温州育英儿童医院急性下呼吸道感染住院患儿病毒病原学研究

目的探讨急性下呼吸道感染住院患儿病毒病原学情况，及其与年龄、呼吸道疾病的关系。 方法选择温州医学院附属育英儿童医院2003年1月~2005年1月因急性下呼吸道感染住院治疗的儿童2073例，取其鼻咽分泌物，采用直接荧光免疫法检测7项呼吸道病毒抗原，分析其结果。 结果2073例患儿送检标本，阳性1006份，阳性率485%。阳性标本中呼吸道合胞病毒(RSV)798例(793%)，副流感病毒Ⅲ型(PIV Ⅲ)106例(105%)，腺病毒(ADV)31例(30%)，流感病毒A型(IVA)26例(26%)，流感病毒B型(IVB)6例(06%)，副流感病毒Ⅰ型(PIVⅠ)15例(15%)、RSV和IVA混合感染18例(18%)，RSV和PIV Ⅲ混合感染3例(03%)，RSV和PIVⅠ混合感染3例(03%)，PIV Ⅱ未检测到。 结论温州地区急性下呼吸道感染以RSV为主要病原，婴幼儿(尤其<6个月)病毒感染率较高，好发于冬春季节，以急性毛细支气管炎的检出率最高(613%)。     

儿童急性呼吸道感染病毒感染特点分析

摘要：目的　分析儿童急性呼吸道感染患儿腺病毒（AdV）感染特点。方法　2009年5月至2009年6月北京儿童医院门诊急性呼吸道感染患儿共492例,入选患儿在就诊当日采集咽拭子标本1份,采用逆转录（RT）-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒（RSV）,鼻病毒（RV）,副流感病毒（PIV）1-4型,流感病毒甲型及乙型（IFA、IFB）,腺病毒（AdV）,肠道病毒（EV）,人冠状病毒（HCoV）,人偏肺病毒（HMPV）及人博卡病毒（HBoV）。AdV核酸扩增阳性片段进行克隆测序,对序列进行Blast和进化分析以对AdV进行分型。结果　492例急性呼吸道感染患儿的咽拭子标本中,165例检出至少1种病毒,总阳性检出率为33.5％。其中53份检出AdV,检出率为10.8％,在所有检出病毒中阳性率最高。53份AdV阳性标本中共检出3个亚组,7个血清型,以3型（23/53）为主,其次是7（8/53）型和1型（7/53）。结论　2009年春季北京地区AdV有多个血清型流行,以3型为主。AdV仍然是儿童呼吸道感染的重要病原。     

肠道病毒相关的小儿急性呼吸道感染的研究

目的初步了解肠道病毒(EV)在小儿急性呼吸道感染(ARI)中的流行概况。 方法2003-09—2005-04，于首都儿科研究所就诊的815例ARI患儿，取其鼻咽深部分泌物，用病毒分离及逆转录聚合酶链反应(RT-PCR)法检测EV ，用病毒分离和间接免疫荧光法检测呼吸道合胞病毒(RSV)等7种呼吸道病毒。取144例患儿双份血清，用酶联免疫吸附试验检测EV抗体。 结果病毒总检出率50.9%，RSV阳性率最高(24.9%)，其次为EV(16.9%)。EV在不同月份阳性率为0~34.2%，冬季阳性率最低。RT-PCR、双份血抗体 检测和病毒分离3种检测EV方法的阳性率分别为16.2%、7.6%和1.0%。332例急性喘息患儿中，EV阳性率20.8%，仅次于RSV(42.5%)；3岁以上喘息 患儿中，EV阳性率最高(33.9%)，而3岁以下患儿中，RSV阳性率最高(48.7%)。 结论在住院ARI患儿中，EV是仅次于RSV的常见病原，也是引起小儿急性喘息性疾病的主要病原之一。EV在年长儿中阳性率相对较高，冬季阳性 率较低。RT-PCR法检测EV，快速、敏感、特异，可用于小儿EV感染的诊断。     

1214例急性呼吸道感染住院患儿9种病原体检测分析

目的分析急性呼吸道感染住院患儿病原体的特点,为临床早期病原学诊断和合理用药提供依据。方法 2014年5月至2015年7月宜兴市中医医院儿科收治住院的急性呼吸道感染患儿1 214例,采用间接免疫荧光法检测患儿血清中9种常见病原体IgM抗体,并对上述病原谱、病原流行情况等进行资料汇总分析。结果1 214例急性呼吸道感染患儿中检出病原体IgM抗体阳性371例,阳性率30.5%,其中肺炎支原体阳性率最高,占总样本的16.8%,其次是乙型流感病毒(5.8%)和副流感病毒(2.7%)。205例患儿肺炎支原体混合其他1种或1种以上感染,占总混合感染的55.2%。肺炎支原体春夏季病毒检出率高于秋冬季,差异有统计学意义(P0.008 3)。乙型流感病毒夏季病毒检出率高于秋季,差异有统计学意义(P0.008 3)。1~3岁患儿肺炎支原体感染率均高于1岁和3岁患儿,差异有统计学意义(P0.017);1~3岁患儿乙型流感病毒感染率均高于1岁和3岁患儿,但差异无统计学意义(P0.017);不同年龄段副流感病毒感染率比较差异无统计学意义(P0.05)。结论本院急性呼吸道感染住院患儿主要病原体是肺炎支原体、乙型流感病毒、副流感病毒;肺炎支原体合并其他病原体感染比较普遍;肺炎支原体和乙型流感病毒以夏季感染为主;1~3岁肺炎支原体感染率高。     

儿童急性下呼吸道感染病毒病原学研究

目的　了解儿童急性下呼吸道感染（ALRTI）病毒病原学特点。方法　2007年3月至2008年2月,在北京儿童医院内科就诊及住院治疗的临床诊断为ALRTI的 患儿共572例。对每例患儿在就诊当日或次日采集鼻咽吸取物1份,采用逆转录（RT）-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒（RSV）、鼻病 毒（RV）、副流感病毒（PIV）1～4型、甲型及乙型流感病毒（IFA、IFB）、腺病毒（AdV）、肠道病毒（EV）、冠状病毒（HCoV）、偏肺病毒（hMPV）及博卡病 毒（HBoV）。结果　572例患儿标本中,444例检出至少1种病毒,总检出率77.6％。各种病毒中,RSV检出率最高,占48.3％,其次是RV（27.1％）和PIV（13.3％ ）。不同年龄组病毒的总检出率差异有统计学意义, < 3岁组检出率较高,≥ 5岁组病毒检出率明显降低。不同年龄组ALRTI病原谱有所不同,< 5岁各组主要是 RSV、RV、PIV,而≥5岁组则主要为RV、IFV、RSV。572例中,158例（27.6％）检出2种或2种以上病毒,< 1岁患儿混合感染率最高,为40.2％,随年龄增长混合 感染率逐渐下降,≥ 5岁患儿混合感染率仅为14.0％。结论　就诊于北京儿童医院的ALRTI患儿中,5岁以下者ALRTI的主要病毒病原是RSV、RV、PIV;≥ 5岁则主 要为RV、IFV、RSV。     

济南地区冬季肺炎患儿呼吸道病毒感染情况分析

目的了解济南地区冬季肺炎住院患儿呼吸道病毒感染情况,为临床诊断、治疗提供依据。方法采集208例2014年12月至2015年2月山东中医药大学附属医院诊为支气管肺炎的住院患儿病历资料,取患儿鼻腔内分泌物,以直接免疫荧光法检测常见的呼吸道病毒,包括呼吸道合胞病毒、腺病毒、流感病毒A、流感病毒B及副流感病毒。结果 208例患儿中男性感染率为68.47%(76/111),女性感染率为67.01%(65/97),不同性别感染率比较差异无统计学意义(P0.05)。在208例肺炎患儿中呼吸道病毒感染者141例(67.79%),其中单种病毒感染56例(39.71%),2种及2种以上病毒感染85例(60.29%);呼吸道合胞病毒、流感病毒A感染率最高。3岁患儿感染率为77.42%(48/62),3~6岁61.42%(78/127),6岁78.94%(15/19)。结论呼吸道合胞病毒、流感病毒A是济南地区冬季肺炎患儿感染的主要病原体。     

儿童急性下呼吸道感染2368例病原学分析

目的 总结儿童急性下呼吸道感染（ALRL）的病原学分布特点。方法 选择2 368例急性下呼吸道感染住院患儿,进行痰细菌培养、用酶联免疫法检测血清非典型病原体及病毒抗体。结果 呼吸道病原总阳性病例为695例（29.35％）,其中细菌阳性标本为151例（21.73％）,非典型病原体阳性标本为193例（27.77％）;病毒阳性标本为217例（31.22％）,混合感染为134例（19.28％）。细菌阳性前6位依次为肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、产气葡萄球菌、鲍氏不动杆菌。非典型病原体阳性标本中,血清支原体抗体呈阳性者为133例（68.91％）,血清衣原体抗体呈阳性者为58例（30.05％）,血清支原体、衣原体同时阳性为22例,嗜肺军团杆菌阳性为2例（1.04％）。病毒阳性标本中,呼吸道合胞病毒阳性为102例（47.00％）,腺病毒阳性为73例（33.64％）,柯萨奇病毒阳性为8例（3.69％）,混合病毒感染阳性为34例（15.67％）。结论 病毒感染是儿童急性下呼吸道感染的最常见病原,其次为非典型病原体,细菌感染最低。     

天津市儿童医院住院腹泻患儿星状病毒感染检测分析

目的了解天津地区腹泻患儿星状病毒感染的临床与流行病学特点。 方法以酶联免疫吸附法检测腹泻患儿粪便中星状病毒抗原以及轮状病毒抗原。 结果2003年天津市儿童医院344例住院腹泻患儿中，星状病毒抗原检出率166%(57/344)，同时合并轮状病毒感染者99%(34/344),发病年龄集中于1个月至2岁，感染多发生于冬季，临床症状与轮状病毒感染相似，预后良好。 结论星状病毒感染可能是天津等中国北方地区儿童腹泻的重要病因之一，开展病原学检测有助于避免滥用抗生素及预防暴发流行。     

昆明地区2002-2004年轮状病毒肠炎患儿的病毒分子流行病学特征

目的研究昆明地区2002~2004年轮状病毒肠炎患儿的病毒分子流行特征。 方法收集昆明医学院第一附属医院2002、2003、2004年9~12月儿科住院和门诊轮状病毒肠炎患儿的粪便标本计210份。采用聚丙烯酰胺凝胶电泳法检测轮状病毒基因组，用逆转录 聚合酶链反应(RT PCR)以及巢式 PCR(net PCR)对5种主要的VP7的血清型(G1、G2、G3、G4和G9)进行分型，并采用RT PCR对VP7阳性标本进行NSP4(非结构蛋白4)的基因扩增，选取30份标本用net PCR法扩增出NSP4 CDNA 500bp送去测序。 结果210份标本中轮状病毒基因阳性143份(681%)，其中长型143份，未发现短型和混合型。143份阳性标本行RT PCR扩增VP7全基因，134份获得阳性产物，进一步用net PCR分型显示G3型73例(73/134，545%)，G1型38例(284%),未分型11例(82%)，混合型8例(6%)，G4型4例(3%),未发现G2和G9型。所有VP7阳性标本均可以扩增出NSP4的全长，其中30份标本送去测序显示有变异。 结论A组轮状病毒是目前昆明地区婴幼儿腹泻的主要致病原，在不同的3年中，轮状病毒电泳型以长型为主，血清型以G3、G1型为主，G4型少见，未见G2、G9型。3年监测结果显示NSP4存在变异，但未发现轮状病毒肠炎临床症状与NSP4的变异有关。     

急性下呼吸道感染住院患儿多瘤病毒检测及临床研究

了解多瘤病毒WU（WUPyV）和多瘤病毒KI （KIPyV） 在急性下呼吸道感染住院患儿中的感染现状及特征。方法　收集2007年9月至2008年3月长沙地区773份急性下呼吸道感染住院儿童鼻咽抽吸物样本,采用巢式聚合酶链反应（nested PCR）扩增方法进行WUPyV和KIPyV基因检测,并将PCR阳性产物测序,将所测序列在GenBank中进行比较分析。 结果　773例样本中,多瘤病毒阳性53例（6.8％）,其中WUPyV 39例（5.0％）,KIPyV 14例（1.8％）。所测得的核苷酸序列与GeneBank中已知的WUPyV与KIPyV序列同源性分别在93％～100％、95％～100％。 结论　WUPyV和KIPyV可能是儿童急性下呼吸道感染中较重要病原之一,且与其他病毒引起的儿童下呼吸道感染存在相关性。     

Outcome of the Respiratory Syncytial Virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study

Aim: To determine the incidence and outcomes of respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (ALRI) including morbidity, nosocomial infection and mortality among newborn infants who were admitted to the neonatal intensive care units (NICUs).

Methods: A multicenter, prospective study was conducted in newborns who were hospitalized with community acquired or nosocomial RSV infection in 44 NICUs throughout Turkey. Newborns with ALRI were screened for RSV infection by Respi-Strip®-test. Main outcome measures were the incidence of RSV-associated admissions in the NICUs and morbidity, mortality and epidemics results related to these admissions.

Findings: The incidence of RSV infection was 1.24% (n: 250) and RSV infection constituted 19.6% of all ALRI hospitalizations, 226 newborns (90.4%) had community-acquired whereas 24 (9.6%) patients had nosocomial RSV infection in the NICUs. Of the 250 newborns, 171 (68.4%) were full-term infants, 183 (73.2%) had a BW >2500?g. RSV-related mortality rate was 1.2%. Four NICUs reported seven outbreaks on different months, which could be eliminated by palivizumab prophylaxis in one NICU.

Conclusion: RSV-associated ALRI both in preterm and term infants accounts an important percent of hospitalizations in the season, and may threat other high-risk patients in the NICU.     

New perspectives in Respiratory Syncitial Virus infection

Abstract

Respiratory syncitial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) in children worldwide and it is associated with significant childhood morbidity. Acute infection may result in respiratory failure with varying degrees of severity, and increasing evidence supports a role of RSV infection as a key determinant for the development of subsequent chronic respiratory disease. Independent predictors of RSV severity include; prematurity, congenital heart disease, cystic fibrosis, immune defects and neuromuscular disorders. Passive immunization with palivizumab has proven to be safe and effective for preventing RSV hospitalization in infants at higher risk of acquiring severe RSV infection, but its expense and cumbersome monthly intravenous delivery schedule make it inaccessible to many. Furthermore, implementing prophylaxis in 32- to 35-week-gestational age infants and the mode of its administration still represent areas of uncertainty. In this review, we describe several aspects of RSV infection and analyze recent advances in the assessment of cost-effective palivizumab prophylaxis.     

Microbial etiology of acute gastroenteritis in hospitalized children in Taiwan.

BACKGROUND/PURPOSE: Viral infections are the most common causes of acute infectious diarrhea in the pediatric population. To explore any possible microbial etiologies of acute gastroenteritis in children, we detected stool viral antigen including rotavirus, adenovirus, norovirus and astrovirus. We also studied the possible precipitating factors. METHODS: During a period of 1 year (from October 2003 to September 2004), children from birth to 15 years old admitted to the pediatric ward were prospectively surveyed. Stool specimens were collected within 48 hours after admission and then frozen at -40 degrees C until analysis. Enzyme immunoassay was used to detect rotavirus, astrovirus, norovirus and adenovirus. Bacterial culture was performed at the same time. RESULTS: During the study period, 82 stool samples were collected due to acute gastroenteritis and fit the definition of a diarrhea episode. Forty-two (51.2%) patients with viral infection, 11 (13.4%) with bacterial infection, and six (7.3%) with mixed viral and bacterial infection were detected. The most prevalent virus was rotavirus (35.4%), followed by norovirus (29.3%). The most prevalent cause of bacterial infection was Salmonella (19.5%). With regard to clinical severity, rotavirus resulted in longer hospital stay, higher rate of vomiting, stool occult blood, leukocytosis, lower rate in stool pus cell, and C-reactive protein elevation more than 5 mg/dL as compared with norovirus. Only the difference in hospital stay reached significant statistical difference. CONCLUSION: Norovirus is an important cause of acute gastroenteritis in children, although rotavirus is still the leading cause of pediatric acute gastroenteritis.     

Is radiological appearance of lower respiratory tract infection due to respiratory syncytial virus a predictor of clinical outcome?

Objective: Respiratory syncytial virus (RSV) lower respiratory tract infection is the most common viral infection in childhood. RSV-infected infants demonstrate various radiographic findings. The aim of the study is to evaluate whether assessment of radiological characteristics of lower tract infection due to RSV may be a predictor of clinical outcome in newborns.

Methods: The study included 36 newborn infants hospitalized for lower tract infection. In order to detect RSV, RSV Respi-Strip (Coris Bioconcept Organization) test kits were used on admission. Chest X-rays and clinical characteristics of the study group were reviewed.

Results: Of 36 patients hospitalized for lower tract infection from October 2012 to April 2013, 18 (50%) newborns were infected with RSV. The study included 36 neonates. Patients with RSV-positive infants at admission had greater need for respiratory support, supplemental oxygen and prolonged stay in the NICU. Newborns with an atelectasis pattern on admission chest radiograph had greater at RSV-positive infants.

Conclusion: Chest radiological patterns with lower respiratory tract infection in newborn infants due to RSV are a predictor of clinical outcome.