Johnson W B, Aderele W I, Osinusi K, Gbadero D
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
Afr J Med Med Sci. 1994 Jun;23(2):127-38.
One hundred and three hospitalised urban pre-school Nigerian children aged 2 weeks to 4 years with various acute lower respiratory tract infection (ALRI), were studied prospectively over a 9- month period (August 1985 - April 1986). Overlapping seasonal peaks, corresponding to the rainy/early harmattan months of August through November were most noticeable for the two major viral ALRI syndromes namely, bronchiolitis and croup. The overall M:F ratio was 1.1:1, but a corresponding ratio of 1.6:1 was recorded in the infants. The commonest ALRI symptoms were cough, breathlessness and fever while chest wall retraction, nasal flaring, tachypnoea and auscultatory crepitations were the most frequently recognised physical findings. Grunting respiration was recognised in 26 patients, majority of whom had pleural effusion and/or severe bronchopneumonia. Bronchopneumonia was the single commonest ALRI diagnosis, recorded alone or in combination with another lower respiratory syndrome, in 64 (61.2%) of the 103 cases. The croup:bronchiolitis: pneumonia ratio was 1:2.3:8.3. Nasopharyngitis was recorded in 42 (40.7%) of cases, and was frequently associated with the presumably viral ALRI syndromes of croup and bronchiolitis. Pleural effusion, frequently purulent, was the commonest respiratory complication, while heart failure and anaemia were the most frequently recognised associated conditions, found predominantly in patients with pneumonia and bronchiolitis. There was an overall ALRI case-fatality of 7.8%, representing 8 deaths, in 3 of whom measles was a co-morbid condition. All the 8 deaths had a final diagnosis of pneumonia with or without other ALRI syndromes/associated complications. While subjects with complicating pleural effusion recorded the longest mean duration of hospitalisation, those with bronchiolitis had the shortest duration of hospitalisation and no death. The epidemiologic, as well as the diagnostic and therapeutic implications of our observations are discussed.
对103名年龄在2周至4岁、患有各种急性下呼吸道感染（ALRI）的尼日利亚城市学龄前住院儿童进行了为期9个月（1985年8月至1986年4月）的前瞻性研究。在两个主要的病毒性ALRI综合征，即细支气管炎和哮吼中，与8月至11月的雨季/早期哈马丹月相对应的重叠季节性高峰最为明显。总体男女比例为1.1:1，但婴儿中的相应比例为1.6:1。最常见的ALRI症状是咳嗽、呼吸急促和发热，而胸壁凹陷、鼻翼扇动、呼吸急促和听诊啰音是最常发现的体征。26名患者出现哼哼呼吸，其中大多数有胸腔积液和/或严重支气管肺炎。支气管肺炎是最常见的ALRI诊断，在103例病例中有64例（61.2%）单独记录或与另一种下呼吸道综合征合并记录。哮吼:细支气管炎:肺炎的比例为1:2.3:8.3。42例（40.7%）病例记录有鼻咽炎，且常与推测为病毒性的哮吼和细支气管炎ALRI综合征相关。胸腔积液（常为脓性）是最常见的呼吸并发症，而心力衰竭和贫血是最常发现的相关病症，主要见于肺炎和细支气管炎患者。总体ALRI病死率为7.8%，即8例死亡，其中3例麻疹为合并病症。所有8例死亡的最终诊断均为肺炎，伴有或不伴有其他ALRI综合征/相关并发症。虽然伴有并发症胸腔积液的患者住院时间最长，但细支气管炎患者住院时间最短且无死亡病例。讨论了我们观察结果的流行病学以及诊断和治疗意义。
