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儿童社区获得性非重症肺炎患者中的呼吸道病毒:一项前瞻性队列研究。

Respiratory viruses among children with non-severe community-acquired pneumonia: A prospective cohort study.

机构信息

Bahiana School of Medicine, Bahiana Foundation for Science Development, Salvador, Brazil.

Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.

出版信息

J Clin Virol. 2018 Aug;105:77-83. doi: 10.1016/j.jcv.2018.06.003. Epub 2018 Jun 6.


DOI:10.1016/j.jcv.2018.06.003
PMID:29908521
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7106541/
Abstract

BACKGROUND: Community-acquired pneumonia (CAP) causes a major burden to the health care system among children under-5 years worldwide. Information on respiratory viruses in non-severe CAP cases is scarce. OBJECTIVES: To estimate the frequency of respiratory viruses among non-severe CAP cases. STUDY DESIGN: Prospective study conducted in Salvador, Brazil. Out of 820 children aged 2-59 months with non-severe CAP diagnosed by pediatricians (respiratory complaints and radiographic pulmonary infiltrate/consolidation), recruited in a clinical trial (ClinicalTrials.gov Identifier NCT01200706), nasopharyngeal aspirate samples were obtained from 774 (94.4%) patients and tested for 16 respiratory viruses by PCRs. RESULTS: Viruses were detected in 708 (91.5%; 95%CI: 89.3-93.3) cases, out of which 491 (69.4%; 95%CI: 65.9-72.7) harbored multiple viruses. Rhinovirus (46.1%; 95%CI: 42.6-49.6), adenovirus (38.4%; 95%CI: 35.0-41.8), and enterovirus (26.5%; 95%CI: 23.5-29.7) were the most commonly found viruses. The most frequent combination comprised rhinovirus plus adenovirus. No difference was found in the frequency of RSVA (16.1% vs. 14.6%; P = 0.6), RSVB (10.9% vs. 13.2%; P = 0.4) influenza (Flu) A (6.3% vs. 5.1%; P = 0.5), FluB (4.5% vs. 1.8%; P = 0.09), parainfluenza virus (PIV) 1 (5.1% vs. 2.8%; P = 0.2), or PIV4 (7.7% vs. 4.1%; P = 0.08), when children with multiple or sole virus detection were compared. Conversely, rhinovirus, adenovirus, enterovirus, bocavirus, PIV2, PIV3, metapneumovirus, coronavirus OC43, NL63, 229E were significantly more frequent among cases with multiple virus detection. CONCLUSIONS: Respiratory viruses were detected in over 90% of the cases, out of which 70% had multiple viruses. Several viruses are more commonly found in multiple virus detection whereas other viruses are similarly found in sole and in multiple virus detection.

摘要

背景:社区获得性肺炎(CAP)在全球范围内对 5 岁以下儿童的医疗保健系统造成了重大负担。关于非重症 CAP 病例中呼吸道病毒的信息很少。

目的:估计非重症 CAP 病例中呼吸道病毒的频率。

研究设计:这是在巴西萨尔瓦多进行的一项前瞻性研究。在一项临床试验(ClinicalTrials.gov 标识符 NCT01200706)中,招募了 820 名年龄在 2-59 个月的患有由儿科医生诊断的非重症 CAP(呼吸道症状和影像学肺部浸润/实变)的儿童,其中 774 名(94.4%)患儿获得了鼻咽抽吸样本,并通过 PCR 检测了 16 种呼吸道病毒。

结果:在 708 例(91.5%;95%CI:89.3-93.3)病例中检测到了病毒,其中 491 例(69.4%;95%CI:65.9-72.7)携带多种病毒。最常发现的病毒为鼻病毒(46.1%;95%CI:42.6-49.6)、腺病毒(38.4%;95%CI:35.0-41.8)和肠道病毒(26.5%;95%CI:23.5-29.7)。最常见的组合是鼻病毒加腺病毒。呼吸道合胞病毒 A(RSVA)(16.1%比 14.6%;P=0.6)、B(RSVB)(10.9%比 13.2%;P=0.4)、流感(Flu)A(6.3%比 5.1%;P=0.5)、B(FluB)(4.5%比 1.8%;P=0.09)、副流感病毒 1(PIV1)(5.1%比 2.8%;P=0.2)或 4(PIV4)(7.7%比 4.1%;P=0.08)的频率在有多种或单一病毒检测的儿童中无差异。相反,鼻病毒、腺病毒、肠道病毒、博卡病毒、PIV2、PIV3、副黏液病毒、冠状病毒 OC43、NL63、229E 在有多种病毒检测的病例中更为常见。

结论:在 90%以上的病例中检测到了呼吸道病毒,其中 70%有多种病毒。一些病毒在多种病毒检测中更为常见,而其他病毒在单一病毒检测和多种病毒检测中同样存在。

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本文引用的文献

[1]
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Pediatr Pulmonol. 2017-10-13

[2]
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Pediatr Allergy Immunol. 2014-12

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Diagn Microbiol Infect Dis. 2014-8

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