El Kholy A A, Mostafa N A, Ali A A, Soliman M M S, El-Sherbini S A, Ismail R I, El Basha N, Magdy R I, El Rifai N, Hamed D H
Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
Eur J Clin Microbiol Infect Dis. 2016 Oct;35(10):1607-13. doi: 10.1007/s10096-016-2698-5. Epub 2016 Jun 10.
Respiratory tract infection is a major cause of hospitalization in children. Although most such infections are viral in origin, it is difficult to differentiate bacterial and viral infections, as the clinical symptoms are similar. Multiplex polymerase chain reaction (PCR) methods allow testing for multiple pathogens simultaneously and are, therefore, gaining interest. This prospective case-control study was conducted from October 2013 to February 2014. Nasopharyngeal (NP) and oropharyngeal (throat) swabs were obtained from children admitted with severe acute respiratory infection (SARI) at a tertiary hospital. A control group of 40 asymptomatic children was included. Testing for 16 viruses was done by real-time multiplex PCR. Multiplex PCR detected a viral pathogen in 159/177 (89.9 %) patients admitted with SARI. There was a high rate of co-infection (46.9 %). Dual detections were observed in 64 (36.2 %), triple detections in 17 (9.6 %), and quadruple detections in 2 (1.1 %) of 177 samples. Seventy-eight patients required intensive care unit (ICU) admission, of whom 28 (35.8 %) had co-infection with multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected among asymptomatic children. This study confirms the high rate of detection of viral nucleic acids by multiplex PCR among hospitalized children admitted with SARI, as well as the high rate of co-detection of multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected in asymptomatic children, resulting in challenges in clinical interpretation. Studies are required to provide quantitative conclusions that will facilitate clinical interpretation and application of the results in the clinical setting.
呼吸道感染是儿童住院的主要原因。尽管大多数此类感染起源于病毒，但由于临床症状相似，很难区分细菌感染和病毒感染。多重聚合酶链反应（PCR）方法可同时检测多种病原体，因此受到关注。这项前瞻性病例对照研究于2013年10月至2014年2月进行。从一家三级医院收治的患有严重急性呼吸道感染（SARI）的儿童中获取鼻咽（NP）和口咽（咽喉）拭子。纳入了40名无症状儿童作为对照组。通过实时多重PCR检测16种病毒。多重PCR在177名因SARI入院的患者中的159名（89.9%）检测到病毒病原体。合并感染率很高（46.9%）。在177个样本中，64个（36.2%）观察到双重检测，17个（9.6%）观察到三重检测，2个（1.1%）观察到四重检测。78名患者需要入住重症监护病房（ICU），其中28名（35.8%）与多种病毒合并感染。在无症状儿童中也检测到了腺病毒（AdV）、人博卡病毒（HBoV）、人鼻病毒（HRV）、肠道病毒（HEV）和人冠状病毒OC43（HCoV-OC43）。本研究证实了多重PCR在因SARI住院的儿童中病毒核酸的高检出率，以及多种病毒的高共检率。在无症状儿童中也检测到了AdV、HBoV、HRV、HEV和HCoV-OC43，这给临床解释带来了挑战。需要开展研究以提供定量结论，从而便于在临床环境中对结果进行临床解释和应用。
