Lower respiratory tract infections associated with influenza A and B viruses in an area with a high prevalence of pediatric human immunodeficiency type 1 infection

BACKGROUND: Despite the high burden of pediatric HIV-1 infection in developing countries, there are few data on the clinical course of influenza virus-associated lower respiratory tract infection (LRTI) in these children. OBJECTIVE: To define and compare the clinical course of HIV-1-infected and -uninfected African children hospitalized with influenza virus associated severe LRTI. METHODS: Children with severe LRTI were prospectively recruited between March, 1997, and March, 1999, as part of a broader study evaluating the etiology and outcome of this condition in hospitalized HIV-1-infected and -uninfected children. The results of children in whom influenza A or B virus was identified by immunofluorescent antibody staining after shell vial culture are reported. Viruses isolated were typed by hemagglutination inhibition assays. RESULTS: Twenty-five (21.6%) of the 116 children hospitalized with severe LRTI in whom influenza A or B virus was identified were HIV-1-infected. HIV-1-infected children were older than uninfected children (mean age +/- SD 17.4 +/- 10.8 months vs. 10.2 +/- 8.9 months; P = 0.002). HIV-1-infected children were more likely to have an underlying medical illness (in addition to HIV-1 infection) predisposing them to more severe LRTI (32.0% vs. 13.2%; P = 0.03). HIV-infected children were also more likely to have indirect evidence of bacterial coinfection, including chest radiographic evidence of confluent alveolar consolidation (78.9% vs. 35.1%, P = 0.006), and were less likely be wheezing (8.0% vs. 31.9%, P = 0.01). However, there was no difference in the clinical outcome of HIV-1-infected and -uninfected children. The duration of hospitalization [median (range) 5 (2 to 33) days vs. 4 (0 to 21) days, P = 0.08] and the mortality rates (8.0% vs. 2.2%, P = 0.20) were similar between HWV-1-infected and -uninfected children. CONCLUSION: HIV-1-infected children hospitalized with severe LRTI associated with influenza virus have an outcome similar to that of HIV-1-uninfected children even in the absence of antiretroviral or anti-influenza virus treatment.     

Hemoglobin level as a risk factor for lower respiratory tract infections

Objective This prospective study was conducted to evaluate the role of hemoglobin level, as a risk factor for Lower Respiratory Tract Infections in children (LRTI). Methods 100 children who came to the outpatient department for LRTI were included in the study. Age and sex-matched 100 children, not having any respiratory illness, were taken as control. They were subjected to complete blood count (CBC) C-reactive protein estimation (CRP), Mantoux test, and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done for all anemic children. Results Radiological evidence of pneumonia was present in 63 children (63%). Hyper inflated lungs were seen in 27 (27%). Mantoux was positive in 22 children (22%) of study group and none among control group. CRP>6mg/L was noted in 45 children (45%) of study group and 14 (14%) of control group. Seventy four of study group (74%) and 33 of control group (33%) had anemia. Of the anemic children, 60 (60%) had iron deficiency, 10 (10%) chronic inflammation and 4 (4%) had hemolytic anemia. These values were 30(30%), 2(2%) and 1(1%) respectively for control group. Low hemoglobin level due to whatever etiology, was a risk factor (p=0.000). Conclusion Anemic children were 5.75 times more susceptible to LRTI compared to the control group. Prevention of anemia, due to whatever etiology, will reduce the incidence of LRTI.     

Viral aetiology of lower respiratory tract infection in young Malaysian children

OBJECTIVE: To study the viral aetiology of lower respiratory tract infection (LRTI) in young Malaysian children. METHODOLOGY: A retrospective review was performed of LRTI patients aged less than 24 months who were admitted to the University Malaya Medical Centre between 1982 and 1997. Respiratory viruses in their nasopharyngeal secretion were identified by indirect immunofluorescence, viral culture, or both. RESULTS: A total of 5691 children were included in the study. The mean age was 8.6 +/- 6.6 months and the M:F ratio was 1.6:1. The most common diagnosis was pneumonia (52%) followed by bronchiolitis (45%) and croup (2%). Positive viral isolation rate was 22.0%. Respiratory syncytial virus (RSV) was the commonest virus isolated (84%), followed by parainfluenza virus (8%), influenza virus (6%) and adenovirus (2%). Patients with positive virus isolation were younger (7.8 +/- 6.2 vs 8.7 +/- 6.7 months, P = 0.0001) and were more likely to have bronchiolitis. CONCLUSION: Young Malaysian children admitted with LRTI had a 22% viral isolation rate and RSV was the commonest virus isolated.     

中性粒细胞CD64在儿童社区获得性肺炎诊断中的价值

目的：探讨外周血中性粒细胞CD64的表达在儿童社区获得性肺炎（CAP）诊断中的价值。方法：依据病原体不同将98例社区获得性肺炎患儿分为细菌感染组（48例）、病毒感染组（29例）以及支原体感染组（21例）;另设健康对照组（20例）。细菌感染组依据患儿的入院情况分为轻症感染组（36例）和重症感染组（12例）。采用流式细胞术检测外周血中性粒细胞CD64的表达,同时免疫比浊法检测外周血C反应蛋白（CRP）的水平。结果：治疗前细菌感染组CD64指数和CRP水平显著高于其他3组,差异有统计学意义（P<0.05）。重症组CD64指数和CRP水平较轻症组显著增高,差异有统计学意义（P<0.05）。细菌感染组经过有效的抗菌治疗后,CD64表达水平下降,和治疗前相比差异有统计学意义（P<0.05）。相关分析结果显示CD64指数与CRP呈正相关（r=0.545,P＜0.01）。 ROC曲线分析结果显示CD64、CRP最佳临界值分别为2.8和8 mg/L,CD64指数的特异性（90%）远高于CRP（74%）。结论：外周血中性粒细胞CD64测定有助于肺部细菌感染的早期诊断,并可以判断病情的严重程度及疗效。     

Relationships between cotinine, lower respiratory tract infection, and eosinophil cationic protein in children

Introduction The aim of this study was to investigate the effect of passive smoking on urine eosinophil cationic protein (u-ECP) in children with lower respiratory tract infections (LRTI). Method This was a case-control study. The study cohort consisted of 150 children with LRTI (case group) and 150 healthy children (control), all from a urban setting. The statistical parameters were: a minimum of 139 children for a 95% confidence interval (95% CI), 80% power, and a possible exposure prevalence of 50%. The u-cotinine and u-ECP levels were measured by radioimmunoassay and fluoroimmunoassay methods, respectively. Data were analyzed by the McNemar chi-square test, t-test, and Pearson correlation. Results When the generally accepted cut-off level of 30 ng/mg urinary cotinine/creatinine was applied, 87.3% of the children with LRTI and 84.7% of healthy children were passive smokers. Using a cut-off level of 60 ng/mg, passive smoking increased the prevalence of LRTI by 4.7-fold (p=0.000). The mean u-ECP values were significantly higher in the case group than in the healthy control group (p=0.018). A positive association was found between u-cotinine and u-ECP values in children with LRTI (p=0.034). Conclusion The results of this study indicate that passive smoking may play an important role in the development of respiratory infections and can cause airway inflammation in children with existing LRTI.     

Defining the potential impact of conjugate bacterial polysaccharide-protein vaccines in reducing the burden of pneumonia in human immunodeficiency virus type 1-infected and -uninfected children

BACKGROUND: The evaluation of bacterial conjugate vaccines in preventing pneumonia requires the definition of suitable outcome measures against which their use can be evaluated. One such possible outcome measure is alveolar consolidation confirmed by chest radiograph (CXR). OBJECTIVE: To define the CXR presentation in relation to identified bacterial and respiratory viral pathogens among HIV-1-infected and -uninfected children. METHODS: The CXRs of 1186 of 1434 children hospitalized with severe lower respiratory tract infection were evaluated for the presence of alveolar consolidation (homogenous airspace infiltrate), bronchopneumonia (patchy airspace consolidation) or other CXR findings. Children were also investigated for bacterial infection by blood culture in 1364 of 1434 episodes and for respiratory viruses in 990 of 1434 episodes by immunofluorescein monoclonal antibody assays. RESULTS: The prevalence of HIV-1 infection among children who had CXRs in the study was 527 (46.2%) of 1142. Alveolar consolidation was more common in HIV-1-infected (63.7%) than in HIV-uninfected children (42.4%, P < 10(-5)) whereas bronchopneumonic changes (29.0% vs. 38.0%, P = 0.001) or a normal CXR occurred in 7.0 vs. 18.2% (P < 10(-5)) of HIV-1-infected and -uninfected children, respectively. Alveolar consolidation was the main CXR presentation in HIV-1-infected (78.6%) and HIV-uninfected children (64.9%, P = 0.14) with all-cause bacteremic pneumonia as well as those with bacteremic Streptococcus pneumoniae pneumonia (76.9% vs. 83.3%, respectively; P = 0.99). Respiratory virus-associated lower respiratory tract infection, however, was more likely to present with alveolar consolidation in HIV-1-infected (55.8%) than in HIV-uninfected (36.1%, P = 0.02) children. CONCLUSION: Although alveolar consolidation may be a useful tool in defining both the efficacy and burden of bacterial pneumonia in HIV-1-uninfected children, this may not be so for HIV-1-infected children. The higher occurrence of respiratory virus-associated alveolar consolidation, possibly coupled with Pneumocystis carinii pneumonia, may be significant confounders in the interpretation of CXR in HIV-1-infected children, limiting the use of alveolar consolidation as an outcome measure when evaluating the efficacy of bacterial conjugate vaccines in HIV-1-infected children.     

Blood culture and respiratory syncytial virus identification in acute lower respiratory tract infection

Even though the incidence of pneumonia in developed and developing countries is similar, the mortality is five times higher in developing countries. This study aimed to determine the prevalence of bacteremia in children with acute lower respiratory tract infection (LRTI) and relative contribution of respiratory syncytial virus (RSV). One hundred and one children under five years of age who attended a primary care level clinic with diagnosis of acute LRTI, were enrolled. Diagnosis and management of pneumonia were done according to the WHO guidelines. Two blood cultures were drawn at the time of admission. A nasopharyngeal sample was taken for detection of RSV by indirect immunofluorescence. Blood cultures were positive for pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus) in three patients. The detection for RSV was positive in 24 patients (23.7%). The clinical and radiographic presentations were not significantly different between patients with and without RSV (p > 0.05). RSV is a common cause of LRTI in children younger than five years old. Blood cultures are not commonly positive in outpatients with acute LRTI. The practice of obtaining blood cultures in primary and secondary care clinics is not useful to guide the treatment of patients with community-acquired pneumonia.     

Viral etiology of lower respiratory tract infections in hospitalized children in Mexico

BACKGROUND: Respiratory viruses are the main cause of lower respiratory tract infections (LRTI) reported worldwide. The contribution of viral infections to respiratory infections in Mexico has not been fully determined. OBJECTIVE: To determine the contribution of viral infections in hospitalized children with LRTI. METHODS: Children younger than 15 years of age with the admission diagnosis of LRTI were eligible for this study. A nasal wash specimen for virus identification by direct immunofluorescent assay (DFA) was obtained as soon as possible after admission. Clinical and radiographic findings of children with positive and negative detection of viruses were compared. RESULTS: Of 285 subjects admitted to the hospital with LRTI, 265 (93%) had an appropriate specimen for DFA. A viral agent was detected in 125 (47.2%) specimens. Viruses that were identified included respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and pneumonia (91). Of the subjects included in the study, 71.3% were younger than 1 year of age. Children with a confirmed viral etiology for their LRTI were younger, had higher respiratory rates on admission and were more likely to present with bronchiolitis than subjects with a negative DFA result. CONCLUSIONS: Respiratory viruses are responsible for at least 47.2% of LRTI requiring hospitalization at our hospital. Respiratory syncytial virus was the most important respiratory agent identified.     

Usefulness of C-reactive protein to define pneumococcal conjugate vaccine efficacy in the prevention of pneumonia

OBJECTIVES AND METHODS: This study explored whether C-reactive protein (CRP) and/or procalcitonin levels were useful to measure vaccine efficacy (VE) and impact against the burden of pneumonia of a 9-valent pneumococcal conjugate vaccine (PCV), compared with chest radiograph-confirmed alveolar consolidation (CXR-AC) as an outcome. Sera obtained from children participating in a phase 3 PCV efficacy trial who were hospitalized for treatment of clinically diagnosed lower respiratory tract infection (C-LRTI) were retrospectively analyzed for CRP and procalcitonin measurements. RESULTS: For non-human immunodeficiency virus (HIV)-infected children, the VE estimates for C-LRTI with CRP levels of > or =40 mg/dL (VE 26.3%; P = 0.003) or CRP levels of > or =120 mg/dL (VE 41.0%; P = 0.003) were 1.7-fold (P = 0.002) and 2.7-fold (P < 0.0001) greater, respectively, than that for CXR-AC (VE 15.1%; P= 0.15). The sensitivity of CXR-AC as an outcome to detect the burden of pneumonia prevented by PCV was 44% (95% confidence interval, 36-55%) in comparison with C-LRTI with CRP levels of > or =40 mg/dL and 73% (95% confidence interval, 58-92%) in comparison with C-LRTI with CRP levels of > or =120 mg/dL. CRP also helped to measure the PCV efficacy for children with C-LRTI but the absence of CXR-AC, for whom the outcome of C-LRTI with CRP levels of > or =40 mg/dL (VE 31.5%; P = 0.007) increased the VE estimate 19.8-fold (P < 0.0001) in comparison with C-LRTI alone (VE 1.6%; P = 0.78) and 3.2-fold (P = 0.005) in comparison with WHO-defined severe pneumonia (VE 10.0%; P = 0.17). Although there was a significant correlation between CRP and procalcitonin levels (Spearman's rho = 0.45; P < 0.0001), the use of procalcitonin levels did not improve either the specificity or sensitivity of measuring the effect of PCV against pneumonia for non-HIV-infected children. The observations were similar for HIV-infected children. CONCLUSIONS: CRP levels of > or =40 mg/dL provide a better measure than chest radiographs to assess the effect of PCV in preventing pneumonia.     

Lower respiratory tract illness and RSV prophylaxis in very premature infants.

AIMS: To determine the frequency of and the risk factors for readmissions for any lower respiratory tract illness (LRTI) and for respiratory syncytial virus (RSV) documented LRTI in children born very prematurely who had or had not received RSV prophylaxis. METHODS: Multicentre prospective longitudinal cohort study of 2813 infants, born between April 2000 and December 2000 at less than 33 weeks of gestational age, and followed until the end of the epidemic season. RESULTS: Among the 2256 children who had no bronchopulmonary dysplasia at 36 weeks of postmenstrual age and were not submitted to RSV prophylaxis, 27.4% were readmitted at least once for any reason during the epidemic season; 15.1% and 7.2% were readmitted at least once for any LRTI and RSV related LRTI, respectively. Children born at less than 31 weeks' gestation, having an intrauterine growth restriction, or living in a single mother family were at a significantly higher risk of readmission for LRTI in general as well as for RSV related LRTI. Of the 376 children submitted to prophylaxis, 28.2% were readmitted at least once for any LRTI and 6.1% for RSV related LRTI. CONCLUSION: One out of four children who had received no prophylaxis, was born very prematurely, and was without bronchopulmonary dysplasia at 36 weeks of postmenstrual age, was readmitted at least once for any reason. Roughly 50% and 20% of these readmissions were related to a LRTI and an RSV infection, respectively. Further epidemiological studies are warranted to assess the aetiology and impact of other respiratory pathogens on post-discharge readmission and respiratory morbidity in this population.     

Empiric use of cefepime in the treatment of lower respiratory tract infections in children

BACKGROUND: These studies were designed to assess the efficacy and safety of cefepime, a fourth generation cephalosporin, for the treatment of serious infections, including lower respiratory tract infections (LRTI) in children. METHODS: Four clinical trials of cefepime for the treatment of serious bacterial infections enrolled 259 children with LRTI. In 3 trials cefepime was compared with ceftazidime (n = 166), cefotaxime (n = 16) or cefuroxime (n = 12). One trial was noncomparative (n = 65). RESULTS: Treatment with cefepime 50 mg/kg/ dose administered every 8 to 12 h produced a satisfactory clinical response (clinical signs of infection resolved or improved with no evidence of recurrent infection at posttreatment follow-up) in 88 to 100% of patients, comparable with comparator therapy. In children from whom a causative pathogen was identified, bacteriologic eradication was comparable between cefepime and comparator therapy. Cefepime was as safe and well-tolerated as comparator therapy. Few treatment-related clinical or laboratory adverse events were noted and were equivalent to comparator in all studies. CONCLUSION: Cefepime is as effective, safe and well-tolerated for the empiric treatment of children with LRTI as comparator agents but offers the advantage of an enhanced spectrum of activity for Gram-positive and Gram-negative pathogens compared with second or third generation cephalosporins.     

儿童下呼吸道感染常见细菌病原分布及耐药现状

下呼吸道感染(LRTI)尤其肺炎,是主要的儿童杀手。在发展中国家儿童LRTI病原菌以细菌为主。肺炎链球菌是最重要的社区获得性LRTI细菌病原。随着7价肺炎链球菌结合疫苗的应用,非疫苗血清型菌株所致的侵袭性肺炎链球菌疾病增多,且对抗生素的耐药性增强。社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)和医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)有着不同的遗传背景,其耐药性也有明显差异。革兰阴性杆菌仍是医院获得性LRTI的重要病原菌。社区获得性LRTI与医院获得性LRTI常见细菌病原有区别,亦有重叠。了解儿童LRTI常见细菌病原的分布及耐药现状,对指导临床合理诊治至关重要。     

降钙素原对儿童急性肾盂肾炎的诊断价值

目的：探讨降钙素原（PCT）对儿童急性肾盂肾炎（APN）的诊断价值。方法：回顾性分析2011年9月至2012年2月诊断为初发的尿路感染（UTI）且年龄<3岁患儿的病例资料,以核素肾静态扫描（99mTc-DMSA）结果作为诊断APN的金标准,比较上尿路感染（APN）及下尿路感染（非APN）患儿血清PCT、CRP的水平,并绘制二者诊断APN的受试者工作特征曲线（ROC曲线）,判断其诊断性能。结果：共65例UTI患儿纳入研究,其中APN 39例,下尿路感染者26例,前者的血清PCT、CRP水平显著高于后者（分别 3.08 ng/mL vs 0.37 ng/mL;6.25 mg/L vs 3.01 mg/L;均P<0.01）。血清PCT诊断APN的敏感性为84.6%,特异性为88.5%,曲线下面积为0.873（95%可信区间为0.781~0.965）,最佳阈值为1.03 ng/mL;血清CRP诊断APN的敏感性为71.8%,特异性为69.2%,曲线下面积为0.735（95%可信区间为0.612~0.858）,最佳阈值为3.91 mg/L。结论：PCT对儿童APN的诊断具有较高的敏感性及特异性,有助于临床对APN的早期识别。     

Respiratory diseases in infants hospitalized during the 1st 2 years of life for viral lower respiratory tract infections: a one-year follow-up

BACKGROUND: Epidemiologic data suggest strong links between hospitalisation with bronchiolitis in infancy and subsequent higher risk of developing lower respiratory tract infections (LRTI) and/or hyperreactive airway diseases. The aim of this study was to evaluate in an Italian population the natural history of respiratory diseases in children hospitalised for LRTI when they were <2 years. METHODS: An observational, perspective, longitudinal study was performed through telephone interviews. Nine pediatric tertiary care centres participated to the study evaluating a population of 187 children, hospitalised in the previous year (November 1999-April 2000) for bronchiolitis or pneumonia when they were <2 years of age and participated to a previous study on the prevalence of infant LRTI in Italy (RADAR). RESULTS: Twenty-three (12.3%) children had a gestational age <36 weeks. In the 12 months following the first hospitalisation, an elevated frequency of respiratory symptoms was found. Indeed, 152 (81.3%) children suffered from not-requiring-hospital-admission respiratory infections and 21 (11.2%) were hospitalized again for LRTI: 11.6% had bronchiolitis, 23.5% bronchitis and 35.2% pneumonia. In addition, 1.2% had gs;3 infectious episodes and 21.4% gs;6: 68 (36.4%) showed wheezy bronchitis and 17 (9.1%) were reported to have asthma; 132 children (71%) took antibiotics during the last year, 19.4% >3 times; 111 (59.4%) bronchodilators and 49 (26.2%) oral corticosteroids. One year after the first hospitalisation, 19 subjects (10.2%) were found to be positive to at least one class of allergens by prick test or RAST. CONCLUSIONS: Thus, the demonstration of a high morbidity rate for LRTI, wheezing and asthma in this study group during the first year follow-up after hospital admission further support the need for prophylactic interventions to reduce the morbidity and severity of sequelae of LRTI, in particularly in premature children and/or with additional risk factors.     

血清C反应蛋白、白介素-6和降钙素原对小儿急性复杂性阑尾炎的诊断价值研究

目的探索血清C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin 6,IL-6)和降钙素原(procalcitonin,PCT)水平对小儿急性复杂性阑尾炎的诊断价值。方法以2016年1月至2017年5月包头市第四医院小儿外科收治并进行手术治疗的96例急性阑尾炎患者为研究对象,分为两组:单纯性阑尾炎组30例,复杂性阑尾炎(包括化脓性阑尾炎及坏疽性阑尾炎)组66例,两组患者年龄、性别、体重差异均无统计学意义(P>0.05),检测两组患者术前血清CRP、IL-6、和PCT浓度,并绘制ROC曲线分析CRP、IL-6和PCT对小儿急性复杂性阑尾炎的诊断价值。结果复杂性阑尾炎组CRP、IL-6及PCT水平均显著高于单纯性阑尾炎组(P<0.05);以手术后病理结果为金标准,CRP、PCT、IL-6及三者联合检验ROC曲线下面积别为0.906(95%置信区间:0.829~0.956),0.953(95%置信区间:0.889~0.986),0.765(95%置信区间:0.668~0.846),0.973(95%置信区间:0.971~0.995)。曲线下面积值由大到小排序:PCT+CRP+IL-6>PCT>CRP>IL-6,通过两两比较发现,联合检验曲线下面积与CRP、IL-6单独检验曲线下面积比较差异具有统计学意义(Z=2.932,P=0.003;Z=3.854,P=0.0001);联合检验曲线下面积与PCT单独检验曲线下面积比较差异无统计学意义(Z=1.861,P=0.063);CRP与PCT单独检验曲线下面积差异无统计学意义(Z=1.668,P=0.095),IL-6单独检验与CRP单独检验、PCT单独检验比较曲线下面积差异具有统计学意义(Z=2.312,P=0.021;Z=3.371,P=0.001);得到最佳临界点分别为11.47(95%置信区间:11.42~14.48)mg/L,0.87(95%置信区间:0.63~0.98)ng/L,88.60(95%置信区间:87.12~170.83)pg/mL。结论CRP、IL-6和PCT有助于临床医师对阑尾炎严重程度进行早期判断,从而早期争取家长配合,尽早手术治疗并减少并发症的发生。     

Enhanced thrombin generation and depressed anticoagulant function in children with pneumonia

Aims: To clarify the status of the coagulation system in children with community‐acquired pneumonia. Methods: Coagulation activation markers (prothrombin fragment F1 + 2, thrombin–antithrombin complexes, D‐dimer), the natural anticoagulants (antithrombin, protein C and S) and tissue factor were measured in 28 consecutive children with pneumonia on admission to the hospital. Patients were divided into those with either bacterial‐type pneumonia (at least two of the following three criteria: plasma C‐reactive protein (CRP) >80 mg/L, white blood cell count >15 × 10⁹/L and alveolar infiltrates on the chest radiograph) or viral‐type pneumonia. Results: The majority of the patients (79%) showed elevation of at least one of the three coagulation activation markers. Plasma CRP concentration correlated with F1 + 2 (R = 0.44, p < 0.05) and D‐dimer (R = 0.71, p < 0.0001). Patients with bacterial‐type pneumonia (n = 17) had higher D‐dimer levels (p < 0.05) and lower levels of antithrombin (p = 0.005) and protein C (p = 0.08) than the patients with viral‐type pneumonia. Conclusions: Children with community‐acquired bacterial‐type pneumonia show distinctive changes in their coagulation system. The finding of coagulation system activation and depressed function of natural anticoagulants in uncomplicated pneumonia helps to understand the rapid and unpredictable changes observed in the coagulation status in patients with more severe forms of disease.     

Epidemiology and clinical presentation of respiratory syncytial virus infection in a rural area of southern Mozambique

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) in infants throughout most of the world, but little is known about RSV infection in Africa where LRTI are among the leading causes of infant and childhood death. METHODS: The study took place in a rural district hospital in southern Mozambique between October, 1998, and May, 2000. From all children (n = 5635) <1 year of age presenting to an outpatient department with cough or nasal secretion and all children (n = 1307) <5 years of age admitted to hospital with a LRTI, a nasopharyngeal aspirate was collected and tested for RSV by enzyme-linked immunosorbent assay (Abbott). RESULTS: RSV infection was found in 8.6% of study infants in the outpatient department and 10.6% of admitted children with LRTI. Cases presented in predictable yearly outbreaks during the warm and rainy season. Lower respiratory tract involvement was frequent (59.7%). Cough, chest indrawing and increased respiratory rate were all independently related to RSV infection. Wheezing was infrequent. Bacterial coinfection (4.6%) and the case-fatality rate (3.4%) were low. CONCLUSIONS: There is a substantial burden of disease attributable to RSV infection in this rural African setting, with the highest incidence and severity occurring in young infants.     

Baby swimming and respiratory health

AIM: To estimate the effect of baby swimming in the first 6 months of life on respiratory diseases from 6 to 18 months. METHODS: We used data from The Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health in children born between 1999 and 2005 followed from birth to the age of 18 months (n = 30,870). Health outcomes: lower respiratory tract infections (LRTI), wheeze and otitis media between 6 and 18 months of age. Exposure: baby swimming at the age of 6 months. The effect of baby swimming was estimated by logistic regression analysis adjusting for potential confounders. RESULTS: About 25% of the children participated in baby swimming. The prevalence of LRTI was 13.3%, wheeze 40.0% and otitis media 30.4%. Children who were baby swimming were not more likely to have LRTI, to wheeze or to have otitis media. However, children with atopic mothers who attended baby swimming had an increased risk of wheeze, adjusted odds ratios (aOR) 1.24 (95% CI 1.11, 1.39), but not LRTI or otitis media. This was also the case for children without respiratory diseases before 6 months aOR 1.08 (95%CI 1.02-1.15). CONCLUSION: Baby swimming may be related to later wheeze. However, these findings warrant further investigation.     

White blood cell count,C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract

Laboratory findings such as white blood cell (WBC) count, C-reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) level in patients with bronchiolitis, bronchopneumonia and lobar pneumonia caused by respiratory syncytial virus (RSV) were studied. The diagnosis of having RSV infection of the lower respiratory tract was made on the presence of RSV antigen in nasopharyngeal specimens by means of enzyme immunoassay, on chest X-ray appearances and clinical manifestations. The WBC counts in the lobar pneumonia cases (n = 25, 12 288 ± 6296/mm³) were significantly greater than those for the bronchiolitis (n = 52, 9562 ± 2720/mm³) and bronchopneumonia (n = 43, 8369 ± 3714/mm³) cases. The concentrations of CRP in lobar pneumonia cases (n = 25, 6.5 ± 7.3 mg/dL) were significantly greater than those in the bronchiolitis (n = 52, 1.9 ± 2.0 mg/dL) and bronchopneumonia (n = 43, 2.1 ± 2.4 mg/dL) cases. The ESR levels in the lobar pneumonia cases (n = 24, 43.8 ± 29. mm/h) were also significantly higher than those in the bronchiolitis (n = 34, 20.1 ± 12.3 mm/h) and bronchopneumonia (n = 40, 24.7 ± 15.9 mm/h) cases. There were no significant differences in the WBC counts, the CRP concentrations and ESR levels between the bronchiolitis and bronchopneumonia cases. These results suggest that the RSV lobar pneumonia cases are coinfected with some bacterial organisms more heavily than in the RSV bronchiolitis and bronchopneumonia cases.