Rafei Rayane, Osman Marwan, Barake Bashir Amer, Mallat Hassan, Dabboussi Fouad, Hamze Monzer
Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2025 Aug 22;20(8):e0329481. doi: 10.1371/journal.pone.0329481. eCollection 2025.
Respiratory tract infections, caused by various bacteria and viruses, pose a significant global health burden. In Lebanon, post-COVID-19 epidemiological data on respiratory infections remain scarce. To address this gap, this multicenter study investigates the epidemiology of community-acquired acute respiratory infections among children and adults in Tripoli, North Lebanon. From May 2023 to February 2024, nasopharyngeal samples were collected from outpatients with acute respiratory infections visiting hospitals and pediatric clinics in Tripoli. Samples were analyzed using BioFire® Respiratory Panel 2.1 Plus (bioMérieux, France), which targets 23 pathogens, including 19 viruses and four bacteria. We used multivariable logistic regression models to identify the determinants of respiratory infections and examine associations between respiratory pathogens. Among 324 enrolled patients, 69.1% were co-infected with at least one pathogen. Human rhinovirus/enterovirus was the most prevalent (27.2%), followed by influenza A (19.8%), particularly influenza A/H1-2009 (16.4%), and RSV (11.4%). SARS-CoV-2 was still circulating with a prevalence of 6.8%. Classical human coronaviruses accounted for 6.1% of infections, with HCoV-NL63 (2.8%) being the most common. Parainfluenza viruses were identified in 5.2% of patients, with type 4 (2.5%) being the most prevalent, followed by type 3 (1.5%), type 1 (1.2%), and type 2 (0.3%). Logistic regression analysis revealed that human rhinovirus/enterovirus infection decreased the likelihood of influenza A (OR=0.25; 95%CI = 0.10-0.54; P = 0.001) or SARS-CoV-2 (OR=0.21; 95%CI = 0.03-0.75; P = 0.039) co-infection. Additionally, our logistic regression models identified significant associations between various determinants, symptoms, and common viruses, including a lower likelihood of influenza A (OR=0.23; 95%CI = 0.06-0.76; P = 0.019) and RSV (OR=0.29; 95%CI = 0.10-0.76; P = 0.017) infection among patients with higher educational levels. Notably, parainfluenza virus infections occurred significantly more in refugee patients (OR=7.22; 95%CI = 1.19-37.0; P = 0.020) compared to the host community. In conclusion, this study provides critical insights into the post-pandemic epidemiology of respiratory infections in Lebanon, informing clinicians, health authorities, and policymakers to optimize diagnostics, preventive measures, and antimicrobial stewardship strategies.
由各种细菌和病毒引起的呼吸道感染给全球健康带来了重大负担。在黎巴嫩，关于新冠疫情后呼吸道感染的流行病学数据仍然匮乏。为填补这一空白，这项多中心研究调查了黎巴嫩北部的黎波里儿童和成人社区获得性急性呼吸道感染的流行病学情况。2023年5月至2024年2月，从的黎波里的医院和儿科诊所就诊的急性呼吸道感染门诊患者中采集鼻咽样本。使用BioFire® Respiratory Panel 2.1 Plus（法国生物梅里埃公司）对样本进行分析，该检测针对23种病原体，包括19种病毒和4种细菌。我们使用多变量逻辑回归模型来确定呼吸道感染的决定因素，并研究呼吸道病原体之间的关联。在324名登记患者中，69.1%的患者至少感染了一种病原体。人鼻病毒/肠道病毒最为常见（27.2%），其次是甲型流感（19.8%），尤其是甲型H1N1流感（2009）（16.4%），以及呼吸道合胞病毒（11.4%）。新冠病毒仍在传播，感染率为6.8%。经典人类冠状病毒占感染病例的6.1%，其中HCoV - NL63（2.8%）最为常见。5.2%的患者检测出副流感病毒，其中4型（2.5%）最为常见，其次是3型（1.5%）、1型（1.2%）和2型（0.3%）。逻辑回归分析显示，人鼻病毒/肠道病毒感染降低了甲型流感（OR = 0.25；95%CI = 0.10 - 0.54；P = 0.001）或新冠病毒（OR = 0.21；95%CI = 0.03 - 0.75；P = 0.039）合并感染的可能性。此外，我们的逻辑回归模型确定了各种决定因素、症状和常见病毒之间的显著关联，包括受教育程度较高的患者感染甲型流感（OR = 0.23；95%CI = 0.06 - 0.76；P = 0.019）和呼吸道合胞病毒（OR = 0.29；95%CI = 0.10 - 0.76；P = 0.017）的可能性较低。值得注意的是，与当地社区相比，难民患者中副流感病毒感染的发生率显著更高（OR = 7.22；95%CI = 1.19 - 37.0；P = 0.020）。总之，本研究为黎巴嫩疫情后呼吸道感染的流行病学提供了关键见解，为临床医生、卫生当局和政策制定者优化诊断、预防措施和抗菌药物管理策略提供了依据。
