Marafungana N, Naidoo K L, Gounder L, Masekela R
Department of Paediatrics and Child Health, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
King Edward VIII Hospital, Durban, South Africa.
Afr J Thorac Crit Care Med. 2024 Jul 4;30(2):e1208. doi: 10.7196/AJTCCM.2024.v30i2.1208. eCollection 2024.
Viral causes of lower respiratory tract infections (LRTIs) are associated with increased mortality in children aged <5 years (U5). Human adenovirus (HAdV) has been associated with severe LRTI; however, its relationship with HIV and malnutrition in South Africa (SA) is not understood.
To identify the prevalence of and factors associated with HAdV LRTIs in hospitalised U5 childen.
Clinical and viral data on U5 children hospitalised with severe LRTI from January 2018 to June 2020 at King Edward VIII Hospital, Durban, SA, including results of a multiplex polymerase chain reaction (PCR) panel assay for respiratory viruses, were retrieved from inpatient files and laboratory databases and retrospectively analysed. Standard descriptive statistics and Pearson's χ², Fisher's exact and Mann-Whitney tests were used to determine significant associations with HAdV LRTI.
Among the 206 viral assays analysed (15.6% of all LRTI admissions), HAdV was the most common virus identified. The cohort had a median (interquartile range) age of 5 (2 - 13) months, 47.3% had perinatal HIV exposure, and 34.5% had severe acute malnutrition (SAM). No seasonal pattern with HAdV could be demonstrated. SAM and prematurity were significant risk factors for readmission, and perinatal HIV exposure was a significant risk factor for presence of multiple viruses on analysis of a respiratory specimen. Detection of HAdV was not associated with an increased risk of requiring oxygen or ventilatory support.
HAdV was the most common virus found on analysis of multiplex PCR panel results in children hospitalised with severe LRTI in SA, where high rates of HIV exposure may result in increased susceptibility to viral co-infections. The role of HAdV as a cause of severe LRTI in SA infants, who have high rates of HIV exposure, requires greater scrutiny.
This study provides retrospective data identifying human adenovirus (HAdV) as the most common cause of severe lower respiratory tract infection (LRTI) in children aged <5 years (U5). The impact of respiratory syncytial virus as a common pathogen in children is well established. The study confirms anecdotal evidence that HAdV is an important disease-causing pathogen associated with LRTI. Children with perinatal HIV exposure and severe acute malnutrition (SAM) may be particularly susceptible. HAdV must be considered a major cause of severe LRTI in U5 children. Children with LRTI who had perinatal HIV exposure and those with SAM need to be tested for HAdV and to be monitored for severe disease.
下呼吸道感染（LRTIs）的病毒病因与5岁以下（U5）儿童死亡率增加相关。人类腺病毒（HAdV）与严重LRTI有关；然而，在南非（SA）其与HIV和营养不良的关系尚不清楚。
确定住院U5儿童中HAdV LRTIs的患病率及相关因素。
从南非德班爱德华八世国王医院2018年1月至2020年6月因严重LRTI住院的U5儿童的临床和病毒学数据，包括呼吸道病毒多重聚合酶链反应（PCR）检测结果，从住院病历和实验室数据库中检索并进行回顾性分析。采用标准描述性统计以及Pearson卡方检验、Fisher精确检验和Mann-Whitney检验来确定与HAdV LRTI的显著关联。
在分析的206次病毒检测中（占所有LRTI入院病例的15.6%），HAdV是最常见的病毒。该队列儿童的年龄中位数（四分位间距）为5（2 - 13）个月，47.3%有围产期HIV暴露，34.5%有重度急性营养不良（SAM）。未发现HAdV的季节性模式。SAM和早产是再入院的显著危险因素，围产期HIV暴露是呼吸道标本分析中存在多种病毒的显著危险因素。检测到HAdV与需要氧气或通气支持的风险增加无关。
在南非，HAdV是对因严重LRTI住院儿童进行多重PCR检测结果分析时发现的最常见病毒，在该地高HIV暴露率可能导致对病毒合并感染的易感性增加。在HIV暴露率高的南非婴儿中，HAdV作为严重LRTI病因的作用需要更深入研究。
本研究提供的回顾性数据表明，人类腺病毒（HAdV）是5岁以下（U5）儿童严重下呼吸道感染（LRTI）的最常见病因。呼吸道合胞病毒作为儿童常见病原体的影响已得到充分证实。该研究证实了传闻证据，即HAdV是与LRTI相关的重要致病病原体。有围产期HIV暴露和重度急性营养不良（SAM）的儿童可能特别易感。HAdV必须被视为U5儿童严重LRTI的主要病因。有围产期HIV暴露的LRTI儿童和患有SAM的儿童需要进行HAdV检测并监测是否患有严重疾病。
