Centre d'Infectiologie Charles Mérieux, Faculty of Medicine, Antananarivo, Madagascar.
PLoS One. 2012;7(8):e43666. doi: 10.1371/journal.pone.0043666. Epub 2012 Aug 17.
In Madagascar, very little is known about the etiology and prevalence of acute respiratory infections (ARIs) in a rural tropical area. Recent data are needed to determine the viral and atypical bacterial etiologies in children with defined clinical manifestations of ARIs.
During one year, we conducted a prospective study on ARIs in children between 2 to 59 months in the community hospital of Ampasimanjeva, located in the south-east of Madagascar. Respiratory samples were analyzed by multiplex real-time RT-PCR, including 18 viruses and 2 atypical bacteria. The various episodes of ARI were grouped into four clinical manifestations with well-documented diagnosis: "Community Acquired Pneumonia"(CAP, group I), "Other acute lower respiratory infections (Other ALRIs, group II)", "Upper respiratory tract infections with cough (URTIs with cough, group III)"and "Upper respiratory tract infections without cough (URTIs without cough, group IV)".
295 children were included in the study between February 2010 and February 2011. Viruses and/or atypical bacteria respiratory pathogens were detected in 74.6% of samples, the rate of co-infection was 27.3%. Human rhinovirus (HRV; 20.5%), metapneumovirus (HMPV A/B, 13.8%), coronaviruses (HCoV, 12.5%), parainfluenza virus (HPIV, 11.8%) and respiratory syncytial virus A and B (RSV A/B, 11.8%) were the most detected. HRV was predominantly single detected (23.8%) in all the clinical groups while HMPV A/B (23.9%) was mainly related to CAP (group I), HPIV (17.3%) to the "Other ALRIs" (group II), RSV A/B (19.5%) predominated in the group "URTIs with cough" (group III) and Adenovirus (HAdV, 17.8%) was mainly detected in the "without cough" (group IV).
This study describes for the first time the etiology of respiratory infections in febrile children under 5 years in a malaria rural area of Madagascar and highlights the role of respiratory viruses in a well clinically defined population of ARIs.
在马达加斯加，关于农村热带地区急性呼吸道感染（ARI）的病因和流行情况知之甚少。需要最新数据来确定具有明确 ARI 临床症状的儿童的病毒和非典型细菌病因。
在一年期间，我们在位于马达加斯加东南部的 Ampasimanjeva 社区医院对 2 至 59 个月大的儿童进行了一项急性呼吸道感染的前瞻性研究。通过多重实时 RT-PCR 分析呼吸道样本，包括 18 种病毒和 2 种非典型细菌。将各种 ARI 发作分为具有明确诊断的四种临床症状：“社区获得性肺炎”（CAP，I 组）、“其他急性下呼吸道感染”（Other ALRIs，II 组）、“伴有咳嗽的上呼吸道感染”（URTIs with cough，III 组）和“无咳嗽的上呼吸道感染”（URTIs without cough，IV 组）。
2010 年 2 月至 2011 年 2 月期间，共有 295 名儿童入组研究。74.6%的样本中检测到病毒和/或非典型细菌呼吸道病原体，合并感染率为 27.3%。人鼻病毒（HRV；20.5%）、偏肺病毒（HMPV A/B，13.8%）、冠状病毒（HCoV，12.5%）、副流感病毒（HPIV，11.8%）和呼吸道合胞病毒 A 和 B（RSV A/B，11.8%）是最常见的病原体。HRV 是所有临床组中最主要的单一检测病原体（23.8%），而 HMPV A/B（23.9%）主要与 CAP（I 组）相关，HPIV（17.3%）与“其他 ALRIs”（II 组）相关，RSV A/B（19.5%）主要存在于“伴有咳嗽的 URTIs”（III 组）中，而腺病毒（HAdV，17.8%）主要存在于“无咳嗽的 URTIs”（IV 组）中。
这项研究首次描述了马达加斯加疟疾农村地区发热 5 岁以下儿童呼吸道感染的病因，并强调了呼吸道病毒在明确临床定义的 ARI 人群中的作用。
