Reller Megan E, Mehta Kayur, McCollum Eric D, Ahmed Salahuddin, Anderson Jack, Roy Arunangshu D, Chowdhury Nabidul Haque, Saha Samir, Moulton Lawrence H, Santosham Mathuram, Baqui Abdullah H
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Duke Global Health Institute, Durham, North Carolina, USA.
Influenza Other Respir Viruses. 2024 Dec;18(12):e70062. doi: 10.1111/irv.70062.
Acute lower respiratory tract infections (ALRIs) remain the leading infectious cause of death among children < 5 years, with viruses contributing to a large proportion of cases. Little is known about the epidemiology and etiology of viral ALRI in rural Bangladesh.
We enrolled 3- to 23-month-old children with ALRIs attending a subdistrict hospital outpatient clinic in Sylhet district in Bangladesh. Trained study physicians ascertained the cases and obtained nasopharyngeal swabs to detect 19 respiratory viruses by multiplex PCR using the Luminex Integrated System NxTAG Respiratory pathogen panel.
Between August 2016 and September 2017, we enrolled 1477 children. Median age was 10 months; 58.1% were male. Forty-seven percent presented during autumn (mid-June to mid-October). About a third had temperature ≥ 101°F, 95.4% had cough in the previous 3 days, 72.0% had fast breathing, and 80.0% had chest indrawing. Alveolar consolidation occurred in 23.9%, and 4.4% were hypoxemic (saturation < 90% on room air). Nineteen percent required hospitalization; 79.1% of them were discharged within 48 h. A respiratory virus was identified in 81.8%, majority (75.8%) with single virus isolation. Rhinoenterovirus was most commonly identified (HRV/HEV, 37.9%), followed by respiratory syncytial virus (RSV, 20.2%) and human metapneumovirus (hMPV, 11.7%). Rhinoenterovirus was detected year-round; RSV was detected during August-November and hMPV during December-March.
Respiratory viruses were identified in a majority (82%) of children under 2 years of age presenting with ALRI in rural hospitals of Bangladesh. These findings have implications for future study and potentially for surveillance, antimicrobial stewardship, vaccine program planning, and policy.
急性下呼吸道感染（ALRIs）仍然是5岁以下儿童死亡的主要感染原因，其中很大一部分病例由病毒引起。关于孟加拉国农村地区病毒性ALRI的流行病学和病因知之甚少。
我们纳入了在孟加拉国锡尔赫特地区一家分区医院门诊就诊的3至23个月大的ALRIs儿童。经过培训的研究医生确诊病例，并采集鼻咽拭子，使用Luminex综合系统NxTAG呼吸道病原体检测板通过多重PCR检测19种呼吸道病毒。
2016年8月至2017年9月期间，我们纳入了1477名儿童。中位年龄为10个月；58.1%为男性。47%在秋季（6月中旬至10月中旬）就诊。约三分之一的儿童体温≥101°F，95.4%在过去3天内有咳嗽，72.0%呼吸急促，80.0%有胸凹陷。23.9%出现肺泡实变，4.4%有低氧血症（室内空气下饱和度<90%）。19%需要住院治疗；其中79.1%在48小时内出院。81.8%的病例检测到呼吸道病毒，大多数（75.8%）为单一病毒分离。鼻肠病毒最常见（HRV/HEV，37.9%），其次是呼吸道合胞病毒（RSV，20.2%）和人偏肺病毒（hMPV，11.7%）。鼻肠病毒全年均可检测到；RSV在8月至11月期间检测到，hMPV在12月至3月期间检测到。
在孟加拉国农村医院就诊的大多数（82%）2岁以下患有ALRI的儿童中检测到呼吸道病毒。这些发现对未来的研究以及潜在的监测、抗菌药物管理、疫苗计划规划和政策具有重要意义。
