Prevalence and Correlation of Infectious Agents in Hospitalized Children with Acute Respiratory Tract Infections in Central China

Acute respiratory tract infections (ARTIs) are associated with significant morbidity and mortality worldwide, especially in children under the age of 5 years. Almost 2 million children die from ARTIs each year, and most of them are from developing countries. The prevalence and correlation of pathogens in ARTIs are poorly understood, but are critical for improving case prevention, treatment, and management. In this study, we investigated the prevalence and correlation of infectious agents in children with ARTIs. A total of 39,756 children with one or more symptoms, including fever, cough, sore throat, tonsillitis, pharyngitis, herpangina, pneumonia, and bronchiolitis, were enrolled in the study. All patients were hospitalized in Wuhan Children’s Hospital between October 1, 2010 and September 30, 2012, and were evaluated for infectious agents. Pathogens, including Mycoplasma pneumoniae, influenza A virus, influenza B virus, adenoviruses, respiratory syncytial virus, parainfluenza virus, Legionella pneumophila, Chlamydophila pneumoniae, and Coxiella burnetii, were screened simultaneously in patient blood samples using anti-pathogen IgM tests. Regression analysis was used to reveal correlations among the pathogens. Our results showed that one or more pathogens were identified in 10,206 patients, and that Mycoplasma pneumoniae, adenoviruses, and influenza B virus were the leading infectious agents. Mixed-infections of pathogens were detected in 2,391 cases, with Mycoplasma pneumoniae as the most frequent pathogen. The most common agents in the co-infections were Mycoplasma pneumoniae and influenza B virus. Regression analysis revealed a linear correlation between the proportion of mixed infections and the incidence of multi-pathogen infections. The prevalence of infectious agents in children with ARTIs was determined. Equations were established to estimate multiple infections by single-pathogen detection. This revealed a linear correlation for pathogens in children with ARTIs. This study provides useful information for improving case prevention and management.     

Adenovirus Respiratory Tract Infections in Peru

Background

Currently, there is a paucity of data regarding human adenovirus (HAdv) circulation in Andean regions of South America. To address this shortcoming, we report the clinical, phylogenetic, and epidemiologic characteristics of HAdv respiratory tract infection from a large sentinel surveillance study conducted among adults and children in Peru.

Methods/Principal Findings

Oropharyngeal swabs were collected from participants visiting any of 38 participating health centers, and viral pathogens were identified by immunofluorescence assay in cell culture. In addition, molecular characterization was performed on 226 randomly selected HAdv samples. Between 2000 and 2010, a total of 26,375 participants with influenza-like illness (ILI) or severe acute respiratory infection (SARI) were enrolled in the study. HAdv infection was identified in 2.5% of cases and represented 6.2% of all viral pathogens. Co-infection with a heterologous virus was found in 15.5% of HAdv cases. HAdv infection was largely confined to children under the age of 15, representing 88.6% of HAdv cases identified. No clinical characteristics were found to significantly distinguish HAdv infection from other respiratory viruses. Geographically, HAdv infections were more common in sites from the arid coastal regions than in the jungle or highland regions. Co-circulation of subgroups B and C was observed each year between 2006 and 2010, but no clear seasonal patterns of transmission were detected.

Conclusions/Significance

HAdv accounted for a significant fraction of those presenting with ILI and SARI in Peru and tended to affect the younger population disproportionately. Longitudinal studies will help better characterize the clinical course of patients with HAdv in Peru, as well as determine the role of co-infections in the evolution of illness.     

Viral Co-Infections in Pediatric Patients Hospitalized with Lower Tract Acute Respiratory Infections

Background

Molecular techniques can often reveal a broader range of pathogens in respiratory infections. We aim to investigate the prevalence and age pattern of viral co-infection in children hospitalized with lower tract acute respiratory infection (LT-ARI), using molecular techniques.

Methods

A nested polymerase chain reaction approach was used to detect Influenza (A, B), metapneumovirus, respiratory syncytial virus (RSV), parainfluenza (1–4), rhinovirus, adenovirus (A—F), bocavirus and coronaviruses (NL63, 229E, OC43) in respiratory samples of children with acute respiratory infection prospectively admitted to any of the GENDRES network hospitals between 2011–2013. The results were corroborated in an independent cohort collected in the UK.

Results

A total of 204 and 97 nasopharyngeal samples were collected in the GENDRES and UK cohorts, respectively. In both cohorts, RSV was the most frequent pathogen (52.9% and 36.1% of the cohorts, respectively). Co-infection with multiple viruses was found in 92 samples (45.1%) and 29 samples (29.9%), respectively; this was most frequent in the 12–24 months age group. The most frequently observed co-infection patterns were RSV—Rhinovirus (23 patients, 11.3%, GENDRES cohort) and RSV—bocavirus / bocavirus—influenza (5 patients, 5.2%, UK cohort).

Conclusion

The presence of more than one virus in pediatric patients admitted to hospital with LT-ARI is very frequent and seems to peak at 12–24 months of age. The clinical significance of these findings is unclear but should warrant further analysis.     

Tannic Acid Supplemented Fixation Improves Ultrastructural Evaluation of Respiratory Epithelium in Children with Recurrent Respiratory Tract Infections

Samples of the respiratory mucosa of children with recurrent respiratory infections suspected of having primary ciliary dyskinesia are routinely fixed with glutaraldehyde before ultrastructural examination. This standard technique, however, may not be optimal for visualizing ciliary components or for preserving several cellular and extracellular structures during dehydration and embedding procedures. In this study, brushes of nasal (28 samples) and/or tracheal (9 samples) mucosa from 32 children with recurrent respiratory tract infections were examined. Twenty-nine samples were fixed with glutaraldehyde supplemented with tannic acid to determine if the ultrastructural analysis of respiratory epithelium and bronchial secretions could be improved. Eight samples were conventionally fixed with glutaraldehyde alone. Lesions of the cellular membrane and damaged cells were easily visualized using tannic acid supplemented fixation. Internal ciliary structures including individual microtubules and dynein arms were also more clearly observed. In addition, the internal structure of microvilli of the respiratory epithelium could be studied and the presence of phospholipid-rich surfactant-like material within nasal and tracheal secretions were visualized after tannic acid supplemented fixation. We suggest that addition of tannic acid during fixation is useful for accurate ultrastructural evaluation of respiratory mucosa in both clinical and experimental situations.     

液相芯片MASA技术用于儿童呼吸道感染病原学研究

利用多靶点液相芯片(Multi-Analyte Suspension Array,MASA)技术对引起儿童呼吸道感染(respiratory tract infections,RTI)的病原,包括人类呼吸道合胞病毒A型和B型(Human respiratory syncytial virus A and B, RSVA、RSVB)、严重急性呼吸综合征冠状病毒(Severe acute respiratory syndrome coronavirus,SARS-CoV)、流行 性感冒病毒A型和B型(Influenza A virus and Influenza B virus,INFa,INFb)、副流感病毒1型和3型(Parain- fluenza virus 1 and 3,PIV1,PIV3)、衣原体(C．pneumoniae,CPN)和支原体(M．pneumoniae,MPN)进行了病原学 研究。我们采集并分析了140例患典型呼吸道感染症状儿童的咽拭子,发现在这些标本中至少被前述的一种病 原感染的标本有95例,阳性率为67．86％。结果显示这些标本中上述病原感染的情况分别为:RSVB感染的患儿 占35．71％、PIV3感染的占4．29％、INFa感染的占28．57％、INFb感染的占2．14％、MPN感染的占3．57％、CPN 感染的占17．86％,被两种以上病原混合感染的患儿有17．14％。这些标本中都没有检测到RSVA、PIV1和SARS- CoV病原的感染。RSVB病原的感染率在3岁以下的患儿中明显高于3岁以上的患儿,而INFa的感染情况则相 反;在上呼吸道感染患儿中检测到INFa病原感染的比例明显高于下呼吸道感染,而RSVB病原感染的情况相反。 此外,我们发现在2005年3月-5月中造成武汉地区儿童呼吸道感染的主要病原是以RSVB、INFa、CPN为主,而 RSVB感染则又是引起儿童下呼吸道感染和引起低龄儿童呼吸道感染的重要病原。     

液相芯片MASA技术用于儿童呼吸道感染病原学研究

利用多靶点液相芯片(Multi-Analyte Suspension Array,MASA)技术对引起儿童呼吸道感染(respiratorytract infections,RTI)的病原,包括人类呼吸道合胞病毒A型和B型(Human respiratory syncytial virus A and B,RSVA、RSVB)、严重急性呼吸综合征冠状病毒(Severe acute respiratory syndrome coronavirus,SARS-CoV)、流行性感冒病毒A型和B型(Influenza A virus and Influenza B virus,INFa,INFb)、副流感病毒1型和3型(Parainfluenza virus 1 and 3,PIV1,PIV3)、衣原体(C.pneumoniae,CPN)和支原体(M.pneumomae,MPN)进行了病原学研究.我们采集并分析了140例患典型呼吸道感染症状儿童的咽拭子,发现在这些标本中至少被前述的一种病原感染的标本有95例,阳性率为67.86%.结果显示这些标本中上述病原感染的情况分别为RSVB感染的患儿占35.71%、PIV3感染的占4.29%、INFa感染的占28.57%、INFb感染的占2.14%、MPN感染的占3.57%、CPN感染的占17.86%,被两种以上病原混合感染的患儿有17.14%.这些标本中都没有检测到RSVA、PIV1和SARS-CoV病原的感染.RSVB病原的感染率在3岁以下的患儿中明显高于3岁以上的患儿,而INFa的感染情况则相反;在上呼吸道感染患儿中检测到INFa病原感染的比例明显高于下呼吸道感染,而RSVB病原感染的情况相反.此外,我们发现在2005年3月-5月中造成武汉地区儿童呼吸道感染的主要病原是以RSVB、INFa、CPN为主,而RSVB感染则又是引起儿童下呼吸道感染和引起低龄儿童呼吸道感染的重要病原.     

Etiologic Diagnosis of Lower Respiratory Tract Infections

Decision as to the role of infection in lower respiratory tract disease requires examination by culture of specimens known to be derived from the infra-laryngeal respiratory tract. Methods that involve the upper respiratory tract in collection of specimens entail the hazard of contamination by microbiota resident in the upper respiratory tract.The extrapulmonary approaches of cutting-needle biopsy and needle aspiration of intrathoracic disease have not been impressively productive of etiologic diagnosis of infections. While open-chest surgical biopsy has been a highly effective means to diagnosis, this approach does have special requirements in facilities and technical skills.Percutaneous transtracheal aspiration of tracheo-broncho-pulmonary secretions-exudates has been productive of useful information. Because of inherent simplicity and safety, transtracheal aspiration should precede resort to more demanding, difficult, dangerous procedures.     

Epidemiology of Acute Respiratory Infections in Children in Guangzhou: A Three-Year Study

Acute Respiratory Infections (ARI) are some of the most common human diseases worldwide. However, they have a complex and diverse etiology, and the characteristics of the pathogens involved in respiratory infections in developing countries are not well understood. In this work, we analyzed the characteristics of 17 common respiratory pathogens in children (≤14 years old) with ARI in Guangzhou, southern China over a 3-year period using real-time polymerase chain reaction. Pathogens were identified in 2361/4242 (55.7%) patients, and the positivity rate varied seasonally. Ten of the 17 pathogens investigated showed positivity rates of more than 5%. The most frequently detected pathogens were respiratory syncytial virus (768/2361, 32.5%), influenza A virus (428/2361, 18.1%), enterovirus (138/2361, 13.3%), Mycoplasma pneumoniae (267/2361, 11.3%) and adenovirus (213/2361, 9.0%). Co-pathogens were common and found in 503 of 2361 (21.3%) positive samples. When ranked according to frequency of occurrence, the pattern of co-pathogens was similar to that of the primary pathogens, with the exception of human bocavirus, human coronavirus and human metapneumovirus. Significant differences were found in age prevalence in 10 of the 17 pathogens (p≤0.009): four basic patterns were observed, A: detection rates increased with age, B: detection rates declined with age, C: the detection rate showed distinct peaks or D: numbers of patients were too low to detect a trend or showed no significant difference among age groups (p>0.05). These data will be useful for planning vaccine research and control strategies and for studies predicting pathogen prevalence.     

中国浙江地区儿童下呼吸道感染KI多瘤病毒的鉴定

呼吸道病毒感染可以导致大面积人群致病[1],近些年,临床上由于不明原因导致的小儿下呼吸道感染病例屡见不鲜,对于该类患儿一般采取抗生素混合治疗的方法,但是治疗效果不佳.尽管过去几年开展的多项研究已经鉴定到了很多的病原体,如腺病毒,鼻病毒属病毒,冠状病毒属病毒,呼吸道合胞体病毒,流感病毒,副流感病毒等.