Berman S
Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262.
Rev Infect Dis. 1991 May-Jun;13 Suppl 6:S454-62. doi: 10.1093/clinids/13.supplement_6.s454.
Acute respiratory infections cause four and a half million deaths among children every year, the overwhelming majority occurring in developing countries. Pneumonia unassociated with measles causes 70% of these deaths; post-measles pneumonia, 15%; pertussis, 10%; and bronchiolitis and croup syndromes, 5%. Both bacterial and viral pathogens are responsible for these deaths. The most important bacterial agents are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. The data on bacterial etiology of pneumonia during the first 3 months of life are limited, and almost no information on the role of chlamydia and pertussis in this age period is available. The distribution of viral pathogens in developing countries can be summarized as follows: respiratory syncytial virus, 15%-20%; parainfluenza viruses, 7%-10%; and influenza A and B viruses and adenovirus, 2%-4%. Mixed viral and bacterial infections occur frequently. Risk factors that increase the incidence and severity of lower respiratory infection in developing countries include large family size, lateness in the birth order, crowding, low birth weight, malnutrition, vitamin A deficiency, lack of breast feeding, pollution, and young age. Effective interventions for prevention and medical case management are urgently needed to save the lives of many children predisposed to severe disease.
急性呼吸道感染每年导致450万儿童死亡，其中绝大多数发生在发展中国家。与麻疹无关的肺炎导致这些死亡病例中的70%；麻疹后肺炎，占15%；百日咳，占10%；细支气管炎和哮吼综合征，占5%。细菌和病毒病原体均导致了这些死亡。最重要的细菌病原体是肺炎链球菌、流感嗜血杆菌和金黄色葡萄球菌。关于出生后头3个月内肺炎的细菌病因的数据有限，而且几乎没有关于衣原体和百日咳在这个年龄段作用的信息。发展中国家病毒病原体的分布情况可总结如下：呼吸道合胞病毒，占15%-20%；副流感病毒，占7%-10%；甲型和乙型流感病毒以及腺病毒，占2%-4%。病毒和细菌混合感染很常见。发展中国家增加下呼吸道感染发病率和严重程度的风险因素包括家庭规模大、出生顺序靠后、拥挤、低出生体重、营养不良、维生素A缺乏、缺乏母乳喂养、污染以及年龄小。迫切需要有效的预防干预措施和医疗病例管理来挽救许多易患重病儿童的生命。
