Chu Helen Y, Englund Janet A, Strelitz Bonnie, Lacombe Kirsten, Jones Charla, Follmer Kristin, Martin Emily K, Bradford Miranda, Qin Xuan, Kuypers Jane, Klein Eileen J
Department of Medicine, University of Washington.
Center for Clinical and Translational Research.
J Pediatric Infect Dis Soc. 2016 Mar;5(1):29-38. doi: 10.1093/jpids/piu099. Epub 2014 Oct 19.
Rhinovirus is the most common cause of viral respiratory tract infections in children. Virologic predictors of lower respiratory tract infection (LRTI), such as viral load and the presence of another respiratory virus (coinfection), are not well characterized in pediatric outpatients.
Mid-nasal turbinate samples were collected from children presenting for care to the Seattle Children's Hospital emergency department (ED) or urgent care with a symptomatic respiratory infection between December 2011 and May 2013. A subset of samples was tested for rhinovirus viral load by real-time polymerase chain reaction. Clinical data were collected by chart reviews. Multivariate logistic regression was used to evaluate the relationship between viral load and coinfection and the risk for LRTI.
Rhinovirus was the most frequent respiratory virus detected in children younger than 3 years. Of 445 patients with rhinovirus infection, 262 (58.9%) had LRTIs, 231 (51.9%) required hospital admission and 52 (22.5%) were hospitalized for 3 days or longer. Children with no comorbidities accounted for 142 (54%) of 262 rhinovirus LRTIs. Higher viral load was significantly associated with LRTI among illness episodes with rhinovirus alone (OR, 2.11; 95% confidence interval [CI], 1.24-3.58). Coinfection increased the risk of LRTI (OR, 1.83; 95% CI, 1.01-3.32).
Rhinovirus was the most common pathogen detected among symptomatic young children in a pediatric ED who had respiratory viral testing performed, with the majority requiring hospitalization. Higher rhinovirus viral load and coinfection increased disease severity. Virologic data may assist clinical decision making for children with rhinovirus infections in the pediatric ED.
鼻病毒是儿童病毒性呼吸道感染最常见的病因。下呼吸道感染（LRTI）的病毒学预测指标，如病毒载量和另一种呼吸道病毒的存在（合并感染），在儿科门诊患者中尚未得到充分描述。
2011年12月至2013年5月期间，从西雅图儿童医院急诊科（ED）或紧急护理中心就诊的有症状呼吸道感染儿童中采集中鼻甲样本。通过实时聚合酶链反应对一部分样本进行鼻病毒病毒载量检测。通过病历审查收集临床数据。采用多因素逻辑回归分析评估病毒载量、合并感染与LRTI风险之间的关系。
鼻病毒是3岁以下儿童中最常检测到的呼吸道病毒。在445例鼻病毒感染患者中，262例（58.9%）发生LRTI，231例（51.9%）需要住院治疗，52例（22.5%）住院3天或更长时间。无合并症的儿童占262例鼻病毒LRTI患者中的142例（54%）。在仅感染鼻病毒的疾病发作中，较高的病毒载量与LRTI显著相关（比值比[OR]，2.11；95%置信区间[CI]，1.24 - 3.58）。合并感染增加了LRTI的风险（OR，1.83；95%CI，1.01 - 3.32）。
在进行呼吸道病毒检测的儿科急诊有症状幼儿中，鼻病毒是最常见的病原体，大多数需要住院治疗。较高的鼻病毒病毒载量和合并感染会增加疾病严重程度。病毒学数据可能有助于儿科急诊中鼻病毒感染儿童的临床决策。
