三年来日本儿科门诊呼吸道感染发热的病毒病因学及特征研究。

Three-year study of viral etiology and features of febrile respiratory tract infections in Japanese pediatric outpatients.

机构信息

From the *Hara Pediatric Clinic, Hiroshima, Japan; †Center for Public Health and Environment, Hiroshima Prefectural Technology Research Institute, Hiroshima, Japan; and ‡Nishimura Pediatric Clinic, Osaka, Japan.

出版信息

Pediatr Infect Dis J. 2014 Jul;33(7):687-92. doi: 10.1097/INF.0000000000000227.

DOI:10.1097/INF.0000000000000227

PMID:24378946

Abstract

BACKGROUND

For most febrile respiratory tract infections (RTIs) in children, the causative pathogen is never identified. We sought to identify the causative pathogen in individual cases of pediatric outpatient with RTIs and to determine whether particular clinical features of RTIs are associated with particular viruses.

METHODS

Over 3 years, we prospectively collected nasopharyngeal aspirate specimens from individual pediatric outpatients with an RTI accompanied by persistent fever (>3 days, ≥38.0°C) and peak temperature ≥39.0°C. Two methods-(1) viral culture for respiratory viruses and (2) real-time polymerase chain reaction (PCR) assays identifying 9 different respiratory viruses and 2 respiratory bacteria-were used to test specimens.

RESULTS

For 495 specimens, viral culture and real-time PCR assays together identified at least 1 pathogen in 83.0% and ≥1 viruses alone in 79.4%. These 2 methods identified 138 children with respiratory syncytial virus, 66 with human metapneumovirus, 73 with parainfluenza viruses, 124 with adenovirus, 23 with rhinovirus, 38 with enterovirus, 11 with influenza type C virus, 15 with Mycoplasma pneumoniae and 3 with Chlamydophila pneumoniae; the coinfection rate was 19.7% among all infections. Among the patients with single-pathogen infections, the rate of lower RTI was 37.6% for respiratory syncytial virus, 40.7% for human metapneumovirus, 18.2% for parainfluenza viruses and 2.2% for adenovirus (P < 0.01).

CONCLUSIONS

Viral culture and real-time PCR assays were used together to identify causative pathogens in 83% of febrile outpatient children with RTI; specific viruses were associated with particular clinical diagnoses.

摘要

背景

对于大多数儿童发热性呼吸道感染（RTI），病原体从未被确定。我们试图确定儿科门诊 RTIs 患者的个体病例中的病原体，并确定 RTI 的特定临床特征是否与特定病毒相关。

方法

在 3 年期间，我们前瞻性地收集了患有伴有持续性发热（>3 天，≥38.0°C）和峰值温度≥39.0°C 的 RTI 的个别儿科门诊患者的鼻咽抽吸标本。使用两种方法（1）呼吸道病毒的病毒培养和（2）实时聚合酶链反应（PCR）检测鉴定 9 种不同的呼吸道病毒和 2 种呼吸道细菌的检测来检测标本。

结果

对于 495 个标本，病毒培养和实时 PCR 检测联合确定了至少 1 种病原体，阳性率为 83.0%；单独≥1 种病毒阳性率为 79.4%。这两种方法鉴定了 138 例呼吸道合胞病毒、66 例人偏肺病毒、73 例副流感病毒、124 例腺病毒、23 例鼻病毒、38 例肠道病毒、11 例丙型流感病毒、15 例肺炎支原体和 3 例肺炎衣原体；所有感染中合并感染率为 19.7%。在单病原体感染的患者中，呼吸道合胞病毒、人偏肺病毒、副流感病毒和腺病毒的下呼吸道感染率分别为 37.6%、40.7%、18.2%和 2.2%（P<0.01）。