ISGlobal, Hospital Clínic - Universitat de Barcelona, carrer Rosselló, 132, 08036 Barcelona, Spain; Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), PO box 446, Old Medical Block, JDWNRH, Menkhang Lam, Thimphu, Bhutan.
Int J Infect Dis. 2020 Jun;95:74-83. doi: 10.1016/j.ijid.2020.04.017. Epub 2020 Apr 10.
The study aim was to describe the etiological profile and clinical characteristics of pneumonia among children hospitalized in Thimphu, Bhutan.
This prospective study enrolled children aged 2-59 months admitted to the Jigme Dorji Wangchuck National Referral Hospital with World Health Organization (WHO)-defined clinical pneumonia. Demographic and clinico-radiological data were collected through questionnaires, physical examination, and chest radiography. Blood samples and nasopharyngeal washing were collected for microbiological analysis including culture and molecular methods.
From July 2017 to June 2018, 189 children were enrolled, of which 53.4% were infants. Pneumonia-related admissions were less frequent over the winter. Chest radiographies were obtained in 149 children; endpoints included pneumonia in 39 cases (26.2%), other infiltrates in 31 (20.8%), and were normal in 79 children (53.0%). Non-contaminated bacterial growth was detected in 8/152 (5.3%) blood cultures, with only two cases of Streptococcus pneumoniae. Viral detection in upper respiratory secretions was common, with at least one virus detected in 103/115 (89.6%). The three most-commonly isolated viruses were respiratory syncytial virus (52/115; 45.2%), rhinovirus (42/115; 36.5%), and human parainfluenza virus (19/115; 16.5%). A third of patients with viral infections showed mixed infections. Case fatality rate was 3.2% (6/189).
Respiratory viral infections predominated among this cohort of WHO-defined clinical pneumonia cases, whereas bacterial aetiologies were uncommon, highlighting the epidemiologic transition that Bhutan seems to have reached.
本研究旨在描述不丹廷布住院儿童肺炎的病因谱和临床特征。
本前瞻性研究纳入了年龄在 2-59 个月、符合世界卫生组织（WHO）定义的临床肺炎标准的患儿。通过问卷调查、体格检查和胸部 X 线摄影收集人口统计学和临床放射学数据。采集血样和鼻咽洗液进行微生物分析，包括培养和分子方法。
2017 年 7 月至 2018 年 6 月，共纳入 189 名患儿，其中 53.4%为婴儿。冬季肺炎相关住院率较低。149 名患儿进行了胸部 X 线摄影；终点包括肺炎 39 例（26.2%）、其他浸润 31 例（20.8%）和正常 79 例（53.0%）。152 份血培养中检出 8 份（5.3%）非污染细菌生长，仅 2 例为肺炎链球菌。上呼吸道分泌物中病毒检测常见，115 份标本中至少有 1 种病毒检出 103 例（89.6%）。最常分离的三种病毒是呼吸道合胞病毒（52/115；45.2%）、鼻病毒（42/115；36.5%）和人副流感病毒（19/115；16.5%）。三分之一的病毒感染患者存在混合感染。病死率为 3.2%（6/189）。
本研究中，WHO 定义的临床肺炎病例中以呼吸道病毒感染为主，而细菌病因少见，突出了不丹似乎已经达到的流行病学转变。
