呼吸道合胞病毒：2000年至2013年间入住儿童医院的儿科患者的临床和流行病学模式

Respiratory syncytial virus: clinical and epidemiological pattern in pediatric patients admitted to a children's hospital between 2000 and 2013.

作者信息

Lucion María Florencia, Juarez María del Valle, Viegas Mariana, Castellano Vanesa, Romanin Viviana Sandra, Grobaporto Marcela, Bakir Julia, Mistchenko Alicia Susana, Gentile Angela

机构信息

Área Epidemiología, División Promoción y Protección de la Salud, Hospital de Niños Ricardo Gutiérrez.

Laboratorio de Virología, Hospital de Niños Ricardo Gutiérrez.

出版信息

Arch Argent Pediatr. 2014 Oct;112(5):397-404. doi: 10.5546/aap.2014.eng.397.

DOI:10.5546/aap.2014.eng.397

PMID:25192519

Abstract

INTRODUCTION

Respiratory syncytial virus (RSV) is the major causative organism associated with acute lower respiratory tract infections in children.The objective of this study was to describe the clinical and epidemiological pattern of RSV and identify risk factors for RSV infection.

POPULATION AND METHODS

Prospective, cohort study on patients hospitalized due to acute lower respiratory tract infection at Hospital de Niños Ricardo Gutiérrez between March and November throughout the 2000-2013 period. The virological diagnosis of RSV, adenovirus, influenza and parainfluenza was performed by indirect immunofluorescence using nasopharyngeal aspirates.

RESULTS

A total of 12,555 children were included, 38.2% (4798) had virus rescued from samples. RSV accounted for 81.8% of cases (3924/4798) with no significant annual variations (71.2- 88.1) and with an epidemic seasonal pattern(May through July); RSV was followed by influenza (7.6%), parainfluenza (5.9%), and adenovirus (4.7%).The median age of patients with RSV rescue (3924) was 7 months old (0- 214 months old), while 74.2% were younger than 1 year old, 43.1% were younger than 6 months old, 56.5% were males and the most common clinical presentation was bronchiolitis (60.7%). Comorbidities were observed in 41.6% of cases. The most common comorbidities were chronic respiratory disease (74%), congenital heart disease (14%), and chronic neurological disease (10.2%).Complications occurred in 25%of cases. The case fatality rate was 1.9% (74/3888). Independent predictors of RSV infection were age <3 months old (OR: 2.8 [2.14-3.67], p < 0.01),clinical presentation of bronchiolitis (OR: 1.54 [1.32-1.79], p < 0.01), and hypoxemia at the time of admission (OR: 1.84 [1.42-2.37], p < 0.01).

CONCLUSIONS

RSV infection displayed a seasonal pattern and was associated with infants younger than 3 months old with bronchiolitis and hypoxemia at the time of admission.

摘要

引言

呼吸道合胞病毒（RSV）是导致儿童急性下呼吸道感染的主要病原体。本研究的目的是描述RSV的临床和流行病学特征，并确定RSV感染的危险因素。

研究对象与方法

对2000年至2013年3月至11月期间在里卡多·古铁雷斯儿童医院因急性下呼吸道感染住院的患者进行前瞻性队列研究。使用鼻咽抽吸物通过间接免疫荧光法对RSV、腺病毒、流感和副流感进行病毒学诊断。

结果

共纳入12555名儿童，38.2%（4798名）的样本中检测出病毒。RSV占病例的81.8%（3924/4798），年度变化不显著（71.2%-88.1%），呈季节性流行模式（5月至7月）；其次是流感（7.6%）、副流感（5.9%）和腺病毒（4.7%）。RSV检测阳性患者（3924名）的中位年龄为7个月（0-214个月），74.2%的患者年龄小于1岁，43.1%的患者年龄小于6个月，56.5%为男性，最常见的临床表现为细支气管炎（60.7%）。41.6%的病例存在合并症。最常见的合并症为慢性呼吸道疾病（74%）、先天性心脏病（14%）和慢性神经系统疾病（10.2%）。25%的病例出现并发症。病死率为1.9%（74/3888）。RSV感染独立预测因素为年龄小于3个月（OR：2.8[2.14-3.67]，p<0.01）、细支气管炎临床表现（OR：1.54[1.32-1.79]，p<0.01）和入院时低氧血症（OR：1.84[1.42-2.37]，p<0.01）。