Clinical manifestations of human coronavirus NL63 infection in children in Taiwan

Human coronavirus NL63 (HCoV-NL63) is a global respiratory tract pathogen; however, the epidemiology of this virus in subtropical area is not well known. To evaluate the epidemics and disease spectrum of HCoV-NL63 infection in children in Taiwan, we prospectively screened children admitted to the hospital with respiratory tract infection from May 2004 to April 2005. Every enrolled child had a nasopharyngeal aspirate (NPA) sample taken. Quantitative RT-PCR was used to detect 1b gene of HCoV-NL63. A total of 539 NPAs were collected. Seven (1.3%) were positive for HCoV-NL63. All cases were boys younger than 3 years of age and most cases occurred in autumn. Co-infection with other pathogens was observed in three cases. The most common symptoms/signs of HCoV-NL63 infection were cough, fever, and inspiratory stridor. HCoV-NL63 was the most common pathogen (14.7%) in children with croup and was the cause of three cases of croup in October. The odds ratio of croup in children infected with HCoV-NL63 was 43.4 (95% CI 8.1∼233.1). In conclusion, HCoV-NL63 is an important respiratory tract pathogen as the main cause in children admitted to the hospital in Taiwan.     

从北京地区急性呼吸道感染患儿标本中检测到新型冠状病毒NL63基因

目的了解北京地区婴幼儿急性呼吸道感染是否与一种新发现的冠状病毒——HCoV-NL63相关。方法选取2003年12月—2004年3月,从首都儿科研究所附属儿童医院收集的245份因急性呼吸道感染就诊的门诊患儿的咽拭子标本以及住院患儿的鼻咽洗液标本,进行HCoV-NL63的筛查。这些标本已经过间接免疫荧光法和病毒分离检测,常见的七种呼吸道病毒（包括RSV,甲、乙型流感病毒,Ⅰ、Ⅱ、Ⅲ型副流感病毒和腺病毒）检测均为阴性;同时还经逆转录-聚合酶链反应（RT-PCR）方法检测人偏肺病毒（hMPV）也为阴性。首先用位于HCoV—NL631b基因的两对引物用巢式PCR方法进行筛查,阳性者再用位于HCoV-NL63 1a基因的两对引物扩增进行复核。对用HCoV—NL63 1a基因扩增的长片段产物进行测序并与GenBank中相关序列进行比较分析。结果用HCoV-NL63 1b基因的引物经巢式PCR方法从245份标本中检测到3份阳性标本,阳性率为1．2％。3份阳性标本用HCoV-NL63 1a基因的两对引物经巢式PCR方法进行复核均得到阳性结果,这3份标本均取自住院患儿,患儿年龄分别为4个月、1岁和1岁5个月,临床诊断分别为毛细支气管炎、喉炎和支气管炎,男女比例为2：1。对其中基因扩增产量较高的BJ3140和BJ3787的1a基因长片段扩增产物（838bp）进行序列测定和分析的结果显示,这两株HCoV-NL63与GenBank公布的不同地区的HCoV—NL63的1a基因序列同源性最高,达到98％～99％。基于部分1a基因序列的系统进化分析显示,BJ3140和BJ3787属于HCoV-NL63的第一簇（group 1）。结论结果提示北京地区部分婴幼儿的急性呼吸道感染与HCoV-NL63相关。     

急性下呼吸道感染儿童肠道病毒感染的状况

目的：了解急性下呼吸道感染(ALRTI) 患儿肠道病毒(EV)的感染状况和临床特征。方法：抽取2007年9月至2008年4月因ALRTI在湖南省人民医院儿科医学中心住院的患儿的鼻咽抽吸物单数号样本404份,应用EV5′端非编码区(5′-NCR)保守序列设计引物,采用巢式逆转录RT-PCR法检测标本中EV感染状况。结果：404份ALRTI标本中,检出EV19例（4.7%）,大部分患儿年龄在3岁以下（95%）,男女EV检出阳性率差异无统计学意义。EV阳性患儿临床诊断为支气管肺炎者13例（68%）、毛细支气管炎者6例（32%）,90%患儿有发热症状,84%有咳嗽,63%有气喘,63%有合并症,其中主要为腹泻（6例）、粒细胞减少症（4例）和急性呼吸窘迫综合征（2例）。EV阳性患儿白细胞异常的发生率为26%,一半以上存在肝功能异常,少数有心肌受累。结论：EV是儿童ALRTI不可忽视的病原之一,应密切关注EV感染的流行病学状况和临床特点,并定期测定患儿血常规、肝功能和心肌酶,努力改善其预后。     

1165例急性下呼吸道感染住院儿童的病毒病原学分析

目的：了解长沙地区急性下呼吸道感染(ALRTI) 住院儿童中常见呼吸道病毒的流行特点,为本地区儿童ALRTI的防治提供依据。方法：收集2007年9月至2008年8月诊断为ALRTI的住院患儿鼻咽抽吸物标本1165份,采用RT-PCR方法检测呼吸道合胞病毒(RSV)、鼻病毒(HRV)、流感病毒A(IFVA)、流感病毒B(IFVB)、副流感病毒1~3(PIV1~3)、偏肺病毒(hMPV)、冠状病毒NL63(HCoV-NL63)及冠状病毒HKU1(HCoV-HKU1);PCR方法检测腺病毒(ADV)、博卡病毒(HBoV);巢式PCR方法检测多瘤病毒WU(WUPyV）和多瘤病毒KI(KIPyV)。并对阳性标本进行基因测序以证实。结果：1165份标本中有871份检出了病毒,总检出率74.76%,其中RSV最为常见,检出率为27.03%,其次为HRV（17.33%）、PIV3（13.73%）及新发现病毒HBoV(8.67%)和hMPV(6.52%)。病毒总检出率在男女之间差异无统计学意义,但男性PIV3、hMPV和HBoV的阳性检出率高于女性。病毒阳性检出率在各年龄组之间差异有统计学意义（χ2=10.934,P=0.027）,以6个月至1岁以内年龄组检出率最高。病毒总检出率在四季分布差异有统计学意义（χ2=12.307,P=0.006）,以冬季检出率最高。结论：病毒病原在长沙地区儿童ALRTI中占重要地位,其中RSV、HRV及PIV3是主要病毒病原,近年新发现的HBoV和hMPV也占较高比例;病毒检出率以6个月至1岁以内年龄组最高;冬季病毒总检出率高于其他季节。     

Risk factors for severe acute lower respiratory tract infection in under-five children.

BACKGROUND: Acute lower respiratory infection (ALRTI) is the leading cause of death in children below five years of age. Identification of modifiable risk factors of severe ALRTI may help in reducing the burden of disease. METHODS: A hospital based case control study was undertaken to determine risk factors associated with severe lower respiratory tract infection (LRTI) in under-five children. A case definition of severe ALRTI as given by World Health Organization (WHO) was used for cases. Healthy children attending Pediatrics out patient department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. RESULTS: 512 children including 201 cases and 311 controls were enrolled in the study. On stepwise logistic regression analysis it was found that lack of breastfeeding (OR: 1.64; 95 percent CI: 1.23-2.17); upper respiratory infection in mother (OR: 6.53; 95 percent CI: 2.73-15.63); upper respiratory infection in siblings (OR: 24; 95 percent CI: 7.8-74.4); severe malnutrition (OR: 1.85; 95 percent CI: 1.14-3.0); cooking fuel other than liquid petroleum gas (OR: 2.5; 95 percent CI: 1.51-4.16); inappropriate immunization for age (OR: 2.85; 95 percent CI 1.59-5.0) and history of LRTI in the family (OR 5.15, 95 percent CI 3.0-8.8) were the significant contributors of ALRTI in children under five years. Sex of the child, age of the parents, education of the parents, number of children at home, anemia, inadequate caloric intake, type of housing were not documented to be significant risk factors of ALRTI. CONCLUSION: Lack of breast-feeding, upper respiratory infection in mother, upper respiratory infection in siblings, severe malnutrition, cooking fuel other than liquid petroleum gas, inappropriate immunization for age and history of LRTI in the family were the significant risk factors associated with ALRTI     

5150例急性下呼吸道感染儿童呼吸道病毒检测结果分析

目的 了解急性下呼吸道感染(ALRTI)住院患儿咽拭子呼吸道病毒的分布情况。方法 采用直接免疫荧光法,对该院2014 年3 月至2015 年2 月5 150 例ALRTI 住院患儿咽拭子标本进行流感病毒A 型(FA)、流感病毒B 型(FB)、腺病毒(ADV)、呼吸道合胞病毒(RSV)及副流感病毒1、2、3 型(PIV-1、2、3)检测,了解ALRTI 患儿中呼吸道病毒的分布情况。结果 5 150 例住院患儿的咽拭子样本中病毒检测阳性2 155 例(41.84%),其中RSV、 PIV-3 、FA 是检出率最高的前3 位病毒,分别为1 338 例(25.98%)、439 例(8.52%)、166 例(3.22%),并有29 例为2 种病毒混合感染。随年龄增加病毒检出率呈下降趋势(χ²=279.623,P<0.01)。RSV 检测阳性率自9 月开始呈增高趋势,11 月最高,达60.09%,6 月最低,仅为1.51%。PIV-3 检测阳性率5 月最高(21.38%),11 月最低(1.77%)。结论 ALRTI 患儿的病毒流行分布随年龄、季节而不同,秋冬季以RSV 流行为主,春夏季以PIV-3 流行为主。RSV 是ALRTI 住院儿童的最常见病毒。     

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??Abstract??Objective??To establish a real-time fluorescent quantitative PCR assay to detect the human coronavirus NL63 from nasopharyngeal samples of children with acute respiratory tract infections in Fuzhou. Methods??The specific primers and Tap-man probes were designed targeting the 1a gene. The aimed fragment of 1a gene was amplified with PCR and ligated into a PMD18-T Easy vector for standards. A total of 151 clinical specimens were subsequently tested after determination of the sensitivity and specificity of the established real-time PCR. Amplify and preliminarily analyse the N gene. Results??The specificity of this assay was excellent. The linear amplification of the assay ranged from 101 copies/μL to 1010 copies/μL. Two of 151 clinical specimens??1.3%?? were tested positive for HCoV-NL63. Conclusion??The real-time fluorescent quantitative PCR assay is successfully established to detect HCoV- NL63 .     

255例急性下呼吸道感染并血小板异常患儿病毒病原学分析

目的 了解住院患儿急性下呼吸道感染（ALRTI）并血小板异常的病毒病原学情况。方法 收集2010年3月至2011年2月255例血小板异常及同期442例血小板正常的ALRTI住院患儿鼻咽抽吸物样本,采用RT-PCR或PCR方法 进行14种病毒检测。结果 255例血小板异常并ALRTI患儿中,血小板增多253例（99.2%）,血小板减少2例（0.8%）。血小板异常组中检出至少有1种病毒感染173例（67.8%）,其中,人鼻病毒（HRV）检出率最高,其次是副流感病毒3（PIV3）和呼吸道合胞病毒（RSV）。与血小板正常组相比较,血小板异常组PIV3检出率显著增高（PPPP结论 ALRTI时易引起血小板增多,尤其是PIV3感染者,而IFVB感染则不易引起血小板的变化。小于1岁的ALRTI住院患儿更易出现血小板异常。     

儿童急性下呼吸道感染病毒病原学2007-2010年监测

目的 了解儿童急性下呼吸道感染( ALRTI)的病毒病原学构成及其流行的季节特征.方法 2007年3月-2010年3月首都医科大学附属北京儿童医院急救室就诊及内科住院的ALRTI患儿共1914例.采集每例患儿鼻咽吸取物1份,用(RT) PCR方法进行病毒核酸检测,包括呼吸道合胞病毒(RSV),人鼻病毒(HRV),副流感病毒(PIV)1 ～4型,流感病毒(IFA、IFB和IFC),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 (1)总的病毒阳性检出率70.3％,其中＜1岁、1～＜3岁、3～＜6岁和≥6岁组分别为83.0％、80.1％、60.8％和27.7％,其差异有统计学意义(x2=2213.5,P=0.000).检出率高的前3种病毒依次为RSV、HRV和PIV,其在＜1岁组分别是50.9％、36.2％和12.0％.(2)RSV和HRV的流行季节在冬春,而PIV在春夏.(3)＜1岁、1～＜3岁、3～＜6岁和≥6岁组病毒阳性患儿中检出2种以上病毒的比例分别为38.2％、36.4％、30.2％和15.2％,其差异有统计学意义(x2=1346.00,P=0.000).结论 病毒是小年龄儿童ALRTI的主要病原,以RSV、HRV和PⅣ最为重要,其感染存在季节特征;ALRTI患儿存在多种病毒感染,其临床意义有待进一步研究.     

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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JLRTI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岁惠儿混合感染率最高,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.     

重庆地区急性呼吸道感染儿童肠道病毒检测结果分析

目的 了解2006-2007年度重庆地区住院急性呼吸道感染(ARTIs)儿童中肠道病毒(EV)的感染率和临床特点.方法 前瞻性收集2006年4月至2007年3月在重庆医科大学附属儿童医院呼吸科住院的部分ARTIs患儿鼻咽深部吸取物390份,应用针对EV 5′端非编码区(5′-NCR)保守序列设计引物,采用套式逆转录PCR方法检测标本中EV.结果 390例标本中检出EV 63例,阳性率16.2%.年龄分组中2～5岁组和>5岁组患儿EV阳性率分别为32.8%和28.6%,<2岁组为12.2%.EV感染几乎全年散发,2006年7～11月为EV感染的高发季节,EV检测阳性率为19.2%～31.3%.2006年8月EV检测阳性率最高.EV感染的临床表现主要为发热(38.1%)、咳嗽(92.1%)、喘息(33.3%)、气促(71.4%)、腹泻(28.6%)和皮疹(17.5%).EV阳性患儿中,临床诊断依次为支气管肺炎30例(47.6%),间质性肺炎17例(27.0%),毛细支气管炎6例(9.5%),重症肺炎4例(6.3%),喘息性支气管炎3例(4.8%),支气管哮喘3例(4.8%).结论 EV是重庆地区儿童急性下呼吸道感染较为常见的病毒病原,夏秋季为流行高峰.     

粤东地区住院小儿急性下呼吸道感染病毒病原学研究

目的：了解2007年粤东地区住院小儿下呼吸道感染患儿的病毒病原现状并比较各个年龄组、不同季节、不同病种的病毒检出情况。方法：选择因急性下呼吸道感染住院治疗的小儿345例,取其鼻咽抽吸物采用多重PCR方法以筛查呼吸道合胞病毒,腺病毒,流感病毒A型、B型,副流感病毒1型、3型,鼻病毒,博卡病毒及人类偏肺病毒。结果：①病毒总检出率为51.6%(178/345),其中呼吸道合胞病毒占首位,病毒检出率为19.3%（66/345）,而人类偏肺病毒为3.2%(11/345),博卡病毒为3.2%(11/345)。②1～3月份(阳性率为61.9%)、毛细支气管炎患儿(阳性率为72.6%)、1～6个月婴幼儿(阳性率为71.3%)病毒检出率较高,4～6月份(阳性率为40.2%)、3岁以上儿童(阳性率为19.0%)病毒检出率较低,呼吸道感染病毒病原的总阳性率与性别无关。结论：粤东地区小儿下呼吸道感染的主要病毒病原为呼吸道合胞病毒等常见病毒,此外博卡病毒及人类偏肺病毒等也是重要的病原体;年龄越小,阳性率越高,不同季节的呼吸道病毒检出率不同,毛细支气管炎患儿的病毒总检出率最高。［中国当代儿科杂志,2009,11（3）：203-206］     

杭州市19例新型冠状病毒Omicron变异株感染儿童的临床特征

目的 探讨儿童新型冠状病毒Omicron变异株感染者的临床特征,为临床诊疗提供参考。方法 回顾性分析杭州市19例2022年1月28日至3月3日确诊为新型冠状病毒Omicron变异株感染儿童的临床资料。结果 19例患儿中,男性7例(37%),女性12例(63%);年龄0.5～16.0岁,中位年龄为2岁1个月,以婴幼儿(≤3岁)多见(53%)。未接种新型冠状病毒疫苗者11例(58%),接种者8例(42%)。3例(16%)有基础疾病史。19例患儿均有明确的新型冠状病毒感染者的密切接触史,其中母婴看护机构聚集性发病10例(53%)。临床表现为轻型13例(68%),普通型6例(32%),无重型病例。最常见症状为咳嗽(100%)和发热(63%)。患儿外周血白细胞计数(84%)及淋巴细胞计数多正常(68%)。患儿的血小板计数、降钙素原、肝功能指标(丙氨酸氨基转移酶、天冬氨酸氨基转移酶)、肾功能指标(肌酐、尿素)无明显异常。6例(32%)胸部CT有明显肺炎征象。19例患儿均给予对症治疗,12例(63%)雾化吸入干扰素α。所有患儿治愈出院。结论 儿童Omicron变异株感染病例以婴幼儿多见,症状轻,预后...     

Immunisation with a polyvalent pneumococcal vaccine. Effect of respiratory mortality in children living in the New Guinea highlands

In Tari, in the southern highlands of Papua New Guinea, each child experienced, on average, two acute lower respiratory tract infections (ALRTI) between birth and age 5 years. The yearly mortality rate from ALRTI was 30 per 1000 in infants, and 4 per 1000 in children aged between 1 and 4 years. A double-blind trial of a 14-valent pneumococcal polysaccharide vaccine was carried out on 871 children from this community who were aged between 6 months and 5 years. Morbidity from ALRTI was lower (by 37%) in children given the vaccine provided they were at least 17 months of age at the time of immunisation. There were 8 deaths from ALRTI in the placebo group, but only 1 death in the vaccine group.     

Short-term therapeutic role of zinc in children < 5 years of age hospitalised for severe acute lower respiratory tract infection

In contrast to its 'preventive role', no consensus has evolved for the therapeutic role of zinc in pneumonia in children. We conducted a meta-analysis to find the therapeutic role of zinc in children <5 years of age hospitalised for severe acute lower respiratory tract infection (ALRTI). A comprehensive search was performed of the major electronic databases. Randomised controlled trials (RCTs) comparing treatment with zinc versus placebo were included. Seven RCTs (1066 subjects) conducted in developing countries were eligible for inclusion. There was no significant difference between the two groups regarding the time of resolution of severe illness (standardised mean difference (SMD) -0.15 (95% confidence interval (CI) -0.5, 0.2; p=0.4)) and duration of hospitalisation (SMD -0.29 (95% CI -0.68, -0.09; p=0.13)). No significant difference between the two groups was also noted for other parameters (duration of resolution of hypoxia, chest indrawing or tachypnoea, change of antibiotics and treatment failure rates). The adverse events were not significant. To conclude, present available data do not support the efficacy of zinc in treatment of severe ALRTI.     

A case-control study of SARS versus community acquired pneumonia

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.     

A case-control study of SARS versus community acquired pneumonia.

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.     

Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial

Objective  

To evaluate the efficacy of zinc supplementation on duration of illness in children with severe acute lower respiratory tract infection (ALRTI).     

急性呼吸道感染儿童两亚型呼吸道合胞病毒检测分析

目的 了解2006-2007年度重庆地区住院急性呼吸道感染(ARTIs)儿童两亚型呼吸道合胞病毒(RSV)的感染特点及流行规律.方法 收集2006年4月至2007年3月全年在重庆医科大学附属儿童医院呼吸科住院的部分ARTIs患儿的鼻咽深部吸取物390份,针对RSV G基因保守区序列设计分型引物,采用RT-PCR方法检测标本中RSV的基因组RNA.结果 390例标本中RSV阳性例数为133例(133/390,阳性率为34.10%).阳性标本中A亚型阳性129例,B亚型阳性4例.RSV阳性患儿中,84.9%为2岁以下小儿.2006年11月～2007年1月为RSV高发季节,RSV检测阳性率为55.6%～62.3%,2006年12月RSV检测阳性率最高.B亚型出现于本地区RSV感染低发季节(4、5、6月).RSV感染的临床表现主要为发热(56.4%)、咳嗽(98.5%)、喘息(63.9%)、气促(76.7%)、紫绀(84.9%).临床诊断依次为毛细支气管炎(33.1%),支气管肺炎(27.8%),间质性肺炎(18.1%),重症肺炎伴呼吸衰竭(10.5%),喘息性支气管炎(5.3%),支气管哮喘(4.5%).结论 本研究初步阐明了重庆地区两亚型RSV感染的流行病学特点,证实RSV是重庆地区冬春季婴幼儿ARI的重要病原,2006-2007年度以A亚型RSV流行为主.今后的研究将纳入门诊及社区惠儿并进行多年度连续监测以进一步阐明重庆地区两亚型RSV流行规律及病毒进化特点.     

Coronavirus-associated pneumonia in previously healthy children

The extent to which coronaviruses are associated with lower respiratory tract disease in previously healthy children without underlying medical conditions is unknown. We investigated instances of radiographically confirmed lower respiratory tract disease among symptomatic children with coronavirus infection. Here, we document the clinical courses of 2 previously healthy children with coronavirus-associated pneumonia.