joseph Little
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Charlotte Hookham
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Kate Rowley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanne Euden
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim Harman
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Samuel Coenen
- Department of Family Medicine & Population Health and Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Robert C Read
- National Institute for Health and Care Research (NIHR) Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Catherine Woods
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Saul N Faust
- National Institute for Health and Care Research (NIHR) Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Geraldine Leydon
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Mandy Wan
- Evelina Pharmacy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jane Whitehurst
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Coventry, UK
| | - Samantha Richards-Hall
- Southampton Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Peter Smith
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Michael Thomas
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Theo Verheij
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
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Hartiala M, Lahti E, Toivonen L, Waris M, Ruuskanen O, Peltola V. Biomarkers of viral and bacterial infection in rhinovirus pneumonia. Front Pediatr 2023; 11:1137777. [PMID: 37009280 PMCID: PMC10050547 DOI: 10.3389/fped.2023.1137777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background Rhinovirus (RV) is often detected in children hospitalized with pneumonia, but the role of RV in causing pneumonia is still unclear. Methods White blood cell count, C-reactive protein, procalcitonin, and myxovirus resistance protein A (MxA) levels were determined from blood samples in children (n = 24) hospitalized with radiologically verified pneumonia. Respiratory viruses were identified from nasal swabs by using reverse transcription polymerase chain reaction assays. Among RV-positive children, the cycle threshold value, RV subtyping by sequence analysis, and the clearance of RV by weekly nasal swabs were determined. RV-positive children with pneumonia were compared to other virus-positive children with pneumonia, and to children (n = 13) with RV-positive upper respiratory tract infection from a separate earlier study. Results RV was detected in 6 children and other viruses in 10 children with pneumonia (viral co-detections excluded). All RV-positive children with pneumonia had high white blood cell counts, plasma C-reactive protein or procalcitonin levels, or alveolar changes in chest radiograph strongly indicating bacterial infection. The median cycle threshold value for RV was low (23.2) indicating a high RV load, and a rapid clearance of RV was observed in all. Blood level of viral biomarker MxA was lower among RV-positive children with pneumonia (median 100 μg/L) than among other virus-positive children with pneumonia (median 495 μg/L, p = 0.034) or children with RV-positive upper respiratory tract infection (median 620 μg/L, p = 0.011). Conclusions Our observations suggest a true viral-bacterial coinfection in RV-positive pneumonia. Low MxA levels in RV-associated pneumonia need further studies.
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Affiliation(s)
- Maria Hartiala
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Correspondence: Maria Hartiala
| | - Elina Lahti
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Child and Adolescent Clinic, City of Turku Welfare Division, Turku, Finland
| | - Laura Toivonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Matti Waris
- Department of Clinical Virology, Institute of Biomedicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Olli Ruuskanen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Little P, Read RC, Becque T, Francis NA, Hay AD, Stuart B, O'Reilly G, Thompson N, Hood K, Faust S, Wang K, Moore M, Verheij T. Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing. Clin Microbiol Infect 2022; 28:1238-1244. [PMID: 35289295 DOI: 10.1016/j.cmi.2022.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/08/2022] [Accepted: 02/13/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts the benefit of antibiotics. METHODS Children between 6 months and 12 years presenting to UK general practices with an acute LRTI were randomized to receive amoxicillin 50 mg/kg/d for 7 days or placebo. Children not randomized (ineligible or clinician/parental choice) could participate in a parallel observational study. The primary outcome was the duration of symptoms rated moderately bad or worse. Throat swabs were taken and analyzed for the presence of bacteria and viruses by multiplex PCR. RESULTS Swab results were available for most participants in the trial (306 of 432; 71%) and in the observational (182 of 326; 59%) studies. Bacterial pathogens potentially sensitive to amoxicillin (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae) were detected among 51% of the trial placebo group and 49% of the trial antibiotic group. The median difference in the duration of symptoms rated moderately bad or worse between antibiotic and placebo was similar when potentially antibiotic-susceptible bacteria were present (median: -1 day; 99% CI, -12.3 to 10.3) or not present (median: -1 day; 99% CI, -4.5 to 2.5). Furthermore, bacterial genome copy number did not predict benefit. There were similar findings for all secondary outcomes and when including the data from the observational study. DISCUSSION There was no clear evidence that antibiotics improved clinical outcomes conditional on the presence or concentration of bacteria or viruses in the upper airway. Before deploying microbiologic point-of-care tests for children with uncomplicated LRTI in primary care, rigorous validating trials are needed.
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Affiliation(s)
- Paul Little
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK.
| | - Robert C Read
- National Institute for Health Research, Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Nick A Francis
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Gilly O'Reilly
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Natalie Thompson
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Saul Faust
- National Institute for Health Research, Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Moore
- Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK
| | - Theo Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Pratt MTG, Abdalla T, Richmond PC, Moore HC, Snelling TL, Blyth CC, Bhuiyan MU. Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:555-570. [DOI: 10.1016/s2352-4642(22)00092-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/17/2022]
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Choo S, Lee YY, Lee E. Clinical significance of respiratory virus coinfection in children with Mycoplasma pneumoniae pneumonia. BMC Pulm Med 2022; 22:212. [PMID: 35637540 PMCID: PMC9150047 DOI: 10.1186/s12890-022-02005-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia has been increasing. However, few studies have investigated the impact of respiratory virus coinfection in patients with MP pneumonia, and their results have been inconclusive. This study aimed to investigate the impact of respiratory virus coinfection in children hospitalized with MP pneumonia. METHODS This study enrolled 145 children hospitalized with MP pneumonia between May 2019 and March 2020. The patients were divided into two groups: the respiratory virus coinfection and non-coinfection groups. All the children underwent polymerase chain reaction testing for respiratory virus infection. Information on clinical, laboratory, and radiologic findings were obtained retrospectively via medical chart reviews. RESULTS Children in the respiratory virus coinfection group were younger than those in the non-coinfection group. Respiratory virus coinfection in children hospitalized with MP pneumonia was significantly associated with persistence of fever more than 6 days (adjusted odds ratio [aOR], 2.394; 95% confidence interval [95% CI], 1.172-4.892), severe pneumonia (aOR, 4.602; 95% CI, 1.154-18.353), and poor response to the stepwise approach for MP pneumonia (aOR, 4.354; 95% CI, 1.374-13.800). In addition, higher levels of liver enzymes and lactate dehydrogenase at admission were associated with respiratory virus coinfection in children with MP pneumonia. CONCLUSIONS The results of this study suggest that respiratory virus coinfection in children hospitalized with MP pneumonia may be associated with refractory MP pneumonia.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Xie LM, Yin X, Xie TA, Su JW, Huang Q, Zhang JH, Huang YF, Guo XG. Meta-Analysis of the Diagnostic Efficacy of the Luminex xTAG Respiratory Viral Panel FAST v2 Assay for Respiratory Viral Infections. Yonsei Med J 2022; 63:95-103. [PMID: 34913289 PMCID: PMC8688366 DOI: 10.3349/ymj.2022.63.1.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Acute respiratory viral infections pose significant morbidity and mortality, making it essential to diagnose respiratory viral infections rapidly. In this study, the diagnostic efficacy of the Luminex xTAG Respiratory Virus Panel (RVP) FAST v2 test was evaluated on respiratory viral infections. MATERIALS AND METHODS Information was retrieved from electronic databases, including Embase, Web of Science, PubMed, and Cochrane Library, for systematic review. Studies that fulfilled predefined inclusion criteria were included. After the extraction of information, statistical software was utilized for quality evaluation, data analysis, and assessment of publication bias. RESULTS Eighty groups in fourfold tables from nine articles were included to perform statistical analyses. Therein, the mean specificity and mean sensitivity of Luminex xTAG RVP FAST v2 test for the detection of respiratory viral infections were 0.99 (0.98-0.99) and 0.88 (0.87-0.90), respectively. Additionally, the negative and positive likelihood ratios were 0.14 (0.11-0.19) and 87.42 (61.88-123.50), respectively. Moreover, the diagnostic odds ratio and area under the curve of summary receiver operating characteristic were 714.80 and 0.9886, respectively. CONCLUSION The Luminex xTAG RVP FAST v2 test could be a reliable and rapid diagnostic method for multiple respiratory viral infections.
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Affiliation(s)
- Li-Min Xie
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xin Yin
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pediatrics, The Pediatrics School of Guangzhou Medical University, Guangzhou, China
| | - Tian-Ao Xie
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Jian-Wen Su
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Qin Huang
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Jing-Hao Zhang
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Yin-Fei Huang
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Bianchini S, Silvestri E, Argentiero A, Fainardi V, Pisi G, Esposito S. Role of Respiratory Syncytial Virus in Pediatric Pneumonia. Microorganisms 2020; 8:microorganisms8122048. [PMID: 33371276 PMCID: PMC7766387 DOI: 10.3390/microorganisms8122048] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory viral infections represent the leading cause of hospitalization in infants and young children worldwide and the second leading cause of infant mortality. Among these, Respiratory Syncytial Virus (RSV) represents the main cause of lower respiratory tract infections (LRTIs) in young children worldwide. RSV manifestation can range widely from mild upper respiratory infections to severe respiratory infections, mainly bronchiolitis and pneumonia, leading to hospitalization, serious complications (such as respiratory failure), and relevant sequalae in childhood and adulthood (wheezing, asthma, and hyperreactive airways). There are no specific clinical signs or symptoms that can distinguish RSV infection from other respiratory pathogens. New multiplex platforms offer the possibility to simultaneously identify different pathogens, including RSV, with an accuracy similar to that of single polymerase chain reaction (PCR) in the majority of cases. At present, the treatment of RSV infection relies on supportive therapy, mainly consisting of oxygen and hydration. Palivizumab is the only prophylactic method available for RSV infection. Advances in technology and scientific knowledge have led to the creation of different kinds of vaccines and drugs to treat RSV infection. Despite the good level of these studies, there are currently few registered strategies to prevent or treat RSV due to difficulties related to the unpredictable nature of the disease and to the specific target population.
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Affiliation(s)
- Sonia Bianchini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.B.); (E.S.)
- Pediatric Unit, ASST Santi Carlo e Paolo, 20142 Milan, Italy
| | - Ettore Silvestri
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.B.); (E.S.)
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.A.); (V.F.); (G.P.)
- Correspondence: ; Tel.: +39-0521-704790
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Andrés-Martín A, Escribano Montaner A, Figuerola Mulet J, García García ML, Korta Murua J, Moreno-Pérez D, Rodrigo-Gonzalo de Liria C, Moreno Galdó A. Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. Arch Bronconeumol 2020; 56:725-741. [PMID: 32534869 DOI: 10.1016/j.arbres.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.
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Affiliation(s)
- Anselmo Andrés-Martín
- Sección de Neumología Pediátrica, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España.
| | - Amparo Escribano Montaner
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Joan Figuerola Mulet
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Maria Luz García García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, España
| | - Javier Korta Murua
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Donostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España
| | - David Moreno-Pérez
- Infectología e Inmunodeficiencias, UGC de Pediatría, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Universidad de Málaga, Málaga, España
| | - Carlos Rodrigo-Gonzalo de Liria
- Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Antonio Moreno Galdó
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España; CIBER de enfermedades raras, Madrid, España
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10
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Veiga ABGD, Martins LG, Riediger I, Mazetto A, Debur MDC, Gregianini TS. More than just a common cold: Endemic coronaviruses OC43, HKU1, NL63, and 229E associated with severe acute respiratory infection and fatality cases among healthy adults. J Med Virol 2020; 93:1002-1007. [DOI: 10.1002/jmv.26362] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ana B. Gorini da Veiga
- Department of Basic Health Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Rio Grande do Sul Brazil
| | - Letícia G. Martins
- Centro Estadual de Vigilância em Saúde da Secretaria de Saúde do Estado do Rio Grande do Sul (CEVS/SES‐RS) Porto Alegre Rio Grande do Sul Brazil
| | - Irina Riediger
- Laboratório Central de Saúde Pública da Secretaria de Saúde do Estado do Paraná (LACEN‐PR) São José dos Pinhais Paraná Brazil
| | - Alix Mazetto
- Laboratório Central de Saúde Pública da Secretaria de Saúde do Estado do Paraná (LACEN‐PR) São José dos Pinhais Paraná Brazil
| | - Maria do Carmo Debur
- Laboratório Central de Saúde Pública da Secretaria de Saúde do Estado do Paraná (LACEN‐PR) São José dos Pinhais Paraná Brazil
| | - Tatiana S. Gregianini
- Laboratório Central de Saúde Pública da Secretaria de Saúde do Estado do Rio Grande do Sul (LACEN‐RS) Porto Alegre Rio Grande do Sul Brazil
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11
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Wei H, Zhao H, Li R, Yang F, Wu Y. Rhinovirus impairs the immune response of alveolar macrophages to facilitate Streptococcus pneumonia infection. Pathog Dis 2020; 78:5828079. [PMID: 32358959 DOI: 10.1093/femspd/ftaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022] Open
Abstract
Pneumonia is one important cause of mortality in neonates. However, the mechanism remains still unclear. Viral infection greatly enhances the morbidity of Streptococcus pneumonia. In this study, we tried to understand how human rhinovirus (HRV) would accelerate Streptococcus pneumonia infection. Alveolar macrophages (AMs) were isolated from neonatal mice. Cytokine concentrations were detected using ELISA. The phagocytosis of Streptococcus pneumonia by AMs was indicated by immunofluorescence. Toll-like receptor 3 (TLR3) and CD68 expression in isolated AMs or infected mice were determined by western blot or immunochemistry. The mortality was explored using Kaplan-Meier analysis. HRV infection enhanced cytokine release by AMs, and decreased Streptococcus pneumonia-induced TNF-α, IL-1β and IL-6 release by AMs, while has no influence on IL-10 release. HRV infection impaired phagocytosis of Streptococcus pneumonia in AMs. Mechanically, HRV infection up-regulated TLR3 expression in AMs. Mortality and pneumococcal burden decreased in TLR3-/- neonatal mice and inflammation and phagocytosis were restored in TLR3-/- AMs. Neonatal rhinovirus impairs the immune response of alveolar macrophages to facilitate Streptococcus pneumonia infection via TLR3 signaling.
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Affiliation(s)
- Huiping Wei
- Department of Emergency, Hubei Maternal and Child Health Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei, China
| | - Hui Zhao
- Department of Emergency, Hubei Maternal and Child Health Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei, China
| | - Ruifang Li
- Department of Neurology, the Third People's Hospital of Hubei Province, No. 26 Zhongshan Road, Qiaokou District, Wuhan 430030, Hubei, China
| | - Feiyun Yang
- Department of Emergency, the First Affiliated Hospital of Xinxiang Medical College, No. 88 Jiankang Road, Weihui 453100, Henan, China
| | - Yan Wu
- Department of Emergency, Hubei Maternal and Child Health Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei, China
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12
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Community-acquired pneumonia among children: the latest evidence for an updated management. J Pediatr (Rio J) 2020; 96 Suppl 1:29-38. [PMID: 31518547 PMCID: PMC7094337 DOI: 10.1016/j.jped.2019.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. DATA SOURCE A comprehensive search was conducted in PubMed, by using the expressions: "community-acquired pneumonia" AND "child" AND "etiology" OR "diagnosis" OR "severity" OR "antibiotic". All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. DATA SYNTHESIS In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25ng/dL was 92% (77-98%) and 93% (90-99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. CONCLUSIONS Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.
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13
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Wen S, Yu M, Zheng G, Lv F, Chen X, Lin L, Li C, Zhang H. Changes in the etiology of viral lower respiratory tract infections in hospitalized children in Wenzhou, China: 2008-2017. J Med Virol 2020; 92:982-987. [PMID: 31889316 DOI: 10.1002/jmv.25660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/26/2019] [Indexed: 01/01/2023]
Abstract
This study investigated the seasonality and secular trends in the etiology of viral lower respiratory tract infections (LRTIs) among hospitalized children in Wenzhou, southeastern China. A retrospective review was conducted concerning viral LRTIs in children hospitalized at a university hospital between January 1, 2008 and December 31, 2017. Direct immunofluorescence was used to detect respiratory syncytial virus (RSV), adenovirus (AdV), influenza A virus (Inf A), influenza B virus (Inf B), and human parainfluenza virus types 1 to 3 (hPIV1-3). Of 89 898 children tested, at least one viral respiratory pathogen was identified in 25.6% and multiple pathogens were identified in 0.4%. RSV (17.6%), hPIV3 (4.0%), and AdV (2.2%) were the most frequently detected pathogens. The proportion of positive samples varied with age and was the highest in children aged <6 months (36.2%). Seasonal differences were observed in RSV, AdV, Inf A, Inf B, hPIV1, and hPIV3 infections. There was a declining trend in the proportion of positive samples over time, primarily due to a decrease in RSV and hPIV3 infections. RSV, hPIV3, and AdV were the most common viral respiratory pathogens identified among hospitalized children with LRTIs. The distribution of viruses varied with age and season.
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Affiliation(s)
- Shunhang Wen
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengfei Yu
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guifeng Zheng
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fangfang Lv
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaofang Chen
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li Lin
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Changchong Li
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hailin Zhang
- Department of Children's Respiratory Disease, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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14
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Hartiala M, Lahti E, Forsström V, Vuorinen T, Ruuskanen O, Peltola V. Characteristics of Hospitalized Rhinovirus-Associated Community-Acquired Pneumonia in Children, Finland, 2003-2014. Front Med (Lausanne) 2019; 6:235. [PMID: 31750306 PMCID: PMC6842953 DOI: 10.3389/fmed.2019.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 10/07/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Rhinovirus (RV) is the most common cause of respiratory tract infections in children but, still, the clinical characteristics of RV-associated pneumonia have not been sufficiently investigated. Methods: We identified children and adolescents younger than 18 years of age treated for community-acquired pneumonia as inpatients at the Turku University Hospital from 2003 to 2014 and analyzed for RV by PCR of a respiratory tract specimen. We collected the data from medical records and compared RV-positive children with RV-negative children. Results: Of the study population of 313 children with pneumonia who were studied for RV, it was detected in 82 (26%). RV-positive children were younger (median age 2.6 years, interquartile range [IQR] 1.1–4.6 vs. 3.5 years, IQR 1.7–8.3, p = 0.002) and they had more often a history of preterm birth (16% vs. 5%, adjusted odds ratio 2.89, 95% confidence interval 1.21–6.92, p = 0.017) than RV-negative children. RV-positive children had a higher median white blood cell count than RV-negative children at presentation with pneumonia. The signs, symptoms, and severity of pneumonia were mostly similar in RV-positive and RV-negative children. Conclusions: RV was frequently detected in young children hospitalized with community-acquired pneumonia. We identified premature birth as a factor associated with RV-positive pneumonia. The clinical features of pneumonia did not clearly differ between RV-positive and RV-negative children. Further studies are needed to clarify the clinical significance of detection of RV in children with pneumonia.
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Affiliation(s)
- Maria Hartiala
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Elina Lahti
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland.,Child and Adolescent Clinic, City of Turku Welfare Division, Turku, Finland
| | - Ville Forsström
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Virology and Clinical Virology, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli Ruuskanen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
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15
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Nascimento-Carvalho AC, Nascimento-Carvalho CM. Clinical management of community-acquired pneumonia in young children. Expert Opin Pharmacother 2018; 20:435-442. [DOI: 10.1080/14656566.2018.1552257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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16
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Bhuiyan MU, Snelling TL, West R, Lang J, Rahman T, Granland C, de Gier C, Borland ML, Thornton RB, Kirkham LAS, Sikazwe C, Martin AC, Richmond PC, Smith DW, Jaffe A, Blyth CC. The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case -control study. Thorax 2018; 74:261-269. [PMID: 30337417 PMCID: PMC6467248 DOI: 10.1136/thoraxjnl-2018-212096] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Respiratory pathogens associated with childhood pneumonia are often detected in the upper respiratory tract of healthy children, making their contribution to pneumonia difficult to determine. We aimed to determine the contribution of common pathogens to pneumonia adjusting for rates of asymptomatic detection to inform future diagnosis, treatment and preventive strategies. METHODS A case-control study was conducted among children <18 years in Perth, Western Australia. Cases were children hospitalised with radiologically confirmed pneumonia; controls were healthy children identified from outpatient and local immunisation clinics. Nasopharyngeal swabs were collected and tested for 14 respiratory viruses and 6 bacterial species by Polymerase chain reaction (PCR). For each pathogen, adjusted odds ratio (aOR; 95% CI) was calculated using multivariate logistic regression and population-attributable fraction (95% CI) for pneumonia was estimated. RESULTS From May 2015 to October 2017, 230 cases and 230 controls were enrolled. At least one respiratory virus was identified in 57% of cases and 29% of controls (aOR: 4.7; 95% CI: 2.8 to 7.8). At least one bacterial species was detected in 72% of cases and 80% of controls (aOR: 0.7; 95% CI: 0.4 to 1.2). Respiratory syncytial virus (RSV) detection was most strongly associated with pneumonia (aOR: 58.4; 95% CI: 15.6 to 217.5). Mycoplasma pneumoniae was the only bacteria associated with pneumonia (aOR: 14.5; 95% CI: 2.2 to 94.8). We estimated that RSV, human metapneumovirus (HMPV), influenza, adenovirus and Mycoplasma pneumoniae were responsible for 20.2% (95% CI: 14.6 to 25.5), 9.8% (5.6% to 13.7%), 6.2% (2.5% to 9.7%), 4% (1.1% to 7.1%) and 7.2% (3.5% to 10.8%) of hospitalisations for childhood pneumonia, respectively. CONCLUSIONS Respiratory viruses, particularly RSV and HMPV, are major contributors to pneumonia in Australian children.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Rachel West
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jurissa Lang
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Tasmina Rahman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Caitlyn Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Camilla de Gier
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Meredith L Borland
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Ruth B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter C Richmond
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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