Kristo Aila, Uhari Matti, Kontiokari Tero, Glumoff Virpi, Kaijalainen Tarja, Leinonen Maija, Luotonen Jukka, Koivunen Petri, Kujala Tiia, Pokka Tytti, Alho Olli-Pekka
Departments of Otorhinolaryngology, PO Box 5000, University of Oulu, Oulu FIN-90014, Finland.
Pediatr Infect Dis J. 2006 Feb;25(2):108-12. doi: 10.1097/01.inf.0000201048.65828.b5.
To test our hypothesis that children with potentially pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis) in the nasal middle meatus might have more prolonged symptoms of acute respiratory infection than children without such bacteria, we conducted a prospective cohort study of such children.
We recruited prospectively child volunteers between 6 and 13 years of age with acute respiratory infections present for fewer than 10 days. Nasal middle meatal bacterial culture was taken with a rigid endoscope at enrollment and again after 3 weeks and evaluated for presence or absence of 3 potential pathogens: S. pneumoniae, H. influenzae and M. catarrhalis. The subsequent persistence of acute symptoms (nasal discharge: clear/colored, nasal obstruction and cough) was determined by means of a diary. Viral etiology was studied with polymerase chain reaction methods.
The 82 children had had symptoms for an average of 4 days (range, 1-10) at entry, and viruses were detected in 54% (39 of 72). The endoscopic procedure and bacteriologic sampling succeeded in all cases. Thirty-eight children (46%) had at least 1 of the 3 pathogens in the middle meatus specimen. The children with nasal pathogens present at entry had a significantly longer mean duration of symptoms than those with nonpathogenic bacteria (difference, 3.6 days; 95% confidence interval, 0.7-6.5; P = 0.025). The effect remained significant after adjustment for age, sex, allergic symptoms and the presence of virus (adjusted relative hazard of delayed recovery, 2.0; 95% confidence interval, 1.1-3.6).
We found that the use of endoscopic swab culture sampling from the nasal middle meatus is well-tolerated by children older than 6 years of age and that it can be useful in selected situations to determine pathogenic bacteria in the culture of these specimens.
为了验证我们的假设，即中鼻道存在潜在致病菌（肺炎链球菌、流感嗜血杆菌或卡他莫拉菌）的儿童，其急性呼吸道感染症状持续时间可能比无此类细菌的儿童更长，我们对这些儿童进行了一项前瞻性队列研究。
我们前瞻性招募了6至13岁患有急性呼吸道感染且病程少于10天的儿童志愿者。在入组时用硬式内窥镜采集鼻中道细菌培养样本，并在3周后再次采集，评估是否存在三种潜在病原体：肺炎链球菌、流感嗜血杆菌和卡他莫拉菌。通过日记确定后续急性症状（鼻分泌物：清涕/脓性、鼻塞和咳嗽）的持续情况。采用聚合酶链反应方法研究病毒病因。
82名儿童入组时症状平均持续4天（范围1 - 10天），72名儿童中54%（39名）检测到病毒。所有病例的内窥镜检查和细菌学采样均成功。38名儿童（46%）中鼻道标本至少含有三种病原体中的一种。入组时存在鼻病原体的儿童症状平均持续时间显著长于无病原菌的儿童（差异3.6天；95%置信区间0.7 - 6.5；P = 0.025）。在调整年龄、性别、过敏症状和病毒感染情况后，该效应仍然显著（调整后延迟恢复的相对风险为2.0；95%置信区间1.1 - 3.6）。
我们发现6岁以上儿童对鼻中道内窥镜拭子培养采样耐受性良好，在特定情况下，该方法有助于确定这些标本培养中的病原菌。
