Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China.
BMC Infect Dis. 2021 Feb 9;21(1):161. doi: 10.1186/s12879-021-05863-9.
Although Respiratory syncytial virus (RSV) is one of the common pathogens in children with pertussis and viral coinfection, the clinical impact of RSV infection on pertussis remains unclear. We compared clinical characteristics and sought differences between infants with single Bordetella pertussis (B. pertussis) infection and those with RSV coinfection.
We enrolled 80 patients with pertussis who were hospitalized in Shenzhen Children's Hospital from January 2017 to December 2019. Respiratory tract samples were tested for B. pertussis with real-time polymerase chain reaction and respiratory viruses with immunofluorescence assay. Clinical data were obtained from hospital records and collected using a structured questionnaire.
Thirty-seven of 80 patients had B. pertussis infection alone (pertussis group) and 43 had RSV-pertussis coinfection (coinfection group). No significant differences were found with regard to sex, body weight, preterm birth history, pertussis vaccination, symptoms, presence of pneumonia, or lymphocyte count between the 2 groups. Univariate analysis showed patients with RSV coinfection were older (median, 4.57 months vs 4.03 months, p = 0.048); more commonly treated with β-lactam antibiotics (21% vs 5%, p = 0.044); had higher rates of wheezes (40% vs 14%, p = 0.009) and rales (35% vs 14%, p = 0.028) on chest auscultation, a higher rate of readmission (40% vs 11%, p = 0.004), and a longer hospital stay (median, 10 days vs 7 days, p = 0.002). In the further binary logistic regression analysis, patients with RSV coinfection had higher rates of wheezes (OR = 3.802; 95% CI: 1.106 to 13.072; p = 0.034) and readmission (OR = 5.835; 95% CI: 1.280 to 26.610; p = 0.023).
RSV coinfection increases readmission rate in children hospitalized for pertussis. RSV infection should be suspected when wheezes are present on auscultation of the chest in these patients. Early detection of RSV may avoid unnecessary antibiotic use.
呼吸道合胞病毒（RSV）是小儿百日咳和病毒合并感染的常见病原体之一，但 RSV 感染对百日咳的临床影响尚不清楚。我们比较了单纯博德特氏菌（B. pertussis）感染和 RSV 合并感染婴儿的临床特征，并寻找差异。
我们纳入了 2017 年 1 月至 2019 年 12 月期间在深圳市儿童医院住院的 80 例百日咳患儿。通过实时聚合酶链反应检测呼吸道样本中的 B. pertussis，通过免疫荧光法检测呼吸道病毒。临床数据来自医院记录，并使用结构化问卷收集。
80 例患儿中 37 例单纯 B. pertussis 感染（百日咳组），43 例 RSV-pertussis 合并感染（合并感染组）。两组间性别、体重、早产史、百日咳疫苗接种、症状、肺炎存在、淋巴细胞计数无显著差异。单因素分析显示，合并 RSV 感染的患儿年龄较大（中位数 4.57 个月 vs 4.03 个月，p=0.048）；更常使用β-内酰胺类抗生素治疗（21% vs 5%，p=0.044）；胸部听诊时哮鸣音（40% vs 14%，p=0.009）和啰音（35% vs 14%，p=0.028）发生率较高，再入院率（40% vs 11%，p=0.004）和住院时间（中位数 10 天 vs 7 天，p=0.002）较长。进一步的二元逻辑回归分析显示，合并 RSV 感染的患儿哮鸣音（OR=3.802；95%CI：1.106 至 13.072；p=0.034）和再入院（OR=5.835；95%CI：1.280 至 26.610；p=0.023）发生率较高。
RSV 合并感染会增加小儿百日咳住院患儿的再入院率。当这些患者胸部听诊出现哮鸣音时，应怀疑 RSV 感染。早期检测 RSV 可避免不必要的抗生素使用。
