Aderele W I, Johnson W B, Osinusi K, Gbadero D, Fagbami A H, Babarinde Z O, Okubanjo O A
Department of Paediatrics, University College Hospital, Ibadan.
Afr J Med Med Sci. 1995 Mar;24(1):47-53.
An analysis of the features of lower respiratory diseases (LRD) associated with Respiratory Syncytial Virus (RSV) in 21 children aged 1-23 months, indicated that the clinical features did not differ appreciably from those described for LRD due to other infective agents. It was however, remarkable that none of the children was grossly malnourished, neither was there any death. The final respiratory diagnoses were bronchiolitis alone (6 cases), bronchopneumonia (6 cases), empyema/pleural effusion (3 cases, including one with bronchopneumonia), lobar pneumonia (3 cases, including one with associated bronchopneumonia). Streptococcus pneumonia and Klebsiella pneumoniae respectively, were isolated from blood culture in the two cases with lobar pneumonia alone. One child had laryngotracheobronchitis (croup) alone and another, croup associated with bronchiolitis and bronchopneumonia. Radiologically, the single most common lesion was patchy consolidation (8 cases) followed by hyper-inflation (6 cases); in one case, there was no observable lesion on the chest radiograph. All the 6 children who had bronchiolitis alone were aged 12 months and below, and were well nourished; conversely, 8 of the 12 children with pneumonia alone or in addition to other lesions and both children with pleural effusion, were older than 12 months and underweight. Other viral agents were identified in 8 (38%) of the cases. Complications included heart failure in 4 cases and a combination of anaemia and heart failure in one child with empyema. In a child with symptom complex and radiological features suggestive of acute obstructive lower respiratory infection with immunofluorescence evidence of RSV infection, age and nutritional status are important factors in determining the need for antibiotic therapy pending the outcome of bacterial cultures.
对21名年龄在1至23个月的儿童中与呼吸道合胞病毒（RSV）相关的下呼吸道疾病（LRD）特征进行分析后发现，其临床特征与因其他感染因子导致的LRD并无明显差异。然而值得注意的是，这些儿童均无严重营养不良情况，也无死亡病例。最终的呼吸道诊断结果为：单纯细支气管炎（6例）、支气管肺炎（6例）、脓胸/胸腔积液（3例，其中1例合并支气管肺炎）、大叶性肺炎（3例，其中1例合并支气管肺炎）。仅有的2例大叶性肺炎患儿血培养分别分离出肺炎链球菌和肺炎克雷伯菌。1名儿童仅患喉气管支气管炎（哮吼），另1名儿童患哮吼合并细支气管炎和支气管肺炎。放射学检查显示，最常见的单一病变为斑片状实变（8例），其次为肺过度充气（6例）；1例患儿胸部X光片未见明显病变。仅患细支气管炎的6名儿童年龄均在12个月及以下，且营养状况良好；相反，仅患肺炎或合并其他病变的12名儿童中的8名以及2名胸腔积液患儿年龄均超过12个月且体重不足。8例（38%）病例中还鉴定出其他病毒因子。并发症包括4例心力衰竭，1例脓胸患儿合并贫血和心力衰竭。对于有症状且放射学特征提示急性阻塞性下呼吸道感染、并有RSV感染免疫荧光证据的患儿，年龄和营养状况是在细菌培养结果出来之前决定是否需要使用抗生素治疗的重要因素。
