Service de pneumologie pédiatrique et CRCM enfant, Hôpital Femme Mère Enfant, Hospices civils de Lyon, Bron, France.
Centre de ressources et de compétence pour la Mucoviscidose, 59 boulevard Pinel, 69677, BRON CEDEX, France.
Virol J. 2019 Sep 3;16(1):111. doi: 10.1186/s12985-019-1208-7.
Viral respiratory tract infections are common during early childhood. How they impact cystic fibrosis lung disease history in young children is poorly known. The principal aim of our study was to determinate respiratory tract infections frequency in this cystic fibrosis young population. Secondary outcomes were nature of viral agents recovered and impact of such infections.
We conducted a prospective cohort study of 25 children affected by cystic fibrosis and aged less than 2 years. Nasal samplings were taken systematically monthly or bimonthly with additional samples taken during respiratory tract infections episodes. Ten pathogens were tested by a combination of five duplex RT-PCRs or PCRs: influenza A and B, respiratory syncytial virus (RSV), metapneumovirus (MPV), rhinovirus/enterovirus (RV/EV)), coronavirus (HKU1, NL63, 229E and OC43), parainfluenza virus (1-4), adenovirus and bocavirus (Respiratory Multi-Well System MWS r-gene®, BioMérieux, Marcy l'Étoile, France). Cycle thresholds (CTs) were reported for all positive samples and considered positive for values below 40. Quantitative variables were compared using a nonparametric statistical test (Wilcoxon signed rank for paired comparisons). Pearson's correlation coefficient (r) was used to assess relationships between two variables. Statistical analyses were performed using SAS v9.4 (SAS Institute, Cary, NC, USA) or GraphPad Prism V6.00 (GraphPad Software, La Jolla, CA, USA). The significance level was set at 0.05.
The mean age at inclusion was 9.6 ± 6.7 months. The patients had 3.4 ± 1.7 respiratory tract infections episodes per child per year. Forty-four respiratory tract infections (69%) were associated with virus: rhinovirus and enterovirus (RV/EV) were implied in 61% of them and respiratory syncytial virus (RSV) in 14%. Only one patient required hospitalization for lower respiratory tract infections. 86% of the patients were treated by antibiotics for a mean of 13.8 ± 6.2 days. RSV infections (n = 6) were usually of mild severity.
Respiratory tract infections in young children with cystic fibrosis were of mild severity, rarely requiring hospitalization. Unsurprisingly, RV/EV were the most frequent agents. RSV-related morbidity seems low in this population. This raises the question of the usefulness of RSV preventive medication in this young population.
病毒性呼吸道感染在幼儿中很常见。它们如何影响幼儿期囊性纤维化的肺部疾病史尚不清楚。我们研究的主要目的是确定该囊性纤维化幼儿人群中呼吸道感染的频率。次要结局是病毒制剂的性质及其感染的影响。
我们对 25 名年龄小于 2 岁的囊性纤维化患儿进行了前瞻性队列研究。每月或每两个月系统地进行鼻腔采样，并在呼吸道感染发作期间采集额外样本。通过五种双联 RT-PCR 或 PCR 组合测试了十种病原体：流感 A 和 B、呼吸道合胞病毒（RSV）、副流感病毒（MPV）、鼻病毒/肠道病毒（RV/EV））、冠状病毒（HKU1、NL63、229E 和 OC43）、副流感病毒（1-4）、腺病毒和博卡病毒（呼吸多重井系统 MWS r-基因®，生物梅里埃，马西·莱托伊尔，法国）。所有阳性样本均报告循环阈值（CT），并认为 CT 值低于 40 为阳性。使用非参数统计检验（配对比较的 Wilcoxon 符号秩检验）比较定量变量。Pearson 相关系数（r）用于评估两个变量之间的关系。使用 SAS v9.4（SAS Institute，Cary，NC，USA）或 GraphPad Prism V6.00（GraphPad Software，La Jolla，CA，USA）进行统计分析。显著性水平设为 0.05。
纳入时的平均年龄为 9.6±6.7 个月。患儿每年每例发生 3.4±1.7 次呼吸道感染。44 次呼吸道感染（69%）与病毒有关：鼻病毒和肠道病毒（RV/EV）占 61%，呼吸道合胞病毒（RSV）占 14%。只有 1 名患儿因下呼吸道感染需要住院治疗。86%的患儿接受抗生素治疗，平均 13.8±6.2 天。RSV 感染（n=6）通常为轻度。
囊性纤维化幼儿的呼吸道感染程度较轻，很少需要住院治疗。不出所料，RV/EV 是最常见的病原体。该人群 RSV 相关发病率似乎较低。这引发了 RSV 预防性药物在该年轻人群中是否有用的问题。
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