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Nisar M, Kerai S, Shahid S, Qazi M, Rehman S, Aziz F, Jehan F. Predictors of Respiratory Syncytial Virus, Influenza Virus, and Human Metapneumovirus Carriage in Children Under 5 Years With WHO-Defined Fast-Breathing Pneumonia in Pakistan. Influenza Other Respir Viruses 2024; 18:e13285. [PMID: 38616564 PMCID: PMC11016811 DOI: 10.1111/irv.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality in children < 5 years. We describe nasopharyngeal carriage of respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus among children with fast-breathing pneumonia in Karachi, Pakistan. METHODS We performed a cross-sectional analysis of nasopharyngeal swabs from children aged 2-59 months with fast-breathing pneumonia, enrolled in the randomized trial of amoxicillin versus placebo for fast-breathing pneumonia (RETAPP) (NCT02372461) from 2014 to 2016. Swabs were collected using WHO standardized methods, processed at the Aga Khan University, Pakistan. Viral detection was performed using LUMINEX xTAG respiratory viral panel assay and logistic regression identified clinical and sociodemographic predictors. FINDINGS Of the 1000 children tested, 92.2% (n = 922) were positive for viral carriage. RSV, hMPV, and influenza virus were detected in 59 (6.4%), 56 (6.1%), and 58 (6.3%) children and co-infections in three samples (two RSV-hMPV and one influenza-hMPV). RSV carriage was common in infants (56%), we observed a higher occurrence of fever in children with hMPV and influenza virus (80% and 88%, respectively) and fast breathing in RSV (80%) carriage. RSV carriage was positively associated with a history of fast/difficulty breathing (aOR: 1.96, 95% CI 1.02-3.76) and low oxygen saturation (aOR: 2.52, 95% CI 1.32-4.82), hMPV carriage was positively associated with a complete vaccination status (aOR: 2.22, 95% CI 1.23-4.00) and body temperature ≥ 37.5°C (aOR: 2.34, 95% CI 1.35-4.04) whereas influenza viral carriage was associated with body temperature ≥ 37.5°C (aOR: 4.48, 95% CI 2.53-7.93). CONCLUSION We observed a high nasopharyngeal viral carriage among children with WHO-defined fast-breathing pneumonia in Pakistan. Fever, difficulty in breathing, hypoxia and vaccination status are important clinical predictors for viral nonsevere community-acquired pneumonia.
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Affiliation(s)
| | - Salima Kerai
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Shahira Shahid
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | | | - Sarah Rehman
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fatima Aziz
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
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Fry S, Chokephaibulkit K, Pallem S, Henry O, Pu Y, Akawung A, Kim JH, Yanni E, Tullio AN, Aurpibul L, Lee CMF, Ceballos A, Zaman K, Abadía de Regalado I, Ahmed K, Arias Fernandez DA, Taher SW, Caccavo J, Coutinho CM, D’Andrea Nores U, De León T, D’Silva EC, De Bernardi M, Dieser P, Falaschi A, Flores Acosta CDC, Gentile A, Teo IH, Kotze S, López-Medina E, Luca R, Lucion MF, Mantaring JBIIIV, Marín B, Moelo M, Mussi-Pinhata MM, Pinto J, Puthanakit T, Reyes O, Roa MF, Rodriguez Brieschke MT, Rodriguez CE, Rodriguez Niño JN, Schwarzbold AV, Sierra Garcia A, Sivapatham L, Soon R, Tinoco JC, Velásquez Penagos JA, Dos Santos G. Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2023; 10:ofad553. [PMID: 38088983 PMCID: PMC10715683 DOI: 10.1093/ofid/ofad553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 12/30/2023] Open
Abstract
Background Incidence data of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions. Methods This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV. Results Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3-2.3), 0.8 (.3-1.5), and 1.6 (1.1-2.2) per 100 person-years for infants aged 0-2, 0-5, and 0-11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1-14.0), 11.7 (9.6-14.0), and 8.7 (7.5-10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0-8.3, all-cause LRTI: 0.0-49.6 per 100 person-years for 0- to 11-month-olds). Conclusions RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19-related nonpharmaceutical interventions. Clinical Trials Registration NCT03614676.
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Affiliation(s)
- Samantha Fry
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | | | | | - Linda Aurpibul
- Research Institute for Health Science, Chiang Mai University, Chiang Mai, Thailand
| | | | - Ana Ceballos
- Instituto Médico Río Cuarto, Río Cuarto, Córdoba, Argentina
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research (icddr, b), Dhaka, Bangladesh
| | | | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | | | | | - Juliana Caccavo
- Donación Francisco Santojanni Hospital, Buenos Aires, Argentina
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | - Tirza De León
- Maternity Hospital José Domingo De Obaldia, San Pablo Viejo, Panama
| | | | | | - Pablo Dieser
- Instituto Médico Río Cuarto, Río Cuarto, Córdoba, Argentina
| | - Andrea Falaschi
- Dr Ramon Carrillo Hospital, Mendoza, Argentina
- Dr Diego Paroissien Hospital, Mendoza, Argentina
| | | | - Angela Gentile
- Epidemiology Department, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Sheena Kotze
- Synexus Stanza Clinical Research Centre, Pretoria, South Africa
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Department of Pediatrics, Universidad del Valle, Valle del Cauca, Colombia
- Clinica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Ruben Luca
- Hospital F. F. Santojanni C1407, Buenos Aires, Argentina
| | - Maria Florencia Lucion
- Epidemiology Department, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Jacinto Blas III V Mantaring
- Department of Clinical Epidemiology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | | | | | | | - Jorge Pinto
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thanyawee Puthanakit
- Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Osvaldo Reyes
- Santo Tomás Hospital, Panama City, Panama
- Centro de Vacunación Internacional S.A., La Chorrera, Panama
- Member of the Sistema Nacional de Investigadores (SNI), Panama City, Panama
| | - Maria Fernanda Roa
- Department of Pediatrics, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Camilo Enrique Rodriguez
- Department of Gynecology and Obstetrics, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, University of the Andes, Bogotá, Colombia
| | | | - Alexandre Vargas Schwarzbold
- Hospital Universitário de Santa Maria, Centro de Pesquisa Clínica, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Alexandra Sierra Garcia
- Centro de Estudios en Infectología Pediátrica, Department of Pediatrics, Universidad del Valle, Valle del Cauca, Colombia
- Clinica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Lavitha Sivapatham
- Department of Obstetrics and Gynecology, Ampang Hospital, Ampang, Malaysia
| | - Ruey Soon
- Department of Obstetrics and Gynecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Malaysia
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Hayashida S, Nagano N, Morohashi T, Momoki E, Nezu K, Shimozawa K, Ishii W, Okahashi A, Morioka I. Clinical factors associated with extended hospitalization in pediatric patients ≥3 years of age with respiratory syncytial virus or human metapneumovirus infection: A Japanese single-center, retrospective study. Medicine (Baltimore) 2023; 102:e35565. [PMID: 37861549 PMCID: PMC10589578 DOI: 10.1097/md.0000000000035565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections are common in children worldwide. However, the clinical factors related to extended hospitalization in Japanese patients aged ≥3 years remain elusive. We aimed to elucidate the clinical risk factors contributing to hospital stays ≥7 days in patients with RSV and hMPV infections. Patients ≥3 years of age who were hospitalized due to RSV or hMPV infection between 2014 to 2020 were included. Twenty-one RSV- and 27 hMPV-infected patients were enrolled. Patients were divided into 2 groups: hospitalization for ≥ and <7 days. Univariate and multivariate analyses determined the clinical risk factors contributing to hospital stay ≥7 days. The RSV- and hMPV-infected patients had similar clinical characteristics. The clinical risk factors contributing to extended hospitalization were analyzed in the 48 infected patients of the 2 groups. The presence of prophylactic antibiotics usage, co-bacterial colonization, and underlying diseases were extracted by univariate analysis (P < .05). In multivariate analysis, underlying diseases were determined as an independent clinical risk factor (odds ratio 8.09, P = .005). Underlying diseases contributed to extended hospitalization in RSV- or hMPV-infected patients ≥3 years of age.
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Affiliation(s)
- Shingo Hayashida
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tamaki Morohashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Emiko Momoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Keiko Nezu
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuyoshi Shimozawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Wakako Ishii
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Kamata K, Thein KN, Di Ja L, Win NC, Win SMK, Suzuki Y, Ito A, Osada H, Chon I, Phyu WW, Aizawa Y, Ikuse T, Ota T, Kyaw Y, Tin HH, Shobugawa Y, Watanabe H, Saito R, Saitoh A. Clinical manifestations and outcome of viral acute lower respiratory infection in hospitalised children in Myanmar. BMC Infect Dis 2022; 22:350. [PMID: 35395744 PMCID: PMC8992414 DOI: 10.1186/s12879-022-07342-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/25/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Acute lower respiratory infection (ALRI) remains the leading cause of death in children worldwide, and viruses have been the major cause of ALRI. In Myanmar, ALRI is associated with high morbidity and mortality in children, and detailed information on ALRI is currently lacking. METHODS This prospective study investigated the viral aetiologies, clinical manifestations, and outcomes of ALRI in hospitalised children aged 1 month to 12 years at the Yankin Children Hospital, Yangon, Myanmar from May 2017 to April 2019. The sample size was set to 300 patients for each year. Two nasopharyngeal swabs were obtained for the patients with suspected viral ALRI; one for rapid tests for influenza and respiratory syncytial virus (RSV), and the other for real-time PCR for the 16 ALRI-causing viruses. Pneumococcal colonization rates were also investigated using real-time PCR. Clinical information was extracted from the medical records, and enrolled patients were categorised by age and severity for comparison. RESULTS Among the 5463 patients admitted with a diagnosis of ALRI, 570 (10.4%) were enrolled in this study. The median age of the patients was 8 months (interquartile range, 4-15 months). The most common symptoms were cough (93%) and difficulty in breathing (73%), while the most common signs of ALRI were tachypnoea (78%) and chest indrawing (67%). A total of 16 viruses were detected in 502 of 570 patients' samples (88%), with RSV B (36%) and rhinovirus (28%) being the most commonly detected. Multiple viruses were detected in 221 of 570 samples (37%) collected from 570 patients. Severe ALRI was diagnosed in 107 of 570 patients (19%), and RSV B and human rhinovirus were commonly detected. The mortality rate was 5%; influenza virus A (29%) and RSV B (21%) were commonly detected, and stunting and lack of immunization were frequently observed in such cases. Additionally, 45% (259/570) of the patients had pneumococcal colonization. CONCLUSIONS Viral ALRI in hospitalised children with a median of 8 months has significant morbidity and mortality rates in Myanmar. RSV and rhinovirus were the most commonly detected from nasopharyngeal swabs, while influenza virus and RSV were the most frequently associated with fatal cases.
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Grants
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
- 15fm0108009h0001, 19fm0108009h0005 Japan Agency for Medical Research and Development
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Affiliation(s)
- Kazuhiro Kamata
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | | | - Lasham Di Ja
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
| | - Nay Chi Win
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
| | - Su Mon Kyaw Win
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
| | - Yuko Suzuki
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Ai Ito
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Hidekazu Osada
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
- Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Irina Chon
- Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Wint Wint Phyu
- Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Tatsuki Ikuse
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Tomomi Ota
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
| | - Yadanar Kyaw
- Respiratory Medicine Department, Thingangyun Sanpya General Hospital, Yangon, Myanmar
| | - Htay Htay Tin
- Department of Medical Services, National Health Laboratory, Ministry of Health and Sports, Yangon, Myanmar
| | - Yugo Shobugawa
- Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Hisami Watanabe
- Infectious Diseases Research Center of Niigata University in Myanmar, Yangon, Myanmar
| | - Reiko Saito
- Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan.
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Rahman AE, Hossain AT, Nair H, Chisti MJ, Dockrell D, Arifeen SE, Campbell H. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2022; 10:e348-e359. [PMID: 35180418 PMCID: PMC8864303 DOI: 10.1016/s2214-109x(21)00586-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. METHODS We conducted a systematic review using the following key concepts "children under five years of age" AND "pneumonia" AND "hypoxaemia" AND "low- and middle-income countries" by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO2 <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. FINDINGS We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26-36; 101 775 children) among all children with WHO-classified pneumonia, 41% (33-49; 30 483 children) among those with very severe or severe pneumonia, and 8% (3-16; 2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5-8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high τ2 (ie, 0·17), indicating a high level of heterogeneity between studies, and a high I2 value (ie, 99·6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. INTERPRETATION The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. FUNDING UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109).
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Affiliation(s)
- Ahmed Ehsanur Rahman
- The University of Edinburgh, Edinburgh, UK; International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Jayaweera JAAS, Morel AJ, Abeykoon AMSB, Pitchai FNN, Kothalawela HS, Peiris JSM, Noordeen F. Viral burden and diversity in acute respiratory tract infections in hospitalized children in wet and dry zones of Sri Lanka. PLoS One 2021; 16:e0259443. [PMID: 34919553 PMCID: PMC8682885 DOI: 10.1371/journal.pone.0259443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
The present study was done to identify the viral diversity, seasonality and burden associated with childhood acute respiratory tract infection (ARTI) in Sri Lanka. Nasopharyngeal aspirates (NPA) of hospitalized children (1 month-5 years) with ARTI were collected in 2 centers (wet and dry zones) from March 2013 to August 2014. Respiratory viral antigen detection by immunofluorescence assay (IFA) was used to identify the infecting viruses. IFA negative 100 NPA samples were tested for human metapeumovirus (hMPV), human bocavirus and corona viruses by polymerase chain reaction. Of the 443 and 418 NPAs, 37.2% and 39.4% were positive for any of the 8 different respiratory viruses tested from two centers studied. Viral co-infection was detected with respiratory syncytial virus (RSV) in both centers. Peak viral detection was noted in the wet zone from May-July 2013 and 2014 and in the dry zone from December-January 2014 suggesting a local seasonality for viral ARTI. RSV showed a clear seasonality with a direct correlation of monthly RSV infections with rainy days in the wet zone and an inverse correlation with temperature in both centers. The case fatality rate was 2.7% for RSV associated ARTI. The overall disability adjusted life years was 335.9 and for RSV associated ARTI it was 241.8. RSV was the commonly detected respiratory virus with an annual seasonality and distribution in rainy seasons in the dry and wet zones of Sri Lanka. Identifying the virus and seasonality will contribute to employ preventive measures and reduce the empirical use of antibiotics in resource limited settings.
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Affiliation(s)
- J. A. A. S. Jayaweera
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A. J. Morel
- Teaching Hospital, Gampola, Gampola, Sri Lanka
| | - A. M. S. B. Abeykoon
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - F. N. N. Pitchai
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - H. S. Kothalawela
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - J. S. M. Peiris
- School of Public Health, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - F. Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Divarathne MVM, Ahamed RR, Noordeen F. The Impact of RSV-Associated Respiratory Disease on Children in Asia. J PEDIAT INF DIS-GER 2019; 14:79-88. [PMID: 32300274 PMCID: PMC7117084 DOI: 10.1055/s-0038-1637752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory tract infections (ARTIs) are leading contributors to the global infectious disease burden, which is estimated to be 112,900,000 disability adjusted life years. Viruses contribute to the etiology of ARTIs in a big way compared with other microorganisms. Since the discovery of respiratory syncytial virus (RSV) 61 years ago, the virus has been recognized as a major cause of ARTI and hospitalization in children. The morbidity and mortality attributable to RSV infection appear to be higher in infants < 3 months and in those with known risk factors such as prematurity, chronic lung, and congenital heart diseases. Crowded living conditions, exposure to tobacco smoke, and industrial or other types of air pollution also increase the risk of RSV-associated ARTI. Many epidemiological studies have been conducted in developed countries to understand the seasonal patterns and risk factors associated with RSV infections. Dearth of information on RSV-associated morbidity and mortality in Asian and developing countries indicates the need for regional reviews to evaluate RSV-associated disease burden in these countries. Epidemiological studies including surveillance is the key to track the disease burden including risk factors, seasonality, morbidity, and mortality associated with RSV infection in these countries. These data will contribute to improve the clinical diagnosis and plan preventive strategies in resource-limited developing countries.
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Affiliation(s)
| | - Rukshan Rafeek Ahamed
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Etiology of Coinfections in Children with Influenza during 2015/16 Winter Season in Nepal. Int J Microbiol 2018; 2018:8945142. [PMID: 30510579 PMCID: PMC6230385 DOI: 10.1155/2018/8945142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/05/2018] [Accepted: 10/09/2018] [Indexed: 01/17/2023] Open
Abstract
Acute respiratory infections (ARIs) are one of the major public health problems in developing countries like Nepal. Besides the influenza, several other pathogens are responsible for acute respiratory infection in children. Etiology of infections is poorly characterized at the course of clinical management, and hence empirical antimicrobial agents are used. The objective of this study was to characterize the influenza and other respiratory pathogens by real-time PCR assay. A total of 175 throat swab specimens of influenza-positive cases collected at National Influenza Center, Nepal, during the 2015/16 winter season were selected for detecting other respiratory copathogens. Total nucleic acid was extracted using Pure Link viral RNA/DNA mini kit (Invitrogen), and multiplex RT-PCR assays were performed. Influenza A and B viruses were found in 120 (68.6%) and 55 (31.4%) specimens, respectively, among which coinfections were found in 106 (60.6%) specimens. Among the influenza A-positive cases, 25 (20.8%) were A/H1N1 pdm09 and 95 (79.2%) were A/H3 subtypes. Viruses coinfected frequently with influenza virus in children were rhinovirus (26; 14.8%), respiratory syncytial virus A/B (19; 10.8%), adenovirus (14; 8.0%), coronavirus (CoV)-HKU1 (14; 8.0%), CoV-OC43 (5; 2.9%), CoV-229E (2; 1.1%), metapneumovirus A/B (5; 2.9%), bocavirus (6; 3.4%), enterovirus (5; 2.9%), parainfluenza virus-1 (3; 1.7%), and parainfluenza virus-3 (2; 1.1%). Coinfection of Mycoplasma pneumoniae with influenza virus was found in children (5; 2.8%). Most of the viral infection occurred in young children below 5 years of age. In addition to influenza virus, nine different respiratory pathogens were detected, of which coinfections of rhinovirus and respiratory syncytial virus A/B were predominantly found in children. This study gives us better information on the respiratory pathogen profile and coinfection combinations which are important for diagnosis and treatment of ARIs.
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Bates MN, Pokhrel AK, Chandyo RK, Valentiner-Branth P, Mathisen M, Basnet S, Strand TA, Burnett RT, Smith KR. Kitchen PM 2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type. ENVIRONMENTAL RESEARCH 2018; 161:546-553. [PMID: 29241064 DOI: 10.1016/j.envres.2017.11.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Globally, solid fuels are used by about 3 billion people for cooking and a smaller number use kerosene. These fuels have been associated with acute lower respiratory infection (ALRI) in children. Previous work in Bhaktapur, Nepal, showed comparable relationships of biomass and kerosene cooking fuels with ALRI in young children, compared to those using electricity for cooking. We examine the relationship of kitchen PM2.5 concentrations to ALRI in those households. METHODS ALRI cases and age-matched controls were enrolled from a cohort of children 2-35 months old. 24-h PM2.5 was measured once in each participant's kitchen. The main analysis was carried out with conditional logistic regression, with PM2.5 measures specified both continuously and as quartiles. RESULTS In the kitchens of 393 cases and 431 controls, quartiles of increasing PM2.5 concentration were associated with a monotonic increase in odds ratios (OR): 1.51 (95% CI: 1.00, 2.27), 2.22 (1.47, 3.34), 2.48 (1.63, 3.77), for the 3 highest exposure quartiles. The general kitchen concentration-response shape across all stoves was supralinear. There was evidence for increased risk with biomass stoves, but the slope for kerosene stoves was steeper, the highest quartile OR being 5.36 (1.35, 21.3). Evidence for increased risk was also found for gas stoves. CONCLUSION Results support previous reports that biomass and kerosene cooking fuels are both ALRI risk factors, but suggests that PM2.5 from kerosene is more potent on a unit mass basis. Further studies with larger sample sizes and preferably using electricity as the baseline fuel are needed.
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Affiliation(s)
- Michael N Bates
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
| | - Amod K Pokhrel
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA
| | - Ram K Chandyo
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Sudha Basnet
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway; Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA
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Yang D, Chen L, Chen Z. The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings. PLoS One 2018; 13:e0191951. [PMID: 29377957 PMCID: PMC5788379 DOI: 10.1371/journal.pone.0191951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae infection is a major cause of community-acquired pneumonia in children. We performed a retrospective study to evaluate the clinical impact of the timing of azithromycin treatment in children with Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings. METHODS AND FINDINGS A total of 623 patients were enrolled in this study and were divided into 2 groups according to the timing of azithromycin therapy. Children who received azithromycin within 3 days (72 hours) after the onset of Mycoplasma pneumoniae pneumonia were classified into the early azithromycin treatment group (n = 174), whereas the late azithromycin treatment group (n = 449) comprised children treated with azithromycin more than 72 hours after symptom onset. We evaluated clinical prognosis according to demographic, clinical and laboratory characteristics. Although the early azithromycin treatment group exhibited a longer fever duration after azithromycin administration (7.17±4.12 versus 4.82±3.99 days, P<0.01), the total fever duration exhibited no significant difference (9.02±4.58 versus 9.57±4.91 days, P = 0.212). After azithromycin therapy, the two groups exhibited no significant differences with respect to improvements in the laboratory and radiological findings (all P>0.05). CONCLUSION The timing of azithromycin treatment is not associated with the clinical prognosis of Mycoplasma pneumoniae pneumonia in children in high macrolide-resistant Mycoplasma pneumoniae prevalence settings.
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Affiliation(s)
- Dehua Yang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Linghong Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- The First People’s Hospital of Wenling, Wenling, Zhejiang, P.R. China
| | - Zhimin Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- * E-mail:
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Moe N, Krokstad S, Stenseng IH, Christensen A, Skanke LH, Risnes KR, Nordbø SA, Døllner H. Comparing Human Metapneumovirus and Respiratory Syncytial Virus: Viral Co-Detections, Genotypes and Risk Factors for Severe Disease. PLoS One 2017; 12:e0170200. [PMID: 28095451 PMCID: PMC5240941 DOI: 10.1371/journal.pone.0170200] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is unclarified as to whether viral co-detection and human metapneumovirus (HMPV) genotypes relate to clinical manifestations in children with HMPV and lower respiratory tract infection (LRTI), and if the clinical course and risk factors for severe LRTI differ between HMPV and respiratory syncytial virus (RSV). METHODS We prospectively enrolled hospitalized children aged <16 years with LRTI from 2006 to 2015. Children were clinically examined, and nasopharyngeal aspirates were analyzed using semi-quantitative, real-time polymerase chain reaction tests for HMPV, RSV and 17 other pathogens. HMPV-positive samples were genotyped. RESULTS A total of 171 children had HMPV infection. HMPV-infected children with single virus (n = 106) and co-detections (n = 65) had similar clinical manifestations. No clinical differences were found between HMPV genotypes A (n = 67) and B (n = 80). The HMPV-infected children were older (median 17.2 months) than RSV-infected children (median 7.3 months, n = 859). Among single virus-infected children, no differences in age-adjusted LRTI diagnoses were found between HMPV and RSV. Age was an important factor for disease severity among single virus-infected children, where children <6 months old with HMPV had a milder disease than those with RSV, while in children 12-23 months old, the pattern was the opposite. In multivariable logistic regression analysis for each virus type, age ≥12 months (HMPV), and age <6 months (RSV), prematurity, ≥1 chronic disease and high viral loads of RSV, but not high HMPV viral loads, were risk factors for severe disease. CONCLUSIONS Among hospitalized children with LRTI, HMPV manifests independently of viral co-detections and HMPV genotypes. Disease severity in HMPV- and RSV-infected children varies in relation to age. A history of prematurity and chronic disease increases the risk of severe LRTI among HMPV- and RSV-infected children.
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Affiliation(s)
- Nina Moe
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- * E-mail:
| | - Sidsel Krokstad
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Inger Heimdal Stenseng
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Christensen
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lars Høsøien Skanke
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kari Ravndal Risnes
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Svein Arne Nordbø
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henrik Døllner
- Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Clinical presentation and microbiological diagnosis in paediatric respiratory tract infection: a systematic review. Br J Gen Pract 2016; 65:e69-81. [PMID: 25624310 DOI: 10.3399/bjgp15x683497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Antibiotic prescribing decisions for respiratory tract infection (RTI) in primary care could be improved if clinicians could target bacterial infections. However, there are currently no evidence-based diagnostic rules to identify microbial aetiology in children presenting with acute RTIs. AIM To analyse evidence of associations between clinical symptoms or signs and detection of microbes from the upper respiratory tract (URT) of children with acute cough. DESIGN AND SETTING Systematic review and meta-analysis. METHOD A literature search identified articles reporting relationships between individual symptoms and/or signs, and microbes detected from URT samples. Associations between pathogens and symptoms or signs were summarised, and meta-analysis conducted where possible. RESULTS There were 9984 articles identified, of which 28 met inclusion criteria. Studies identified 30 symptoms and 41 signs for 23 microbes, yielding 1704 potential associations, of which only 226 (13%) have presently been investigated. Of these, relevant statistical analyses were presented for 175 associations, of which 25% were significant. Meta-analysis demonstrated significant relationships between respiratory syncytial virus (RSV) detection and chest retractions (pooled odds ratio [OR] 1.9, 95% confidence interval [CI] = 1.6 to 2.3), wheeze (pooled OR 1.7, 95% CI = 1.5 to 2.0), and crepitations/crackles (pooled OR 1.7, 95% CI = 1.3 to 2.2). CONCLUSIONS There was an absence of evidence for URT pathogens other than RSV. The meta-analysis identified clinical signs associated with RSV detection, suggesting clinical presentation may offer some, albeit poor, diagnostic value. Further research is urgently needed to establish the value of symptoms and signs in determining microbiological aetiology and improve targeting of antibiotics in primary care.
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Do LAH, Bryant JE, Tran AT, Nguyen BH, Tran TTL, Tran QH, Vo QB, Tran Dac NA, Trinh HN, Nguyen TTH, Le Binh BT, Le K, Nguyen MT, Thai QT, Vo TV, Ngo NQM, Dang TKH, Cao NH, Tran TV, Ho LV, Farrar J, de Jong M, van Doorn HR. Respiratory Syncytial Virus and Other Viral Infections among Children under Two Years Old in Southern Vietnam 2009-2010: Clinical Characteristics and Disease Severity. PLoS One 2016; 11:e0160606. [PMID: 27500954 PMCID: PMC4976934 DOI: 10.1371/journal.pone.0160606] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/21/2016] [Indexed: 12/16/2022] Open
Abstract
Background Despite a high burden of respiratory syncytial virus (RSV) infections among children, data on demographic and clinical characteristics of RSV are scarce in low and middle income countries. This study aims to describe the viral etiologies, the demographic, epidemiological, and clinical characteristics of children under two years of age who were hospitalized with a lower respiratory tract infections (LRTI), focusing on RSV (prevalence, seasonality, subgroups, viral load) and its association with disease severity. Methods A prospective study among children under two years of age, hospitalized with LRTI was conducted in two referral pediatric hospitals in Ho Chi Minh City, Vietnam, from May 2009 to December 2010. Socio-demographic, clinical data and nasopharyngeal swabs were collected on enrolment and discharge. Multiplex real-time RT-PCR (13 viruses) and quantitative RSV RT-PCR were used to identify viral pathogens, RSV load and subgroups. Results Among 632 cases, 48% were RSV positive. RSV infections occurred at younger age than three other leading viral infections i.e rhinovirus (RV), metapneumovirus (MPV), parainfluenza virus (PIV-3) and were significantly more frequent in the first 6 months of life. Clinical severity score of RSV infection was significantly higher than PIV-3 but not for RV or MPV. In multivariate analysis, RV infection was significantly associated with severity while RSV infection was not. Among RSV infections, neither viral load nor viral co-infections were significantly associated with severity. Young age and having fever at admission were significantly associated with both RSV and LRTI severity. A shift in RSV subgroup predominance was observed during two consecutive rainy seasons but was not associated with severity. Conclusion We report etiologies, the epidemiological and clinical characteristics of LRTI among hospitalized children under two years of age and risk factors of RSV and LRTI severity.
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Affiliation(s)
- Lien Anh Ha Do
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
- Murdoch Children’s Research Institute, Melbourne, Australia
- * E-mail:
| | - Juliet E. Bryant
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Anh Tuan Tran
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Bach Hue Nguyen
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Thi Thu Loan Tran
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Quynh Huong Tran
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Quoc Bao Vo
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Nguyen Anh Tran Dac
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Hong Nhien Trinh
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Thi Thanh Hai Nguyen
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Bao Tinh Le Binh
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Khanh Le
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Minh Tien Nguyen
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Quang Tung Thai
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Thanh Vu Vo
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Ngoc Quang Minh Ngo
- Children Hospital 1, 341 Su Van Hanh, Ward 10, District 10, Ho Chi Minh City, Vietnam
| | - Thi Kim Huyen Dang
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Ngoc Huong Cao
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Thu Van Tran
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Lu Viet Ho
- Children Hospital 2, 14 Ly Tu Trong, Ben Nghe Ward, District 1, Ho Chi Minh City, Vietnam
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
| | - Menno de Jong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Ding S, Wang X, Chen W, Fang Y, Liu B, Liu Y, Fei G, Wang L. Decreased Interleukin-10 Responses in Children with Severe Mycoplasma pneumoniae Pneumonia. PLoS One 2016; 11:e0146397. [PMID: 26751073 PMCID: PMC4708986 DOI: 10.1371/journal.pone.0146397] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/16/2015] [Indexed: 12/28/2022] Open
Abstract
Several cytokines may play roles in the immunological pathogenesis of mycoplasmal pneumonia caused by Mycoplasma pneumoniae. In this study, we investigated serum cytokine profiles in children with mycoplasmal pneumonia. The serum levels of interleukin (IL)-8, IL-10, and IL-18 were examined using ELISA kits in 34 patients with M. pneumoniae infection (Group 1, 11 with severe mycoplasmal pneumonia; Group 2, 13 with mild mycoplasmal pneumonia; Group 3, 10 with asthma) and 32 age-matched, non-infected controls. The serum levels of IL-8, IL-10, and IL-18 increased significantly in patients with mycoplasmal pneumonia compared with those in controls (P<0.01). The serum levels of IL-10 decreased significantly in Group 1 compared with those in Group 2 (P<0.01). The serum levels of IL-18 increased significantly in Group 1 compared with those in Group 2 (P<0.01). The serum levels of IL-10 and IL-18 decreased significantly in 10 M. pneumoniae-infected patients with asthma compared with those in 24 M. pneumoniae-infected patients without asthma (P<0.01). We examined the level of interleukins (IL-8, IL-10 and IL-18) after the patients started therapy. The data showed that IL-18 were lower after therapy (P<0.01). Collectively, our data suggested that these cytokines may be involved in the pathogenesis of mycoplasmal pneumonia.
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Affiliation(s)
- Shenggang Ding
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaowu Wang
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
- Department of Clinical Laboratory, Fuyang Second People’s Hospital, Fuyang, Anhui, China
| | - Wei Chen
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
| | - Yuan Fang
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
| | - Boyu Liu
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
| | - Yan Liu
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
| | - Guanghe Fei
- Department of Respiratory Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- * E-mail: (LW); (GF)
| | - Linding Wang
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
- * E-mail: (LW); (GF)
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15
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Liu T, Li Z, Zhang S, Song S, Julong W, Lin Y, Guo N, Xing C, Xu A, Bi Z, Wang X. Viral Etiology of acute respiratory tract infections in hospitalized children and adults in Shandong Province, China. Virol J 2015; 12:168. [PMID: 26467854 PMCID: PMC4606902 DOI: 10.1186/s12985-015-0388-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background The dominant viral etiologies responsible for acute respiratory infections (ARIs) are poorly understood, particularly among hospitalized patients. Improved etiological insight is needed to improve clinical management and prevention of ARIs. Methods Clinical and demographic information and throat swabs were collected from 607 patients from 2011 to 2013 in Shandong Province, China. Multiplex RT-PCR (SeeplexTM RV detection, Seegene) was performed to detected 12 respiratory viral pathogens. Results A total of 607 hospitalized patients were enrolled from 2011 to 2013. Viruses were identified in 35.75 % (217/607) of cases, including 78 influenza virus A and B (IVA and IVB), 47 para-influenza viruses (PIVs), 41 respiratory syncytial virus (RSV) and 38 adenovirus (ADV). For the children under 15 year old, the common detected viruses were influenza viruses, RSV, PIVS and ADV, while the principal respiratory viruses were human coronaviruses (HCoV), PIVs, influenza viruses for the old adults. Co-infections with multiple viruses were detected in 15.67 % of patients. Children under 5 years were more likely to have one or more detectable virus associated with their ARI. The peak of ARI caused by the respiratory viruses occurred in winter. Conclusion This study demonstrated respiratory viruses were the major cause of hospitalized ARI patients in Shandong Province, influenza virus was the most common detected, RSV was the highest incidence among the young children (≤5 years). These findings also gave a better understand of virus distribution among different age and seasons, which help to consider potential therapeutic approaches and develop effective prevention strategies for respiratory virus infection.
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Affiliation(s)
- Ti Liu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Zhong Li
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Shengyang Zhang
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Shaoxia Song
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Wu Julong
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Yi Lin
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Nongjian Guo
- Jinan Central Hospital Affiliated to Shandong University, Jinan, 250014, Shandong, China.
| | - Chunyan Xing
- Jinan Central Hospital Affiliated to Shandong University, Jinan, 250014, Shandong, China.
| | - Aiqiang Xu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
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Lanaspa M, Annamalay AA, LeSouëf P, Bassat Q. Epidemiology, etiology, x-ray features, importance of co-infections and clinical features of viral pneumonia in developing countries. Expert Rev Anti Infect Ther 2014; 12:31-47. [PMID: 24410617 PMCID: PMC7103723 DOI: 10.1586/14787210.2014.866517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pneumonia is still the number one killer of young children globally, accounting for 18% of mortality in children under 5 years of age. An estimated 120 million new cases of pneumonia occur globally each year. In developing countries, management and prevention efforts against pneumonia have traditionally focused on bacterial pathogens. More recently however, viral pathogens have gained attention as a result of improved diagnostic methods, such as polymerase chain reaction, outbreaks of severe disease caused by emerging pathogens, discovery of new respiratory viruses as well as the decrease in bacterial pneumonia as a consequence of the introduction of highly effective conjugate vaccines. Although the epidemiology, etiology and clinical characterization of viral infections are being studied extensively in the developed world, little data are available from low- and middle-income countries. In this paper, we review the epidemiology, etiology, clinical and radiological features of viral pneumonia in developing countries.
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Affiliation(s)
- Miguel Lanaspa
- Barcelona Center for International Health Research, Hospital Clinic, University of Barcelona, Rosello 132, 08036 Barcelona, Spain
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Burden of invasive pneumococcal disease in children aged 1 month to 12 years living in South Asia: a systematic review. PLoS One 2014; 9:e96282. [PMID: 24798424 PMCID: PMC4010478 DOI: 10.1371/journal.pone.0096282] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/05/2014] [Indexed: 11/23/2022] Open
Abstract
Objective The primary objective was to estimate the burden of invasive pneumococcal disease (IPD) in children aged 1 month to 12 years in South Asian countries. Methods We searched three electronic databases (PubMed, Embase and the Cochrane Library) using a comprehensive search strategy, we manually searched published databases (Index Medicus and Current Contents) and we also searched the bibliographies of the included studies and retrieved reviews. The searches were current through June 2013. Eligible studies (community-based and hospital-based) were pooled and a separate analysis for India was also completed. A meta-regression analysis and heterogeneity analysis were performed. The protocol was registered with PROSPERO registration number CRD42013004483. Results A total of 22 studies surveying 36,714 children were included in the systematic review. Hospital-based prospective studies from South Asia showed that 3.57% of children had IPD, and 15% of all bacterial pneumonia cases were due to Streptococcus pneumoniae. Indian studies showed that the incidence of IPD was 10.58% in children admitted to hospitals with suspected invasive bacterial diseases, and 24% of all bacterial pneumonia cases were due to S. pneumonia. Population-based studies from South Asian countries showed that 12.8% of confirmed invasive bacterial diseases were caused by S. pneumonia whereas retrospective hospital-based studies showed that 28% of invasive bacterial diseases were due to S. pneumoniae. Meta-regression showed that there was a significant influence of the antigen testing method for diagnosing IPD on IPD prevalence. Conclusion S. pneumoniae is responsible for a substantial bacterial disease burden in children of South Asian countries including India despite the presence of high heterogeneity in this meta-analysis. Treatment guidelines must be formulated, and preventive measures like vaccines must also be considered.
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Verani JR, McCracken J, Arvelo W, Estevez A, Lopez MR, Reyes L, Moir JC, Bernart C, Moscoso F, Gray J, Olsen SJ, Lindblade KA. Surveillance for hospitalized acute respiratory infection in Guatemala. PLoS One 2013; 8:e83600. [PMID: 24391792 PMCID: PMC3877070 DOI: 10.1371/journal.pone.0083600] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/05/2013] [Indexed: 11/03/2022] Open
Abstract
Acute respiratory infections (ARI) are an important cause of illness and death worldwide, yet data on the etiology of ARI and the population-level burden in developing countries are limited. Surveillance for ARI was conducted at two hospitals in Guatemala. Patients admitted with at least one sign of acute infection and one sign or symptom of respiratory illness met the criteria for a case of hospitalized ARI. Nasopharyngeal/oropharyngeal swabs were collected and tested by polymerase chain reaction for adenovirus, parainfluenza virus types 1,2 and 3, respiratory syncytial virus, influenza A and B viruses, human metapneumovirus, Chlamydia pneumioniae, and Mycoplasma pneumoniae. Urine specimens were tested for Streptococcus pneumoniae antigen. Blood culture and chest radiograph were done at the discretion of the treating physician. Between November 2007 and December 2011, 3,964 case-patients were enrolled. While cases occurred among all age groups, 2,396 (60.4%) cases occurred in children <5 years old and 463 (11.7%) among adults ≥65 years old. Viruses were found in 52.6% of all case-patients and 71.8% of those aged <1 year old; the most frequently detected was respiratory syncytial virus, affecting 26.4% of case-patients. Urine antigen testing for Streptococcus pneumoniae performed for case-patients ≥15 years old was positive in 15.1% of those tested. Among 2,364 (59.6%) of case-patients with a radiograph, 907 (40.0%) had findings suggestive of bacterial pneumonia. Overall, 230 (5.9%) case-patients died during the hospitalization. Using population denominators, the observed hospitalized ARI incidence was 128 cases per 100,000, with the highest rates seen among children <1 year old (1,703 per 100,000), followed by adults ≥65 years old (292 per 100,000). These data, which demonstrate a substantial burden of hospitalized ARI in Guatemala due to a variety of pathogens, can help guide public health policies aimed at reducing the burden of illness and death due to respiratory infections.
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Affiliation(s)
- Jennifer R. Verani
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - John McCracken
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Wences Arvelo
- International Emerging Infections Program, Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alejandra Estevez
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Lissette Reyes
- Field Epidemiology Training Program, Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
- Área de Salud de Santa Rosa, Ministerio de Salud Pública y Asistencia Social, Cuilapa, Guatemala
| | - Juan Carlos Moir
- Área de Salud de Quetzaltenango, Ministerio de Salud Pública y Asistencia Social, Quetzaltenango, Guatemala
| | - Chris Bernart
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Jennifer Gray
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Sonja J. Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kim A. Lindblade
- International Emerging Infections Program, Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Roy Mukherjee T, Chanda S, Mullick S, De P, Dey‐Sarkar M, Chawla‐Sarkar M. Spectrum of respiratory viruses circulating in eastern India: prospective surveillance among patients with influenza-like illness during 2010-2011. J Med Virol 2013; 85:1459-65. [PMID: 23765782 PMCID: PMC7166942 DOI: 10.1002/jmv.23607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/07/2022]
Abstract
In developing countries, viruses causing respiratory disease are a major concern of public health. During January 2010-December 2011, 2,737 patients with acute respiratory infection from the outpatient departments as well as patients admitted to hospitals were screened for different respiratory viruses. Nasal and or throat swabs were collected and transported to the laboratory where initial screening of influenza A and influenza B viruses was performed. The samples were tested further for influenza C virus, parainfluenza viruses 1-4, human rhinovirus, metapneumovirus and respiratory syncytial virus by conventional RT- PCR. The study revealed that the majority of the patients were under 5 years of age; both due to their higher susceptibility to respiratory infections and presentation to hospitals. Out of 2,737 patients enrolled in this study, 59% were found positive for one or more respiratory viruses. Influenza B infection was detected in 12% of patients followed by influenza A (11.7%), respiratory syncytial virus (7.1%), parainfluenza virus-2 (6%), metapneumovirus (3%), parainfluenza virus-3 (1%), parainfluenza virus-4 (0.6%), parainfluenza virus-1 (0.3%), influenza C (0.2%) and human rhinovirus (0.2%). Distinct seasonal infection was observed only for influenza A and influenza B viruses.
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Affiliation(s)
| | - Shampa Chanda
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Satarupa Mullick
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Papiya De
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
| | - Malay Dey‐Sarkar
- National Institute of Cholera and Enteric DiseasesBeliaghata, KolkataIndia
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Turner P, Turner C, Watthanaworawit W, Carrara V, Cicelia N, Deglise C, Phares C, Ortega L, Nosten F. Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border. BMC Infect Dis 2013; 13:434. [PMID: 24498873 PMCID: PMC3847692 DOI: 10.1186/1471-2334-13-434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/30/2013] [Indexed: 11/24/2022] Open
Abstract
Background Pneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border. Methods Maela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR. Results Seven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/−gentamicin in 664/701, 94.7%). Conclusions Viral nucleic acid was identified in the nasopharynx in half the patients admitted with clinically diagnosed pneumonia. Development of immunisations targeting common respiratory viruses is likely to reduce the incidence of pneumonia in children living refugee camps and similar settings.
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Affiliation(s)
- Paul Turner
- Shoklo Malaria Research Unit, Mae Sot, Thailand.
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Lakhani D, Muley P. The association of positive chest radiograph and laboratory parameters with community acquired pneumonia in children. J Clin Diagn Res 2013; 7:1629-31. [PMID: 24086859 PMCID: PMC3782916 DOI: 10.7860/jcdr/2013/5132.3222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 05/27/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT This study was designed to compare the sensitivities of different investigations for the diagnosis of Community Acquired Pneumonia (CAP). A prospective study was carried out which compared the sensitivities of the chest radiographs, CRP, TLC, ESR and the blood cultures in sixty-six patients who were diagnosed with WHO defined CAP. METHOD AND MATERIAL The chest radiographs, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total leucocyte count (TLC) and blood cultures were determined in sixty-six patients who were amongst the age group of one month to five years of age, who were diagnosed with WHO defined CAP. STATISTICAL ANALYSIS It was carried out by calculating the proportion, mean, standard deviation (SD) and the sensitivity of the test/.able RESULTS The chest radiographs were found to be positive in 93.9% (n=62) patients, CRP was positive in 90.9% (n=60) patients, ESR was positive in 72.7% (n=42) patients, TLC was positive in 48.5% (n=38) patients and the blood cultures were positive in 6.1% (n=4) patients. Hence, the sensitivity of the chest radiograph, CRP, ESR, TLC and the blood culture in the diagnosis of CAP were 93.9%, 90.9%, 72.7%, 48.5% and 6.1%. CONCLUSION In view of the high sensitivity of CRP, which is almost similar to that of chest X-Ray in detecting CAP, CRP can be used as an alternative test to the chest radiographs at peripheral centres, where X-ray machines are not available.
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Affiliation(s)
- Dhairya Lakhani
- 3 year MBBS Student, S.B.K.S. Medical Institute & Research Centre
| | - Prasad Muley
- Associate Professor, Department of Paediatricts, S.B.K.S. Medical Institute & Research Centre
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Huang G, Yu D, Mao N, Zhu Z, Zhang H, Jiang Z, Li H, Zhang Y, Shi J, Zhang S, Wang X, Xu W. Viral etiology of acute respiratory infection in Gansu Province, China, 2011. PLoS One 2013; 8:e64254. [PMID: 23691184 PMCID: PMC3653869 DOI: 10.1371/journal.pone.0064254] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/12/2013] [Indexed: 11/28/2022] Open
Abstract
Background Acute respiratory infections (ARIs) are the leading cause of children and their leading killer. ARIs are responsible for at least six percent of the world's disability and death. Viruses are one of the most common agents causing ARIs. Few studies on the viral etiology and clinical characteristics of ARIs have been performed in the northwest region of China, including Gansu Province. Methods Clinical and demographic information and throat swabs were collected from 279 patients from January 1st to December 30st, 2011. Multiplex RT-PCR was performed to detect 16 respiratory viral pathogens. Results 279 patients were admitted for ARIs. The patients aged from 1 month to 12 years, with the median age of 2 years. Of which, 105 (37.6%) were positive for at least one pathogen. A total of 136 respiratory viral pathogens were identified from the 105 patients. Respiratory syncytial virus (RSV) was the most frequently detected pathogen (26.5%, 36/136), followed by parainfluenza virus (PIV) 1–3 (22.1%, 30/136), human rhinovirus (HRV) (21.3%, 29/136), human coronavirus (CoV) (10.3%, 14/136) and human adenovirus (HAdV) (9.6%, 13/136). Influenza A (Flu A), human metapneumovirus (hMPV) and human bocavirus (BoCA) were found 4.4%, 3.7% and 2.2%, respectively. Influenza B (Flu B) and seasonal influenza A H1N1(sH1N1) were not detected. Single-infections were detected in 30.5% (85/279) of cases. RSV was the most common pathogens in patients under 1 year and showed seasonal variation with peaks during winter and spring. Conclusions This paper presents data on the epidemiology of viral pathogens associated with ARIs among children in Gansu Province, China. RSV is most frequently detected in our study. The findings could serve as a reference for local CDC in drawing up further plans to prevent and control ARIs.
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Affiliation(s)
- Guohong Huang
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
- Xinjiang Medical University, Urumqi, People's Republic of China
| | - Deshan Yu
- Gansu Center for Disease Control and Prevention, Lanzhou, People's Republic of China
| | - Naiying Mao
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Zhen Zhu
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Hui Zhang
- Gansu Center for Disease Control and Prevention, Lanzhou, People's Republic of China
| | - Zhongyi Jiang
- Gansu Center for Disease Control and Prevention, Lanzhou, People's Republic of China
| | - Hongyu Li
- Gansu Center for Disease Control and Prevention, Lanzhou, People's Republic of China
| | - Yan Zhang
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jing Shi
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuang Zhang
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xinhua Wang
- Gansu Center for Disease Control and Prevention, Lanzhou, People's Republic of China
- * E-mail: (XW); (WX)
| | - Wenbo Xu
- Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
- * E-mail: (XW); (WX)
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Lu G, Li J, Xie Z, Liu C, Guo L, Vernet G, Shen K, Wang J. Human metapneumovirus associated with community-acquired pneumonia in children in Beijing, China. J Med Virol 2012; 85:138-43. [PMID: 23097275 PMCID: PMC7166590 DOI: 10.1002/jmv.23438] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 12/04/2022]
Abstract
Community‐acquired pneumonia is a major cause of morbidity and mortality in children worldwide. However, few studies have been conducted on the infection of human metapneumovirus (hMPV) associated with pediatric community‐acquired pneumonia in China. Nasopharyngeal aspirates were collected between July 2008 and June 2010 from 1,028 children, aged ≤16.5 years, who were diagnosed with community‐acquired pneumonia in Beijing, China. Reverse‐transcriptase polymerase chain reaction was used to screen the samples for hMPV and common respiratory viruses. hMPV was detected in 6.3% of the patients with community‐acquired pneumonia. This detection rate is the third highest for a respiratory virus in children with community‐acquired pneumonia, after that of rhinovirus (30.9%) and respiratory syncytial virus (30.7%). The detection rate of hMPV in 2008/2009 (42/540, 7.8%) was significantly higher than in 2009/2010 (23/488, 4.7%; χ2 = 4.065, P = 0.044). The hMPV subtypes A2, B1, and B2 were found to co‐circulate, with A2 being most prevalent. These results indicate that hMPV plays a substantial role in pediatric community‐acquired pneumonia in China. Overall, these findings provide a better understanding of the epidemiological and clinical features of hMPV infections. J. Med. Virol. 85:138–143, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Guilan Lu
- MOH Key Laboratory of Systems Pathogen Biology and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Lamarão LM, Ramos FL, Mello WA, Santos MC, Barbagelata LS, Justino MCA, da Silva AF, Quaresma AJPG, da Silva VB, Burbano RR, Linhares AC. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil. BMC Infect Dis 2012; 12:119. [PMID: 22591236 PMCID: PMC3449189 DOI: 10.1186/1471-2334-12-119] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 02/23/2012] [Indexed: 12/02/2022] Open
Abstract
Background Childhood pneumonia and bronchiolitis is a leading cause of illness and death in young children worldwide with Respiratory Syncytial Virus (RSV) as the main viral cause. RSV has been associated with annual respiratory disease outbreaks and bacterial co-infection has also been reported. This study is the first RSV epidemiological study in young children hospitalized with community-acquired pneumonia (CAP) in Belém city, Pará (Northern Brazil). Methods With the objective of determining the prevalence of RSV infection and evaluating the patients’ clinical and epidemiological features, we conducted a prospective study across eight hospitals from November 2006 to October 2007. In this study, 1,050 nasopharyngeal aspirate samples were obtained from hospitalized children up to the age of three years with CAP, and tested for RSV antigen by direct immunofluorescence assay and by Reverse Transcription Polymerase Chain Reaction (RT-PCR) for RSV Group identification. Results RSV infection was detected in 243 (23.1%) children. The mean age of the RSV-positive group was lower than the RSV-negative group (12.1 months vs 15.5 months, p<0.001) whereas gender distribution was similar. The RSV-positive group showed lower means of C-reactive protein (CRP) in comparison to the RSV-negative group (15.3 vs 24.0 mg/dL, p<0.05). Radiological findings showed that 54.2% of RSV-positive group and 50.3% of RSV-negative group had interstitial infiltrate. Bacterial infection was identified predominantly in the RSV-positive group (10% vs 4.5%, p<0.05). Rhinorrhea and nasal obstruction were predominantly observed in the RSV-positive group. A co-circulation of RSV Groups A and B was identified, with a predominance of Group B (209/227). Multivariate analysis revealed that age under 1 year (p<0.015), CRP levels under 48 mg/dL (p<0.001) and bacterial co-infection (p<0.032) were independently associated with the presence of RSV and, in the analyze of symptoms, nasal obstruction were independently associated with RSV-positive group (p<0.001). Conclusion The present study highlights the relevance of RSV infection in hospitalized cases of CAP in our region; our findings warrant the conduct of further investigations which can help design strategies for controlling the disease.
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Kwofie TB, Anane YA, Nkrumah B, Annan A, Nguah SB, Owusu M. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana. Virol J 2012; 9:78. [PMID: 22490115 PMCID: PMC3364910 DOI: 10.1186/1743-422x-9-78] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. METHOD Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. RESULTS Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2%) were positive for one or more viruses. Respiratory Syncytial Virus (RSV) was detected in 18(14.1%, 95%CI: 8.5% to 21.3%) patients followed by Adenoviruses (AdV) in 13(10.2%, 95%CI: 5.5% to 16.7%), Parainfluenza (PIV type: 1, 2, 3) in 4(3.1%, 95%CI: 0.9% to 7.8%) and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3). Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36) of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. CONCLUSION The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection.
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Affiliation(s)
- Theophilus B Kwofie
- School of Medical, Sciences, Kumasi, Department of Clinical Microbiology Kwame, Nkrumah University of Science and Technology, Kumasi, Ghana.
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Do AHL, van Doorn HR, Nghiem MN, Bryant JE, Hoang THT, Do QH, Van TL, Tran TT, Wills B, Nguyen VCV, Vo MH, Vo CK, Nguyen MD, Farrar J, Tran TH, de Jong MD. Viral etiologies of acute respiratory infections among hospitalized Vietnamese children in Ho Chi Minh City, 2004-2008. PLoS One 2011; 6:e18176. [PMID: 21455313 PMCID: PMC3063798 DOI: 10.1371/journal.pone.0018176] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/27/2011] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The dominant viral etiologies responsible for acute respiratory infections (ARIs) are poorly understood, particularly among hospitalized children in resource-limited tropical countries where morbidity and mortality caused by ARIs are highest. Improved etiological insight is needed to improve clinical management and prevention. OBJECTIVES We conducted a three-year prospective descriptive study of severe respiratory illness among children from 2 months to 13 years of age within the largest referral hospital for infectious diseases in southern Vietnam. METHODS Molecular detection for 15 viral species and subtypes was performed on three types of respiratory specimens (nose, throat swabs and nasopharyngeal aspirates) using a multiplex RT-PCR kit (Seeplex™ RV detection, Seegene) and additional monoplex real-time RT-PCRs. RESULTS A total of 309 children were enrolled from November 2004 to January 2008. Viruses were identified in 72% (222/309) of cases, including respiratory syncytial virus (24%), influenza virus A and B (17%), human bocavirus (16%), enterovirus (9%), human coronavirus (8%), human metapneumovirus (7%), parainfluenza virus 1-3 (6%), adenovirus (5%), and human rhinovirus A (4%). Co-infections with multiple viruses were detected in 20% (62/309) of patients. When combined, diagnostic yields in nose and throat swabs were similar to nasopharyngeal aspirates. CONCLUSION Similar to other parts in the world, RSV and influenza were the predominant viral pathogens detected in Vietnamese hospitalized children. Combined nasal and throat swabs are the specimens of choice for sensitive molecular detection of a broad panel of viral agents. Further research is required to better understand the clinical significance of single versus multiple viral coinfections and to address the role of bacterial (co-)infections involved in severe respiratory illness.
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Affiliation(s)
- Anh Ha Lien Do
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam.
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Chung HL, Shin JY, Ju M, Kim WT, Kim SG. Decreased interleukin-18 response in asthmatic children with severe Mycoplasma pneumoniae pneumonia. Cytokine 2011; 54:218-21. [PMID: 21356600 PMCID: PMC7129854 DOI: 10.1016/j.cyto.2011.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/14/2011] [Accepted: 02/03/2011] [Indexed: 11/29/2022]
Abstract
Purpose Mycoplasma pneumoniae (M. pneumoniae) is a common causative agent of pneumonia in children. The aim of this study is to determine whether there is any difference in selected cytokine or chemokines response in asthmatic children compared to non-asthmatic children during acute M. pneumoniae pneumonia. Methods Seventy-five children, 6–12 years of age, admitted with M. pneumoniae pneumonia were enrolled. Two patient groups were defined: the children with known asthma (N = 40) and non-asthmatic children (N = 35). Interleukin (IL)-18 and selected chemokines, IL-8, CXCL9, CXCL10, and regulation upon activation normal T-cell expressed and secreted (RANTES) were measured by means of ELISA in the plasma samples of the patients collected on admission. We investigated the values of these mediators in relation to the asthma status and symptom severity of the patients. Twenty age-matched, non-infected controls were also studied. Results Plasma levels of IL-18 and the chemokines increased significantly in the patients with M. pneumoniae pneumonia compared to non-infected, age-matched controls (P < 0.01). However, the asthmatic patients showed significantly reduced IL-18 and CXCL10 responses (P < 0.01, <0.05, respectively) and had more severe pneumonia symptoms (P < 0.01) compared to non-asthmatic patients. IL-18 was significantly lower in severe pneumonia group than in non-severe group (P < 0.05). Conclusions Our study suggests that IL-18 and the chemokines are importantly involved in the pathogenesis of M. pneumoniae pneumonia. It also indicates that some asthmatic children have deficient IL-18 response when affected by M. pneumoniae pneumonia, which might be associated with more severe pneumonia observed in this group of patients.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Catholic University of Taegu, Taegu, South Korea.
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Abstract
BACKGROUND The causative role of respiratory viruses detected in upper airway secretions in childhood pneumonia needs further investigation. OBJECTIVE To measure the association between infection with respiratory RNA viruses and pneumonia in children. METHODS From March 2006 to July 2007, we conducted a case-control study of 680 pneumonia cases (WHO criteria) and 680 randomly selected, concurrently sampled age-matched controls among children aged 2-35 months in Bhaktapur, Nepal. A nasopharyngeal aspirate from each child was examined for 7 respiratory viruses using reverse transcription polymerase chain reaction. We calculated the matched odds ratios (MORs) for the detection of the individual viruses from a case compared with a control as measures of pathogenicity using conditional logistic regression. RESULTS At least 1 virus was recovered in 248 (36.5%) cases and 48 (7.1%) controls. The MOR varied from 2.0 to 13.0; the highest associations were observed for parainfluenza virus type 3 (MOR 13.0; 95% confidence interval [CI] 6.0-28.0), respiratory syncytial virus (MOR 10.7; CI 4.6-24.6), and influenza A (MOR 6.3; CI 1.9-21.4). We observed that the association was lower for children age 2-5 months compared with older children for parainfluenza virus type 3 (P value for interaction 0.002). CONCLUSIONS All of the 7 respiratory viruses were associated with pneumonia, but their pathogenicity varied. Parainfluenza type 3, RSV, and influenza A were most strongly associated with pneumonia.
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