Ivaska Lauri, Niemelä Jussi, Lempainen Johanna, Österback Riikka, Waris Matti, Vuorinen Tytti, Hytönen Jukka, Rantakokko-Jalava Kaisu, Peltola Ville
Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Emergency Services, Turku University Hospital and University of Turku, Turku, Finland.
Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland; Immunogenetics Laboratory, University of Turku, Turku, Finland.
J Infect. 2017 Apr;74(4):385-392. doi: 10.1016/j.jinf.2017.01.002. Epub 2017 Jan 7.
Besides group A streptococcus (GAS), microbial causes of pharyngitis in children are not well known. We aimed to document the viral and bacterial aetiology of pharyngitis and to assess the pathogenic role of viruses by determining the myxovirus resistance protein A (MxA) in the blood as a marker of interferon response.
In this prospective observational study, throat swabs and blood samples were collected from children (age 1-16 years) presenting to the emergency department with febrile pharyngitis. Microbial cause was sought by bacterial culture, polymerase chain reaction, and serology. Blood MxA level was determined.
A potential pathogen was detected in 88% of 83 patients: GAS alone in 10%, GAS and viruses in 13%, group C or G streptococci alone in 2% and together with viruses in 3%, and viruses alone in 59% of cases. Enteroviruses, rhinoviruses, and adenoviruses were the most frequently detected viruses. Blood MxA levels were higher in children with viral (880 [245-1250] μg/L; median [IQR]) or concomitant GAS-viral (340 [150-710] μg/L) than in those with sole GAS (105 [80-160] μg/L) infections.
Detection of respiratory viruses simultaneously with elevated blood MxA levels supports the causative role of viruses in the majority of children with pharyngitis.
除A组链球菌（GAS）外，儿童咽炎的微生物病因尚不清楚。我们旨在记录咽炎的病毒和细菌病因，并通过测定血液中的黏液病毒抗性蛋白A（MxA）作为干扰素反应的标志物来评估病毒的致病作用。
在这项前瞻性观察研究中，从因发热性咽炎到急诊科就诊的儿童（1 - 16岁）中采集咽拭子和血液样本。通过细菌培养、聚合酶链反应和血清学寻找微生物病因。测定血液中的MxA水平。
83例患者中有88%检测到潜在病原体：仅GAS感染占10%，GAS和病毒共同感染占13%，仅C组或G组链球菌感染占2%，C组或G组链球菌与病毒共同感染占3%，仅病毒感染占59%。肠道病毒、鼻病毒和腺病毒是最常检测到的病毒。病毒感染（880 [245 - 1250] μg/L；中位数[四分位间距]）或GAS与病毒合并感染（340 [150 - 710] μg/L）儿童的血液MxA水平高于单纯GAS感染儿童（10 [80 - 160] μg/L）。
呼吸道病毒检测结果与血液MxA水平升高同时出现，支持病毒在大多数咽炎儿童中起致病作用。
