Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France.
Clin Microbiol Infect. 2019 Sep;25(9):1147-1153. doi: 10.1016/j.cmi.2019.01.014. Epub 2019 Jan 29.
We aimed to identify patients' clinical characteristics associated with respiratory viruses identified among patients presenting with influenza-like illness (ILI).
A sample of patients of all ages presenting with ILI was included by physicians of the French Sentinelles network during two seasons (2015/16 and 2016/17). Nasopharyngeal samples were tested for the presence of influenza virus (IV), respiratory syncytial virus (RSV), human rhinovirus (HRV) and human metapneumovirus (HMPV). Patients' characteristics associated with each of the four virus classes were studied using multivariate logistic regressions.
A total of 5859 individuals were included in the study: 48.0% tested positive for IV, 7.9% for HRV, 7.5% for RSV and 4.1% for HMPV. Cough was associated with IV (OR 2.14, 95% CI 1.81-2.52) RSV (OR 2.52, 95% CI 1.75-3.74) and HMPV detection (OR 2.15, 95% CI 1.40-3.45). Rhinorrhoea was associated mainly with HRV detection (OR 1.75, 95% CI 1.34-2.32). Headache was associated with IV detection (OR 1.75, 95% CI 1.34-2.32), whereas absence of headache was associated with RSV and HMPV detection. Dyspnoea was associated with RSV detection (OR 2.33, 95% CI 1.73-3.12) and absence of dyspnoea with IV detection. Conjunctivitis was associated with IV detection (OR 1.27, 95% CI 1.08-1.50). Some associations were observed only in children: dyspnoea and cough with RSV detection (age <5 years), conjunctivitis with IV detection (age <15 years). Period of onset of symptoms differed among aetiological diagnoses. Seasonal influenza vaccination decreased the risk of IV detection (OR, 0.67, 95% CI 0.51-0.86).
This study allowed the identification of symptoms associated with several viral aetiologies in patients with ILI. A proper knowledge and understanding of these clinical signs may improve the medical management of patients.
本研究旨在确定流感样疾病（ILI）患者中呼吸道病毒的临床特征。
本研究纳入了法国 Sentinelles 网络医生在两个季节（2015/16 年和 2016/17 年）期间接诊的所有年龄段 ILI 患者。采用聚合酶链反应（PCR）方法检测鼻咽拭子中流感病毒（IV）、呼吸道合胞病毒（RSV）、人鼻病毒（HRV）和人偏肺病毒（HMPV）。采用多变量逻辑回归分析患者与四类病毒的相关性。
共纳入 5859 例患者：48.0%的患者 IV 检测阳性，7.9%的患者 HRV 检测阳性，7.5%的患者 RSV 检测阳性，4.1%的患者 HMPV 检测阳性。咳嗽与 IV（OR 2.14，95%CI 1.81-2.52）、RSV（OR 2.52，95%CI 1.75-3.74）和 HMPV（OR 2.15，95%CI 1.40-3.45）检测阳性相关。鼻漏主要与 HRV 检测阳性相关（OR 1.75，95%CI 1.34-2.32）。头痛与 IV 检测阳性相关（OR 1.75，95%CI 1.34-2.32），而无头痛与 RSV 和 HMPV 检测阳性相关。呼吸困难与 RSV 检测阳性相关（OR 2.33，95%CI 1.73-3.12），而无呼吸困难与 IV 检测阳性相关。结膜炎与 IV 检测阳性相关（OR 1.27，95%CI 1.08-1.50）。一些关联仅在儿童中观察到：小于 5 岁儿童中，呼吸困难和咳嗽与 RSV 检测阳性相关，小于 15 岁儿童中，结膜炎与 IV 检测阳性相关。症状发作时间因病因诊断而异。季节性流感疫苗接种降低了 IV 检测阳性的风险（OR，0.67，95%CI 0.51-0.86）。
本研究确定了与 ILI 患者几种病毒病因相关的症状。对这些临床症状的正确认识和理解可以改善患者的医疗管理。
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