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García-García ML, Alcolea S, Alonso-López P, Martín-Martín C, Tena-García G, Casas I, Pozo F, Méndez-Echevarría A, Hurtado-Gallego J, Calvo C. Antibiotic Utilization in Hospitalized Children with Bronchiolitis: A Prospective Study Investigating Clinical and Epidemiological Characteristics at a Secondary Hospital in Madrid (2004-2022). Pathogens 2023; 12:1397. [PMID: 38133281 PMCID: PMC10747854 DOI: 10.3390/pathogens12121397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Bronchiolitis is a viral respiratory infection, with respiratory syncytial virus (RSV) being the most frequent agent, requiring hospitalization in 1% of affected children. However, there continues to be a noteworthy incidence of antibiotic prescription in this setting, further exacerbating the global issue of antibiotic resistance. This study, conducted at Severo Ochoa Hospital in Madrid, Spain, focused on antibiotic usage in children under 2 years of age who were hospitalized for bronchiolitis between 2004 and 2022. In that time, 5438 children were admitted with acute respiratory infection, and 1715 infants (31.5%) with acute bronchiolitis were included. In total, 1470 (87%) had a positive viral identification (66% RSV, 32% HRV). Initially, antibiotics were prescribed to 13.4% of infants, but this percentage decreased to 7% during the COVID-19 pandemic thanks to adherence to guidelines and the implementation of rapid and precise viral diagnostic methods in the hospital. HBoV- and HAdV-infected children and those with viral coinfections were more likely to receive antibiotics in the univariate analysis. A multivariate logistic regression analysis revealed a statistically independent association between antibiotic prescription and fever > 38 °C (p < 0.001), abnormal chest-X ray (p < 0.001), ICU admission (p = 0.015), and serum CRP (p < 0.001). In conclusion, following guidelines and the availability of rapid and reliable viral diagnostic methods dramatically reduces the unnecessary use of antibiotics in infants with severe bronchiolitis.
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Affiliation(s)
- María Luz García-García
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
| | - Sonia Alcolea
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
| | - Patricia Alonso-López
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Clara Martín-Martín
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Guadalupe Tena-García
- Pediatrics Department, Severo Ochoa University Hospital, 28911 Leganés, Spain; (M.L.G.-G.); (P.A.-L.); (C.M.-M.); (G.T.-G.)
- Puerta de Hierro Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Inmaculada Casas
- Respiratory Virus and Influenza Unit, National Center of Microbiology, 28222 Madrid, Spain; (I.C.); (F.P.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Pozo
- Respiratory Virus and Influenza Unit, National Center of Microbiology, 28222 Madrid, Spain; (I.C.); (F.P.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Méndez-Echevarría
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
| | - Jara Hurtado-Gallego
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- La Paz University Hospital, 28046 Madrid, Spain
| | - Cristina Calvo
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.-E.); (J.H.-G.)
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain
- La Paz University Hospital, 28046 Madrid, Spain
- La Paz Institute for Health Research (IdiPAZ), 28029 Madrid, Spain
- Universidad Autónoma Madrid (UAM), 28029 Madrid, Spain
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Nguyen DD, Phung LT, Thanh Tran HT, Ly HTT, Vo AHM, Dinh NP, Doan PM, Nguyen AT, Dang LD, Doan TT, Pham KT, Pham HL, Hoang DX, Pham TN, Tran BT, Tran TTT, Le HTM, Pham AN, Antoniou A, Ho NT. Molecular subtypes of Adenovirus-associated acute respiratory infection outbreak in children in Northern Vietnam and risk factors of more severe cases. PLoS Negl Trop Dis 2023; 17:e0011311. [PMID: 37934746 PMCID: PMC10655982 DOI: 10.1371/journal.pntd.0011311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Under the pressure of Human Adenovirus (HAdV)-associated acute respiratory infection (ARI) outbreak in children in Northern Vietnam in the end of 2022, this study was initiated to identify the HAdV subtype(s) and examine the associated clinical features and risk factors of more severe cases. METHODS This study evaluated pediatric patients with ARI which had tested positive for HAdV between October and November 2022 using a multiplex real-time PCR panel. Nasopharyngeal aspirates or nasal swab samples were used for sequencing to identify HAdV subtypes. Clinical data were collected retrospectively. RESULTS Among 97 successfully sequenced samples, the predominant subtypes were HAdV-B3 (83%), HAdV-B7 (16%) and HAdV-C2 (1%). Lower respiratory manifestations were found in 25% of the patients of which 5% were diagnosed with severe pneumonia. There was no significant association between HAdV subtype and clinical features except higher white blood cell and neutrophil counts in those detected with HAdV-B3 (p<0.001). Co-detection of HAdV with ≥1 other respiratory viruses was found in 13/24(54%) of those with lower respiratory manifestations and 4/5(80%) of those with severe pneumonia (odds ratio (95% confidence interval) vs. those without = 10.74 (2.83, 48.17) and 19.44 (2.12, 492.73) respectively after adjusting for age, sex, birth delivery method, day of disease). CONCLUSION HAdV-B3 and HAdV-B7 were predominant in the outbreak. Co-detection of HAdV together with other respiratory viruses was a strong risk factor for lower respiratory tract illnesses and severe pneumonia. The findings advocate the advantages of multi-factor microbial panels for the diagnosis and prognosis of ARI in children.
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Affiliation(s)
- Dinh-Dung Nguyen
- Medical Genetics Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
| | - Lan Tuyet Phung
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
- VinUniversity, Hanoi, Vietnam
| | - Huyen Thi Thanh Tran
- Medical Genetics Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
| | - Ha Thi Thanh Ly
- Medical Genetics Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
| | - Anh Hang Mai Vo
- Medical Genetics Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
| | - Nhung Phuong Dinh
- Medical Genetics Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
| | - Phuong Mai Doan
- Microbiology Lab, Laboratory Department, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Anh Thi Nguyen
- Microbiology Lab, Laboratory Department, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Luc Danh Dang
- Microbiology Lab, Laboratory Department, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Thia Thi Doan
- Microbiology Lab, Laboratory Department, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Khuong Thi Pham
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Huong Lan Pham
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Dai Xuan Hoang
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | | | | | | | - Huong Thi Minh Le
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - An Nhat Pham
- Pediatric Center, Vinmec Times City International General Hospital, Vinmec Healthcare System, Hanoi, Vietnam
| | - Antony Antoniou
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Nhan Thi Ho
- Research & Development Department, Vinmec High Tech Center, Vinmec Healthcare System, Hanoi, Vietnam
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Pneumonia in Children During the 2019 Outbreak in Xiamen, China. Pediatr Infect Dis J 2023; 42:87-93. [PMID: 36638390 DOI: 10.1097/inf.0000000000003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND To understand the regional epidemiology and clinical characteristics of adenovirus pneumonia in hospitalized children during the 2019 outbreak of respiratory adenoviruses in China. METHODS We analyzed the epidemiologic trend of adenovirus in children hospitalized for acute lower respiratory tract infections in Xiamen in 2019. Adenovirus was identified using direct fluorescent antibody detection. During the peak seasons of adenovirus epidemic, 170 adenovirus-positive specimens were obtained for molecular typing, and the clinical data were collected. RESULTS Among the 9890 children hospitalized for acute lower respiratory tract infection, 609 (6.2%) were tested positive for adenovirus. The detection rate of adenovirus was significantly higher in boys than in grils (9.5% vs. 4.6%, P < 0.05). Adenovirus activity increased markedly between April and August with the prevalence of 7.3%-12.4%. During the outbreak season, type 7 accounted for 70.6%, followed by type 3 (28.8%) and type 4 (0.6%). Of the 155 cases of adenovirus pneumonia, the median age was 3.0 years (range: 4 month to 9 years), 153 (98.7%) had fever with a mean fever duration of 9.04 ± 5.52 days, 28 (16.5%) had wheezing, 93 (60%) showed segmental or lobar consolidation with atelectasis and 13 (8.4%) showed pleural effusion. Forty-six (29.6%) cases developed severe pneumonia, 7 (4.1%) required mechanical ventilation and 2 (1.2%) died. Younger age, longer duration of fever and higher fever spike were more frequently seen in severe cases (P < 0.05). Twenty-five (16.2%) had C-reactive protein ≥ 40 mg/L, and 91 (58.7%) had procalcitonin ≥ 0.25 mg/L. CONCLUSIONS Adenovirus types 7 and 3 caused the outbreak of adenovirus pneumonia in community children during late spring to summer in 2019 in Xiamen. The majority of adenovirus pneumonia resembles bacterial pneumonia. The incidence of severe pneumonia was high when type 7 predominantly prevailed. Adenovirus type 7 was more common in severe cases than in nonsevere cases.
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Fatal adenovirus pneumonia in a 15-day-old infant despite extracorporeal life support treatment: A case report. MEDICINE INTERNATIONAL 2022; 2:15. [PMID: 36698502 PMCID: PMC9829201 DOI: 10.3892/mi.2022.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
Infections are one of the most common causes of severe neonatal diseases and the leading cause of neonatal death. Although respiratory viral infections are widespread, they are still not recognized as the predominant causes of neonatal deaths. Adenovirus infection is uncommon during the neonatal period, and it frequently has a fatal outcome. Furthermore, it is difficult to distinguish from other common bacterial and respiratory viral infections. The present study reports the case of a 15-day-old newborn who presented with coagulation disorders and hypoxemia in September, 2020. Human adenovirus of species D-53 (HAdV-D53) was detected in the blood and sputum. Severe pneumonia rapidly progressed to multiple organ failure syndrome and the patient succumbed to the disease, despite receiving extracorporeal membrane oxygenation.
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Zhu G, Xu D, Zhang Y, Wang T, Zhang L, Gu W, Shen M. Epidemiological characteristics of four common respiratory viral infections in children. Virol J 2021; 18:10. [PMID: 33407659 PMCID: PMC7787583 DOI: 10.1186/s12985-020-01475-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Viruses are the main infectious agents of acute respiratory infections in children. We aim to describe the epidemiological characteristics of viral pathogens of acute respiratory tract infections in outpatient children. METHODS From April 2018 to March 2019, the results of viral detection using oral pharyngeal swabs from 103,210 children with acute respiratory tract infection in the outpatient department of the Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV), were detected by the colloidal gold method. RESULTS At least one virus was detected in 38,355 cases; the positivity rate was 37.2%. A total of 1910 cases of mixed infection with two or more viruses were detected, and the positivity rate of multiple infection was 1.9%. The ADV positivity rate was highest in the 3-6-year-old group (18.7%), the FLUA positivity rate was highest in the > 6-year-old group (21.6%), the FLUB positivity rate was highest in the > 6-year-old group (6.6%), and the RSV positivity rate was highest in the < 1-year-old group (10.6%). There was a significant difference in the positivity rate of viral infection among different age groups (χ2 = 1280.7, P < 0.001). The rate of positive viral infection was highest in winter (47.1%). The ADV infection rate was highest in spring (18.2%). The rates of FLUA and FLUB positivity were highest in winter (28.8% and 3.6%, respectively). The rate of RSV positivity was highest in autumn (17.4%). The rate of positive viral infection in different seasons was significantly different (χ2 = 6459.1, P < 0.001). CONCLUSIONS Viral infection rates in children differ for different ages and seasons. The positivity rate of ADV is highest in the preschool period and that of RSV is highest in infants; that of FLU increases with age. The total positive rate of viral infection in different seasons is highest in winter, as is the rate of FLU positivity.
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Affiliation(s)
- Guohong Zhu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China
| | - Dan Xu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China.
| | - Yuanyuan Zhang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China
| | - Tianlin Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, Zhejiang Province, China
| | - Lingyan Zhang
- Department of Internal Medicine, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, China
| | - Weizhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, China
| | - Meiping Shen
- Nursing Department, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, China
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Respiratory Virus-related Emergency Department Visits and Hospitalizations Among Infants in New Zealand. Pediatr Infect Dis J 2020; 39:e176-e182. [PMID: 32675757 DOI: 10.1097/inf.0000000000002681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Estimates of the contribution of respiratory viruses to emergency department (ED) utilization remain limited. METHODS We conducted surveillance of infants with acute respiratory infection (ARI) associated ED visits, which then resulted in either hospital admission or discharge home. Seasonal rates of specific viruses stratified by age, ethnicity, and socioeconomic status were estimated for both visits discharged directly from ED and hospitalizations using rates of positivity for each virus. RESULTS During the 2014-2016 winter seasons, 3585 (66%) of the 5412 ARI ED visits were discharged home directly and 1827 (34%) were admitted to hospital. Among visits tested for all respiratory viruses, 601/1111 (54.1%) of ED-only and 639/870 (73.4%) of the hospital-admission groups were positive for at least one respiratory virus. Overall, respiratory virus-associated ED visit rates were almost twice as high as hospitalizations. Respiratory syncytial virus was associated with the highest ED (34.4 per 1000) and hospitalization rates (24.6 per 1000) among infants. ED visit and hospitalization rates varied significantly by age and virus. Māori and Pacific children had significantly higher ED visit and hospitalization rates for all viruses compared with children of other ethnicities. CONCLUSIONS Many infants with acute respiratory virus infections are managed in the ED rather than admitted to the hospital. Higher rates of ED-only versus admitted acute respiratory virus infections occur among infants living in lower socioeconomic households, older infants and infants of Māori or Pacific versus European ethnicity. Respiratory virus infections resulting in ED visits should be included in measurements of ARI disease burden.
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Rossetto F, Iglesias-Caballero M, Liedtke HC, Gomez-Mestre I, Berciano JM, Pérez-Suárez G, de Paz O, Ibáñez C, Echevarría JE, Casas I, Juste J. Mating strategy is determinant of adenovirus prevalence in European bats. PLoS One 2020; 15:e0226203. [PMID: 31910439 PMCID: PMC6946596 DOI: 10.1371/journal.pone.0226203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
Adenoviruses are double-strained DNA viruses found in a great number of vertebrates, including humans. In order to understand their transmission dynamics, it is crucial, even from a human health perspective, to investigate how host traits influence their prevalence. Bats are important reservoirs for adenoviruses, and here we use the results of recent screenings in Western Europe to evaluate the association between characteristic traits of bat species and their probability of hosting adenoviruses, taking into account their phylogenetic relationships. Across species, we found an important phylogenetic component in the presence of adenoviruses and mating strategy as the most determinant factor conditioning the prevalence of adenoviruses across bat species. Contrary to other more stable mating strategies (e.g. harems), swarming could hinder transmission of adenoviruses since this strategy implies that contacts between individuals are too short. Alternatively, bat species with more promiscuous behavior may develop a stronger immune system. Outstandingly high prevalence of adenoviruses was reported for the Iberian species Pipistrellus pygmaeus, P. kuhlii and Nyctalus lasiopterus and we found that in the latter, males were more likely to be infected by adenoviruses than females, due to the immunosuppressing consequence of testosterone during the mating season. As a general trend across species, we found that the number of adenoviruses positive individuals was different across localities and that the difference in prevalence between populations was correlated with their geographic distances for two of the three studied bat species (P. pygmaeus and P.kuhlii). These results increase our knowledge about the transmission mechanisms of adenoviruses.
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Affiliation(s)
- Federica Rossetto
- Evolutionary Biology Unit, Estación Biológica Doñana (CSIC), Sevilla, Spain
| | | | | | - Ivan Gomez-Mestre
- Evolutionary Biology Unit, Estación Biológica Doñana (CSIC), Sevilla, Spain
| | | | - Gonzalo Pérez-Suárez
- Department of Life Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Oscar de Paz
- Department of Life Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Carlos Ibáñez
- Evolutionary Biology Unit, Estación Biológica Doñana (CSIC), Sevilla, Spain
| | - Juan E. Echevarría
- National Center of Microbiology, (ISCIII), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Javier Juste
- Evolutionary Biology Unit, Estación Biológica Doñana (CSIC), Sevilla, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Korsun N, Angelova S, Trifonova I, Georgieva I, Voleva S, Tzotcheva I, Mileva S, Ivanov I, Tcherveniakova T, Perenovska P. Viral pathogens associated with acute lower respiratory tract infections in children younger than 5 years of age in Bulgaria. Braz J Microbiol 2018; 50:117-125. [PMID: 30637646 PMCID: PMC6863252 DOI: 10.1007/s42770-018-0033-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Acute lower respiratory infections (ALRIs) are a leading cause of morbidity and hospital admissions in children. This study aimed to determine the viral etiology of these infections in children aged < 5 years during three successive epidemic seasons in Bulgaria. Nasopharyngeal and throat specimens were collected from children with bronchiolitis and pneumonia during the 2015/2016, 2016/2017, and 2017/2018 seasons. The viral etiology was determined by individual real-time PCR assays against 11 respiratory viruses. Of the 515 children examined, 402 (78.1%) were positive for at least one virus. Co-infections with two and three viruses were found in 64 (15.9%) of the infected children. Respiratory syncytial virus (RSV) was the predominant pathogen (37.5%), followed by rhinoviruses (13.8%), metapneumovirus (9.1%), adenoviruses (7%), bocaviruses (7%), influenza A(H1N1)pdm09 (4.9%), A(H3N2) (4.3%), type B (4.1%), and parainfluenza viruses 1/2/3 (2.9%). RSV-B were more prevalent than RSV-A during the three seasons. At least one respiratory virus was identified in 82.6% and 70.1% of the children with bronchiolitis and pneumonia, respectively. Respiratory viruses, especially RSV, are principal pathogens of ALRIs in children aged < 5 years. Diagnostic testing for respiratory viruses using molecular methods may lead to the reduced use of antibiotics and may assist in measures to control infection.
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Affiliation(s)
- Neli Korsun
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria.
| | - Svetla Angelova
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria
| | - Ivelina Trifonova
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria
| | - Irina Georgieva
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria
| | - Silvia Voleva
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria
| | - Iren Tzotcheva
- Medical University, University Hospital Alexandrovska, Pediatric Clinic, 1 St. Georgi Sofiiski, 1431, Sofia, Bulgaria
| | - Sirma Mileva
- National Center of Infectious and Parasitic Diseases, National Laboratory "Influenza and ARD", 44A Stoletov Blvd, 1233, Sofia, Bulgaria
- Medical University, University Hospital Alexandrovska, Pediatric Clinic, 1 St. Georgi Sofiiski, 1431, Sofia, Bulgaria
| | - Ivan Ivanov
- Infectious Hospital Prof. Ivan Kirov, 17 Akademik Ivan E. Geshov, 1431, Sofia, Bulgaria
| | | | - Penka Perenovska
- Medical University, University Hospital Alexandrovska, Pediatric Clinic, 1 St. Georgi Sofiiski, 1431, Sofia, Bulgaria
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Iglesias-Caballero M, Juste J, Vázquez-Morón S, Falcon A, Aznar-Lopez C, Ibáñez C, Pozo F, Ruiz G, Berciano JM, Garin I, Aihartza J, Echevarría JE, Casas I. New Adenovirus Groups in Western Palaearctic Bats. Viruses 2018; 10:v10080443. [PMID: 30127258 PMCID: PMC6116233 DOI: 10.3390/v10080443] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/14/2022] Open
Abstract
In the context of long-term screening for viruses on Western Palaearctic bats, we tested for the presence of adenovirus 1392 oropharyngeal swabs and 325 stool samples taken from 27 bat species. Adenoviruses were detected in 12 species of the Vespertilionidae and the Rhinolophidae families. Fifty positive respiratory and 26 positive stool samples were studied. Phylogenetic analyses of partial hexon protein and partial DNA-dependent DNA polymerase genes indicate that all these bat adenoviruses belong to the genus Mastadenovirus but without constituting a monophyletic cluster. According to genetic identities, the new groups are distinct to the previously described Bat mastadenovirus A and B species and contribute with potentially new members. Our data support that diversity of bat mastadenovirus is host-dependent and increase the knowledge of potentially pathogenic virus from bats. Due to the active role of bats as viral reservoirs, the characterization of these viruses is relevant for Public Health.
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Affiliation(s)
- Maria Iglesias-Caballero
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
| | - Javier Juste
- Estación Biológica de Doñana, CSIC, Avda Américo Vespucio 16, 41092 Seville, Spain.
| | - Sonia Vázquez-Morón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
- Centro de Investigación Biomédica Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
| | - Ana Falcon
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
- Consorcio Centro de Investigación Biomédica en Red (CIBER), 28029 Madrid, Spain.
| | - Carolina Aznar-Lopez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
- Centro de Investigación Biomédica Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
| | - Carlos Ibáñez
- Estación Biológica de Doñana, CSIC, Avda Américo Vespucio 16, 41092 Seville, Spain.
| | - Francisco Pozo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
| | - Guillermo Ruiz
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
| | - Jose M Berciano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
| | - Inazio Garin
- Department of Zoology and Animal Cell Biology, University of the Basque Country (UPV/EHU), Leioa 48940, Basque Country, Spain.
| | - Joxerra Aihartza
- Department of Zoology and Animal Cell Biology, University of the Basque Country (UPV/EHU), Leioa 48940, Basque Country, Spain.
| | - Juan E Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
- Centro de Investigación Biomédica Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
| | - Inmaculada Casas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo km 2. Majadahonda 28220, Madrid, Spain.
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Gil J, Almeida S, Constant C, Pinto S, Barreto R, Melo Cristino J, Machado MDC, Bandeira T. Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age. An Pediatr (Barc) 2017; 88:127-135. [PMID: 32363218 PMCID: PMC7185650 DOI: 10.1016/j.anpede.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/27/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. Objective Compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. Methods A 3-year period observational study (2012–2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. Results The study included 524 samples (451 patients); 448 (85.5%) had at least one virus identified. Viral coinfections were found in 159 (35.5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. Discussion Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.
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Key Words
- ADV, adenovirus
- CI, confidence intervals
- COV, coronavírus
- CRP, C reactive protein
- CXR, chest X-ray
- Coinfection
- ED, emergency department
- FLUA, influenza virus A
- FLUB, influenza virus B
- HBOV, human bocavirus
- HEV, human enterovirus
- HRV, human rhinovirus
- ICU, intensive care unit
- IQR, interquartile range
- IVRI, infecciones de la vías respiratorias inferiores
- Inpatients
- LOS, length of stay
- LRTI, lower respiratory tract infection
- MPV, metapneumovirus
- NPA, nasopharyngeal aspirates
- O2, supplemental oxygen
- OR, odds ratio
- PCR, polymerase chain reaction
- PIV, parainfluenza
- RSV, respiratory syncytial virus
- Respiratory tract infection
- SD, standard deviation
- SpO2, peripheral capillary oxygen saturation
- Virus
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Affiliation(s)
- Joana Gil
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sofia Almeida
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Carolina Constant
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sara Pinto
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Rosário Barreto
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - José Melo Cristino
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Maria do Céu Machado
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Teresa Bandeira
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Gil J, Almeida S, Constant C, Pinto S, Barreto R, Cristino JM, Machado MDC, Bandeira T. [Short-term relevance of lower respiratory viral coinfection in inpatients under 2 years of age]. An Pediatr (Barc) 2017; 88:127-135. [PMID: 28571896 PMCID: PMC7185555 DOI: 10.1016/j.anpedi.2017.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/24/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. OBJECTIVE compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. METHODS A 3-year period observational study (2012-2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. RESULTS The study included 524 samples (451 patients); 448 (85,5%) had at least one virus identified. Viral coinfections were found in 159 (35,5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. DISCUSSION Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.
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Affiliation(s)
- Joana Gil
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sofia Almeida
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Carolina Constant
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sara Pinto
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Rosário Barreto
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - José Melo Cristino
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Maria do Céu Machado
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Teresa Bandeira
- Unidad Respiratoria Pediátrica, Servicio de Pediatría, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte EPE, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
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Annamalay A, Le Souëf P. Viral-Bacterial Interactions in Childhood Respiratory Tract Infections. VIRAL INFECTIONS IN CHILDREN, VOLUME I 2017. [PMCID: PMC7122469 DOI: 10.1007/978-3-319-54033-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Sun HQ, Zhang XX, Kuang XN, Gu WJ, Chen ZR, Yan YD, Wang YQ, Zhu CH, Dong HT, Zhang XL, Ji W. [Epidemiological analysis of 440 cases of respiratory adenovirus infections in children from the Suzhou area between 2006 and 2015]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:34-38. [PMID: 28100319 PMCID: PMC7390133 DOI: 10.7499/j.issn.1008-8830.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the epidemiological characteristics of respiratory adenovirus (ADV) infections in children from the Suzhou area, China. METHODS The clinical data of ADV-positive children out of 35 529 children with respiratory tract infections who were hospitalized in the Children's Hospital of Soochow University between January 2006 and December 2015 were retrospectively studied. RESULTS Of the 35 529 children with respiratory tract infections, 440 (1.24%) were ADV-positive. There was no significant difference in the rate of ADV infections between boys and girls (1.18% vs 1.34%). The ADV infection rates of children at the age of <1 year old, 1-3 years old, 3-7 years old and 7-14 years old were 0.39% (71/18 002), 1.12% (103/9 191), 3.14% (201/6 398), and 3.35%( 65/1 938) respectively and the rate increased with age (P<0.01). The ADV infection rates in spring [1.85%(60/8 658)] and summer [2.20%(189/8 606)] were significantly higher than in autumn [0.30%(27/8 952)] and winter [0.69%(64/9 313)] (P<0.01). CONCLUSIONS The ADV infection rate is increased with age in the children from the Suzhou area, but it is not associated with gender. ADV infections are more common in spring and summer.
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Affiliation(s)
- Hui-Quan Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, China.
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Sun HQ, Zhang XX, Kuang XN, Gu WJ, Chen ZR, Yan YD, Wang YQ, Zhu CH, Dong HT, Zhang XL, Ji W. [Epidemiological analysis of 440 cases of respiratory adenovirus infections in children from the Suzhou area between 2006 and 2015]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:34-38. [PMID: 28100319 PMCID: PMC7390133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/27/2016] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the epidemiological characteristics of respiratory adenovirus (ADV) infections in children from the Suzhou area, China. METHODS The clinical data of ADV-positive children out of 35 529 children with respiratory tract infections who were hospitalized in the Children's Hospital of Soochow University between January 2006 and December 2015 were retrospectively studied. RESULTS Of the 35 529 children with respiratory tract infections, 440 (1.24%) were ADV-positive. There was no significant difference in the rate of ADV infections between boys and girls (1.18% vs 1.34%). The ADV infection rates of children at the age of <1 year old, 1-3 years old, 3-7 years old and 7-14 years old were 0.39% (71/18 002), 1.12% (103/9 191), 3.14% (201/6 398), and 3.35%( 65/1 938) respectively and the rate increased with age (P<0.01). The ADV infection rates in spring [1.85%(60/8 658)] and summer [2.20%(189/8 606)] were significantly higher than in autumn [0.30%(27/8 952)] and winter [0.69%(64/9 313)] (P<0.01). CONCLUSIONS The ADV infection rate is increased with age in the children from the Suzhou area, but it is not associated with gender. ADV infections are more common in spring and summer.
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Affiliation(s)
- Hui-Quan Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215003, China.
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Clinical and molecular features of adenovirus type 2, 3, and 7 infections in children in an outbreak in Taiwan, 2011. Clin Microbiol Infect 2016; 23:110-116. [PMID: 27851998 PMCID: PMC7129580 DOI: 10.1016/j.cmi.2016.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 02/01/2023]
Abstract
Objectives We studied paediatric patients with human adenovirus (HAdV) infection during the 2011 outbreak in northern Taiwan to define the clinical features of different HAdV genotypes in children. Methods Between January and December 2011, 637 patients <19 years of age exhibited culture-confirmed adenoviral infection in Chang Gung Memorial Hospital, and provided specimens available for genotyping by multiplex real-time PCR. Clinical data were collected retrospectively. Results Excluding five cases with multiple genotypes, 632 cases were included for analysis. Three genotypes were identified, including HAdV-3 (429/632; 67.6%), HAdV-7 (144/632; 22.6%) and HAdV-2 (59/632; 9.8%). Median age was 4.58 years (range 2 months to 18 years), with children infected with HAdV-3 significantly older (82.9% >3 years; p <0.001). Of the 621 inpatients, 98.2% had fevers and all exhibited respiratory symptoms, 75 patients (12.1%) had lower respiratory tract infections, 20 (3.2%) required intensive care (HAdV-2: 1; HAdV-3: 8; and HAdV-7: 11), and three died (all HAdV-7-infected). HAdV-3-infected patients were significantly more likely to have upper respiratory symptoms and a high serum C-reactive protein level >100 mg/L, whereas leucocytosis (white blood cell count >15 000/mm3) was more common in HAdV-2-infected patients (p 0.007). HAdV-7 infections were significantly associated with a longer duration of fever, leucopenia (white blood cell count <5000/mm3), thrombocytopenia (platelet count <150 000/mm3), lower respiratory tract infections, a longer length of hospital stay, and requiring intensive care (all p <0.001). Conclusion Childhood HAdV-2, HAdV-3 and HAdV-7 infections may exhibit different clinical manifestations. Although HAdV-3 was the most prevalent genotype observed during the 2011 Taiwan outbreak, HAdV-7 caused more severe disease characteristics and outcomes.
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Narra R, Bono P, Zoccoli A, Orlandi A, Piconi S, Grasselli G, Crotti S, Girello A, Piralla A, Baldanti F, Lunghi G. Acute respiratory distress syndrome in adenovirus type 4 pneumonia: A case report. J Clin Virol 2016; 81:78-81. [PMID: 27354307 DOI: 10.1016/j.jcv.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
Human adenoviruses (HAdVs) cause a wide spectrum of clinical syndromes, depending on species and types, from mild respiratory infections to deadly pneumonia: in particular, severe infections occur in immunocompromised patients. In this report, we describe the case of a 36 years-old woman admitted to our intensive care unit (ICU) with severe respiratory distress syndrome caused by adenovirus pneumonia, that required invasive respiratory support (mechanical ventilation and extracorporeal membrane oxygenation). Molecular assays detected the virus in respiratory and plasma specimen and sequencing procedure identified HAdV type 4. Patient improved after cidofovir administration. Leukopenia and subsequent bacterial infection occurred, but the patient recovered completely and was discharged from the hospital after 54days.
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Affiliation(s)
- R Narra
- Virology Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Milan, Italy;, Italy
| | - P Bono
- Virology Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Milan, Italy;, Italy
| | - A Zoccoli
- Virology Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Milan, Italy;, Italy
| | - A Orlandi
- Virology Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Milan, Italy;, Italy
| | - S Piconi
- First Infectious Disease Department, A.O. Luigi Sacco, Milan, Italy
| | - G Grasselli
- Intensive Care Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Italy
| | - S Crotti
- Intensive Care Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Italy
| | - A Girello
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Piralla
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Section of Microbiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - G Lunghi
- Virology Unit, Fondazione IRCCS Ospedale Maggiore Ca' Granda, Milan, Italy;, Italy.
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Wang YF, Shen FC, Wang SL, Kuo PH, Tsai HP, Liu CC, Wang JR, Chi CY. Molecular Epidemiology and Clinical Manifestations of Adenovirus Respiratory Infections in Taiwanese Children. Medicine (Baltimore) 2016; 95:e3577. [PMID: 27149483 PMCID: PMC4863800 DOI: 10.1097/md.0000000000003577] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Human adenoviruses (HAdVs) are important causes of respiratory infections in children. They usually cause mild upper respiratory symptoms, but they can also produce severe pneumonia and other complications. The aims of this retrospective study were to better define the molecular epidemiology of respiratory adenoviruses circulating in Taiwanese children during 2002 and 2013, detect reinfections and co-infections, and characterize the clinical features and laboratory findings according to the causative genotypes.We collected a representative sample of 182 isolates of adenoviruses from 175 children during the 12-year study period. The most prevalent species was HAdV-B genotype 3 (HAdV-3) (92/182, 50.5%) followed by HAdV-C (HAdV-2) (38/182, 20.9%). A single outbreak of HAdV-E (6/182, 3.3%) was noted in 2007. The mean age of children with adenovirus infections was 3.7 ± 2.0 years, with a slight predominance of males (53.1%). Children with HAdV-B tended to be older, had more lower respiratory tract infections, gastrointestinal symptoms, and a higher rate of hospitalization than those with HAdV-C (P < 0.05). Adenovirus co-infections were noted in 25/175 (14.3%) of the children. The most frequent co-infections were with species B (HAdV-3) and C (HAdV-2) (14/25, 56.0%). Additional infections were noted in 23/175 (13.1%) of the children. Of these repeated infections, the initial isolates were always genotypes of HAdV-C. The second isolates were genotypes of HAdV-B or HAdV-E. The clinical features of the first HAdV-B infection and the reinfection of HAdV-B followed the HAdV-C were similar.In conclusion, HAdV-B, C, and E were the only adenovirus species that were isolated from children who were sufficiently ill with respiratory infections to require a visit to the hospital. Human adenovirus B (HAdV-3) accounted for half of these species. HAdV-B was more likely than other species to produce severe disease. The high incidence of adenovirus co-infection and reinfections with different HAdV species supports the need for continued surveillance and has major implications for development of vaccines.
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Affiliation(s)
- Ya-Fang Wang
- From the National Institute of Infectious Diseases and Vaccinology (Y-FW, F-CS, S-LW, J-RW, C-YC), National Health Research Institutes, Miaoli; Department of Pathology (P-HK, H-PT, J-RW), National Cheng Kung University Hospital; Department of Pediatrics (C-CL, C-YC), National Cheng Kung University Hospital; and Departments of Medical Laboratory Science and Biotechnology (J-RW), National Cheng Kung University, Tainan, Taiwan, R.O.C
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Abstract
BACKGROUND The incidence of enterovirus D68 (EV-D68) and the spectrum of clinical disease in children are not well known in European countries. We have designed a study with the objective of describing the clinical impact of EV-D68 detected in children with respiratory tract infections. METHODS As a part of a prospective study to identify the etiology and clinical characteristics of viral respiratory infections in children in Spain, we performed the analysis of the cases of EV infections in all children hospitalized in a secondary hospital in Madrid, during the epidemic respiratory season 2012-2013. A second group of samples was corresponded to infants of the same area, with ambulatory respiratory infection or asymptomatic. Phylogenetic EV-D68 analysis was made using the viral protein 1 gene (VP1). Clinical data of EV-D68 patients were compared with those infected by rhinovirus in the same period and population. RESULTS The study population consisted of 720 patients corresponding to 399 episodes of hospitalization for respiratory causes, 44 episodes of ambulatory respiratory infections and 277 children determined as a healthy control group. A total of 22 patients were positive for EVs (3.05%), and 12 of them were specifically typed as EV-D68 (11/443 respiratory infections, 2.5%). The most frequent diagnosis in the 10 hospitalized children with EV-D68 detection was recurrent wheezing. Hypoxia was present in 70% of cases, but admission in the intensive care unit was not required. No neurological signs or symptoms were observed. One patient had an ambulatory mild bronchiolitis and another was asymptomatic. No differences were found with rhinovirus infections except less duration of hypoxia and fever in EV-D68 group. CONCLUSIONS EV-D68 infections were detected in 3.05% of respiratory studied samples (2.5% of admissions). The infection was associated with wheezing episodes with hypoxia. No admissions to intensive care unit or neurological symptoms were found.
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