2007—2011年长沙地区急性下呼吸道感染住院儿童人偏肺病毒的流行状况

目的了解人偏肺病毒（hMPV）在长沙地区急性下呼吸道感染住院患儿中的流行病学特点。方法收集2007年9月至2011年2月因急性下呼吸道感染在湖南省人民医院儿科医学中心住院儿童的鼻咽抽吸物（nasopharyngealaspirates,NPA）样本2613份,采用逆转录聚合酶链反应法（RT—PCR）检测hMPVM基因,将阳性PCR扩增产物测序并与GenBank中已知的hMPV参考株进行比对、分析。结果2613份标本中hMPV阳性检出数135例,检出率为5．2％,男女之间的检出率比较有统计学差异（x2=8．007,P=0．003）,hMPV阳性检出患儿的年龄以1岁以内多见（63．2％）。hMPV阳性检出率在春季呈现高峰,从检出季节分布显示A2b型主要在冬春季节流行,而B2型主要在春夏季流行。135例hMPV长沙株分为A型和B型两个主要的基因型,其中A2b亚型在2007--2008年为优势流行型别,2009--2010年A2b和B2型共同流行,B2亚型在2011年呈优势流行型别。135例hMPV检出阳性患儿中有66例（48．9％）存在混合病毒感染,其中与HBoV混合检出率最高。结论长沙地区部分儿童的急性下呼吸道感染与hMPV有关,且阳性检出患儿年龄主要集中在1岁以下,男多于女,主要流行季节在春季,A2b型和B2型优势基因型在长沙地区共同流行,与其他病毒混合检出率较高。     

南京地区儿童人偏肺病毒感染的流行病学及临床特征分析

目的了解南京地区儿童人偏肺病毒（hMPV）感染的流行病学特点及临床特征。方法收集2009年8月至2010年7月南京医科大学附属南京儿童医院住院及门诊呼吸道感染患儿的鼻咽抽吸物（NPA）及咽拭子（NPS）共642例,采用逆转录聚合酶链反应法（RT—PCR）检测hMPVM基因,将阳性PCR扩增产物进行测序、同源性和进化分析。结果642例标本中共检出hMPV阳性扩增产物35份,检出率为5．5％。系统进化分析显示南京地区hMPVB1型占51．4％,A2b型占31．4％。hMPV的发病高峰在4月份。其致呼吸道感染以1岁以内多见（71．4％）。35例hMPV感染患儿中有15例（42．8％）存在混合感染,其中与HRV的混合感染检出率最高。临床诊断以肺炎（17例,48．6％）最为常见。结论人偏肺病毒是南京地区儿童急性呼吸道感染的重要病原之一,该年度其优势流行型别为B1型,南京地区A、B两型hMPV感染患儿临床特征无明显差异。     

长沙地区住院儿童人冠状病毒NL63的感染状况及临床特征

目的 了解HCOV-NL63在长沙地区急性下呼吸道感染住院儿童中的流行状况以及临床特征.方法 采集长沙地区2008年9月至2010年10月因急性下呼吸道感染住院儿童NPA样本1185份,用RT-PCR方法检测HCOV-NL63N基因,阳性扩增产物经测序确认,统计分析临床资料.结果 1185份NPA样本中,HCOV-NL63检出阳性10份,检出率为0.8％,其中春季检出1例、夏季检出6例、秋季检出2例、冬季检出1例;阳性检出病例患儿年龄最大2岁半,最小2个月,平均月龄12.5个月;男童7例,女童3例;临床诊断为支气管肺炎6例、毛细支气管炎3例、急性喉气管支气管炎1例;10例中有4例病情危重;4例有基础疾病;7例合并其他病毒混合感染;阳性扩增产物经测序分析与HCOV-NL63参考株同源性为97％～100％.结论 本资料HCOV-NL63阳性检出患儿年龄均在3岁以下;夏季检出率高;男童感染为主;单一基因型在长沙地区流行;HCOV-NL63可能也是我国儿童急性下呼吸道感染中的一种病原.     

人偏肺病毒感染住院儿童的临床特征及病毒基因特性分析

目的 了解急性呼吸道感染住院儿童中人偏肺病毒(hMPV)的感染情况、临床特征及人偏肺病毒基因特性.方法 对2006年2月至5月、2008年3月至4月及2008年9月至2009年2月收集的天津市儿童医院急性呼吸道感染住院儿童的310份鼻咽吸取物标本进行巢式PCR检测hMPV N基因片段,并对其中17株N基因片段进行序列测定,分析序列特征并绘制种系发生树.收集所有阳性患者的临床资料.同时采用多重PCR对N基因阳性标本进行其他常见呼吸道病毒的检测.结果 310份标本中共检出20份(6.5%)hMPV.hMPV阳性患儿的年龄中位数为15.0个月(16天～9岁),其中≤2岁患儿占90.0%(18/20).男性占60.0%(12/20).17株N基因种系发生树分析显示,11株为A2b亚型.20例hMPV阳性患儿的临床诊断均为支气管肺炎,占所有采集的肺炎患儿标本的7.1%(20/282),其临床症状以咳嗽、喘息、呼吸急促、发烧等常见.35%(7/20)需要重症监护,15%(3/20)需要吸氧治疗.平均住院时间为(11.9±4.8)d.A、B型间临床特征未见明显差别.hMPV无明显流行高峰.2例hMPV阳性患儿分别与腺病毒和鼻病毒混合感染.结论 hMPV可引起婴幼儿肺炎等严重疾病.天津地区流行的hMPV以A2b为优势流行型.     

Prevalence of Antibiotic Use for Pediatric Acute Upper Respiratory Tract Infections in Korea

This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.

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长沙地区住院儿童冠状病毒HKU1的感染状况及临床特征

目的了解冠状病毒HKU1在长沙地区急性下呼吸道感染住院儿童中的感染状况及临床特征。方法采集2007年9月至2008年8月长沙地区因急性下呼吸道感染住院儿童鼻咽抽吸物（nasopharyngeal aspirates,NPA）样本1165份,用RT-PCR方法检测冠状病毒HKU1 pol基因,测序分析阳性扩增产物,统计分析临床资料。结果1165份NPA样本中,检测出12份冠状病毒HKU1,阳性率为1．03％（12／1165）,患儿年龄最小8天,最大3岁,临床诊断多见支气管肺炎（83．33％）,所测核苷酸序列与冠状病毒HKU1参考株同源性为98．18％～100％。结论冠状病毒HKU1阳性患儿年龄均在3岁及3岁以下;性别无差异;冬春季检出率高;单一基因型在长沙地区流行;HKU1也是我国儿童急性下呼吸道感染中的一种病原。     

Human metapneumovirus (hMPV) infection in immunocompromised children

BackgroundHuman metapneumovirus (hMPV) is a major cause of upper and lower respiratory tract infection (URTI, LRTI) in children. The prognosis of hMPV is unclear in immunocompromised patients.ObjectivesTo describe the characteristics of hMPV infection in immunocompromised pediatric patients and to review the literature.Study designThis retrospective study included 39 immunocompromised children (age 0–18 years) with proven hMPV infection attending two tertiary pediatric medical centers in 2004–2014. Demographic, clinical, laboratory, and radiological data were collected from the medical files.ResultsMedian age was 6 years. Seven patients had primary immune deficiency and 32, secondary immune deficiency, including 9 patients who underwent hematopoietic stem cell transplantation (HSCT). Most cases (92%) occurred in January–May. Twenty patients (51%) had lower respiratory tract infection and 17 (44%), upper respiratory tract infection; 2 patients (5%) had fever only. Presenting symptoms were fever (70%), cough (54%), and rhinorrhea (35%). Severe lymphopenia (<1000 lymphocytes/mL) was noted in 64% of patients and elevated liver enzyme levels in 49%. Seventeen patients had pneumonia: bilateral and alveolar in 13 patients, each. HSCT was not associated with more severe disease. Respiratory failure occurred in 6 patients, of whom 4 died (10% of cohort). All children who died had severe lymphopenia. On multivariate analysis, bacterial or fungal co-infection was the only major risk factor for death. Review of the literature showed variable clinical presentations and severity in pediatric patients with hMPV infection.ConclusionsInfection with hMPV may be associated with relatively high morbidity and mortality in immunocompromised children. Death was associated with bacterial and fungal co-infection.     

上海地区儿童下呼吸道人类偏肺病毒感染的初步研究

目的 了解人类偏肺病毒（hMPV）在上海地区儿童下呼吸道感染中的致病情况。方法 采集2004年8月-2005年1月秋冬季节我院479例因社区获得性急性下呼吸道感染（CALRTIs）住院儿童的呼吸道分泌物标本，对直接免疫荧光法常规检测病毒阴性的259份标本用逆转录．多聚酶链反应法（RT-PCR）检测hMPVM基因。对PCR阳性产物随机挑选23份直接作核苷酸序列测定，用DNAStar软件对基因序列分析。结果 259份标本中hMPV检测阳性例数为59例（22．8％），占总例数的12．3％。冬季检测阳性率明显高于秋季（31．3％vs7．5％，P〈0．01）。5岁及以下儿童53例（89．8％），5岁以上儿童6例（10．2％）。23份hMPV阳性标本目标基因部分核苷酸序列与GenBank中公布的hMPVM基因同源性达82．8％～100％，部分氨基酸序列同源性为93．0％～100％，对核苷酸序列作基因进化树分析显示存在2种不同的基因型，以Bj1816组为代表的基因型14株，以Bj1887组为代表的基因型9株。结论hMPV是上海地区儿童CALRTIs的重要致病原，上海地区儿童感染的hMPV同时存在2种不同的基因型。     

呼吸道合胞病毒下呼吸道感染对机体细胞免疫的影响

为研究呼吸道合胞病毒（ＲＳＶ）急性下呼吸道感染（ＡＬＲＩ）的细胞免疫变化，对２５例病儿外周血白细胞介素２（ＩＬ－２）和可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平、Ｔ细胞白细胞介素２受体（ＩＬ－２Ｒ）表达率和Ｔ细胞亚群百分率进行检测。结果显示，急性期病儿外周血ＩＬ－２水平明显低于恢复期和正常对照组，Ｔ细胞ＩＬ－２Ｒ表达率亦明显降低，而ｓＩＬ－２Ｒ水平却显著增高。急性期病儿ＩＬ－２水平与Ｔ细胞ＩＬ－２Ｒ表达率和ＣＤ＋４细胞百分率呈正相关，与ｓＩＬ－２Ｒ水平和ＣＤ＋８细胞百分率呈负相关；ｓＩＬ－２Ｒ水平与Ｔ细胞ＩＬ－２Ｒ表达率呈负相关，与临床严重程度呈正相关。上述各项免疫指标异常均提示ＲＳＶ感染时机体存在细胞免疫功能紊乱。     

兰州地区急性呼吸道感染患儿冠状病毒NL63的检测与临床研究

目的 探讨兰州地区冠状病毒NL63(HCoV-NL63)在急性呼吸道感染患儿中的流行现状及临床特点.方法 收集2006年11月至2009年10月兰州大学第一附属医院急性呼吸道感染(ARTIs)患儿1169例鼻咽分泌物,应用RT-PCR方法检测HCoV-NL63以及其余7种常见呼吸道病毒:鼻病毒(HRV),呼吸道合胞病毒(RSV),偏肺病毒(hMPV),流感病毒(IFVA,IFVB)副流感病毒1-3(HPIV1-3)及PCR方法检测腺病毒(ADV),博卡病毒(HBoV).结果 检测出HCoV-NL63阳性标本35例,检出率2.99％,2007年8、9月,2009年7、8月检测阳性标本阳性率较高,分别为23.53％、17.65％,50％、33.33％.2007年12月至2009年2月未检出HCoV-NL63阳性标本.25(25/35)例混合其他病毒感染,混合感染率为71.43％,最常见的混合感染病毒是HRV.3岁及以下和3岁以上HCoV-NL63感染组感染率差异无统计学意义.HCoV-NL63阳性患儿主要的诊断是支气管肺炎和毛细支气管炎,主要的症状是发热和咳嗽.HCoV-NL63单独感染组和混合感染组除消化道症状外,在其余症状和临床诊断方面,差异均无统计学意义.结论 HCoV-NL63是兰州地区呼吸道感染患儿的重要病原,夏季是兰州地区HCoV-NL63感染高峰期,HCoV-NL63的流行存在年度差异.HCoV-NL63感染存在很高的混合感染率,混合感染并不加重HCoV-NL63感染的病情.     

Human metapneumovirus in hospitalized children in Amman,Jordan

Human metapneumovirus (HMPV) has recently been identified as an important cause of acute respiratory infections (ARI) in children worldwide. However, there is little systematic data on its frequency and importance as a cause of ARI in the Middle East. We conducted a viral surveillance study in children <5 years of age admitted with respiratory symptoms and/or fever at two major tertiary care hospitals in Amman, Jordan from 1/18‐3/29/07. Nose and throat swabs were collected and tested for HMPV and other respiratory viruses by real‐time RT‐PCR. A total of 743 subjects were enrolled. Forty‐four (6%) subjects were positive for HMPV, 467 (64%) were positive for RSV and 13 (1.3%) had co‐infection with both HMPV and RSV. The frequency of HMPV in January, February, and March was 4.1%, 3.0%, and 11.9% respectively. Clinical features associated with HMPV infection were similar to those of other respiratory viruses, except children with HMPV were more likely to present with fever than children not infected with HMPV. Children with HMPV and RSV co‐infection were administered supplemental oxygen and were admitted to the ICU more frequently than children infected with HMPV alone or RSV alone, though these differences did not reach statistical significance. We conclude that HMPV is an important cause of acute respiratory infections in children in Amman, Jordan. Longer surveillance studies are needed to better understand the seasonal epidemiology of HMPV and to assess if co‐infection with HMPV and RSV leads to more severe illness. J. Med. Virol. 82:1012–1016, 2010. © 2010 Wiley‐Liss, Inc.     

2011—2012年徐州地区儿童急性呼吸道感染中腺病毒感染特征

目的了解徐州地区儿童腺病毒感染的型别及流行特点。方法采用Real—timePCR方法对2011年1月至2012年12月共990份急性呼吸道感染患儿鼻咽分泌物标本进行检测;对腺病毒阳性的标本进行常规PCR扩增hexon基因并对扩增产物进行测序分型,同时用Hep-2进行细胞分离。结果990份标本中,Real-timePCR检测腺病毒阳性数为164（16．6％）;腺病毒感染全年散发,其高峰期为3—4月;以7岁以下儿童多见,感染阳性率为91．5％;对其中100例PCR阳性标本扩增产物进行测序分型,涵盖B＼C＼E三个亚种,以HAdVB318株（占18．O％）,HAdVC217株（占17．0％）,HAdVB716株（占16．0％）多见,混合HAdVB3和HAdVB7感染2例;134例PCR阳性标本中分离出毒株59株,分离率为44．0％。结论腺病毒是徐州地区儿童急性呼吸道感染的重要病原,徐州地区腺病毒型别种类多样化,病毒重组变异概率较高,需加强对该病毒的流行监测。