Zheng Guixing, Zhan Changwen, Pan Hainei, Lu Yingfang, Zhang Haiqi, Xu Xueying, Lin Xinyuan, Qin Sheng
Department of Blood Transfusion, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Clinical Laboratory, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, China.
Pediatr Res. 2025 Jul 1. doi: 10.1038/s41390-025-04214-7.
Community-acquired pneumonia (CAP) is a common infectious disease with a mortality rate of 2-14%. Respiratory syncytial virus (RSV) frequently causes CAP in children. This study aimed to investigate RSV genetic diversity in children under 15 years of age with CAP, evaluate nucleotide substitution rates, and examine associations with clinical characteristics and outcomes.
A retrospective observational study was conducted using nasal swab samples collected from children under 15 years of age diagnosed with CAP. RSV identification involved cell culture and immunofluorescence microscopy, followed by molecular analyses using qPCR, nested PCR, and Sanger sequencing. Bioinformatics tools were applied to assess phylogenetics, evolutionary trends, genetic distance, and nucleotide substitution rates. Statistical analysis of clinical and laboratory data was performed to identify correlations between RSV features and patient characteristics.
Among 346 CAP cases, RSV was detected in 26.88%, with the highest prevalence in children aged 1-2 years. Subtype A exhibited higher nucleotide substitution rates than subtype B. Shortness of breath and high fever were significantly associated with increased nucleotide diversity. RSV infections peaked in winter, particularly in 2018 and 2019. Elevated substitution rates were linked to longer hospital stays, greater risk of complications such as secondary bacterial infections, and increased RSV-related morbidity.
RSV higher nucleotide substitution rates, especially in children under 3 years of age, were associated with more severe clinical outcomes and prolonged hospitalization. Phylogenetic analysis indicated distinct evolutionary patterns, with subtype B exhibiting a more rapid evolutionary rate than subtype A.
This study highlights the high prevalence of respiratory viruses, particularly respiratory syncytial virus (RSV), in children with community-acquired pneumonia in Guangzhou. It provides detailed molecular epidemiological data on RSV, including genetic variation patterns and evolutionary rates. The findings contribute regional data essential for epidemiological research and public health planning in similar geographic areas. These results support clinical decision-making and inform public health strategies, particularly those focused on RSV vaccination and infection control.
社区获得性肺炎（CAP）是一种常见的传染病，死亡率为2%-14%。呼吸道合胞病毒（RSV）常导致儿童CAP。本研究旨在调查15岁以下CAP儿童的RSV基因多样性，评估核苷酸替换率，并研究其与临床特征和结局的关联。
采用回顾性观察研究，使用从诊断为CAP的15岁以下儿童采集的鼻拭子样本。RSV鉴定包括细胞培养和免疫荧光显微镜检查，随后使用qPCR、巢式PCR和桑格测序进行分子分析。应用生物信息学工具评估系统发育、进化趋势、遗传距离和核苷酸替换率。对临床和实验室数据进行统计分析，以确定RSV特征与患者特征之间的相关性。
在346例CAP病例中，RSV检出率为26.88%，在1-2岁儿童中患病率最高。A型亚型的核苷酸替换率高于B型亚型。呼吸急促和高热与核苷酸多样性增加显著相关。RSV感染在冬季达到高峰，特别是在2018年和2019年。替换率升高与住院时间延长、继发细菌感染等并发症风险增加以及RSV相关发病率增加有关。
RSV较高的核苷酸替换率，尤其是在3岁以下儿童中，与更严重的临床结局和住院时间延长有关。系统发育分析表明存在不同的进化模式，B型亚型的进化速度比A型亚型更快。
本研究突出了广州社区获得性肺炎儿童中呼吸道病毒，特别是呼吸道合胞病毒（RSV）的高患病率。它提供了关于RSV的详细分子流行病学数据，包括基因变异模式和进化率。这些发现为类似地理区域的流行病学研究和公共卫生规划提供了重要的区域数据。这些结果支持临床决策，并为公共卫生策略提供信息，特别是那些侧重于RSV疫苗接种和感染控制的策略。
