Human bocavirus amongst an all‐ages population hospitalised with acute lower respiratory infections in Cambodia

Please cite this paper as: Arnott et al. (2013) Human bocavirus amongst an all‐ages population hospitalised with acute lower respiratory infections in Cambodia. Influenza and Other Respiratory Viruses 7(2) 201–210. Background Human bocavirus (HBoV) is a novel parvovirus that is associated with respiratory and gastrointestinal tract disease. Objectives To investigate the prevalence and genetic diversity of HBoV amongst hospitalized patients with acute lower respiratory infection (ALRI) in Cambodia. Study Design Samples were collected from 2773 patients of all ages hospitalised with symptoms of ALRI between 2007 and 2009. All samples were screened by multiplex RT‐PCR/PCR for 18 respiratory viruses. All samples positive for HBoV were sequenced and included in this study. Results Of the samples tested, 43 (1·5%) were positive for HBoV. The incidence of HBoV did not vary between the consecutive seasons investigated, and HBoV infections were detected year‐round. The incidence of HBoV infection was highest in patients aged <2 years, with pneumonia or bronchopneumonia the most common clinical diagnosis, regardless of age. A total of 19 patients (44%) were co‐infected with HBoV and an additional respiratory pathogen. All isolates were classified as HBoV type 1 (HBoV‐1). High conservation between Cambodian NP1 and V1V2 gene sequences was observed. Conclusions Human bocavirus infection can result in serious illness, however is frequently detected in the context of viral co‐infection. Specific studies are required to further understand the true pathogenesis of HBoV in the context of severe respiratory illness.     

2020年深圳地区4株冠状病毒HCoV-NL63基因组特征分析

目的 了解2020年深圳市冠状病毒HCoV-NL63全基因组序列的遗传特征和变异.方法 对HCoV-NL63核酸检测阳性的咽拭子标本进行全基因组测序、系统发生树重建和生物信息学分析.结果 获得4株HCoV-NL63全基因组序列,均属于B基因型B2亚型,株间核苷酸(氨基酸)同源性为99.80％～99.98％ (99.64...     

Human respiratory syncytial virus diversity and epidemiology among patients hospitalized with severe respiratory illness in South Africa, 2012–2015

BackgroundWe aimed to describe the prevalence of human respiratory syncytial virus (HRSV) and evaluate associations between HRSV subgroups and/or genotypes and epidemiologic characteristics and clinical outcomes in patients hospitalized with severe respiratory illness (SRI).MethodsBetween January 2012 and December 2015, we enrolled patients of all ages admitted to two South African hospitals with SRI in prospective hospital‐based syndromic surveillance. We collected respiratory specimens and clinical and epidemiological data. Unconditional random effect multivariable logistic regression was used to assess factors associated with HRSV infection.ResultsHRSV was detected in 11.2% (772/6908) of enrolled patients of which 47.0% (363/772) were under the age of 6 months. There were no differences in clinical outcomes of HRSV subgroup A‐infected patients compared with HRSV subgroup B‐infected patients but among patients aged <5 years, children with HRSV subgroup A were more likely be coinfected with Streptococcus pneumoniae (23/208, 11.0% vs. 2/90, 2.0%; adjusted odds ratio 5.7). No significant associations of HRSV A genotypes NA1 and ON1 with specific clinical outcomes were observed.ConclusionsWhile HRSV subgroup and genotype dominance shifted between seasons, we showed similar genotype diversity as noted worldwide. We found no association between clinical outcomes and HRSV subgroups or genotypes.     

Antiviral therapy for respiratory tract infections

Viruses are important pathogens causing respiratory tract infections both in the community and health-care facility settings. They are extremely common causes of morbidity in the competent hosts and some are associated with significant mortality in the compromised individuals. With wider application of molecular techniques, novel viruses are being described and old viruses are found to have new significance in different epidemiological and clinical settings. Some of these emerging pathogens may have the potential to cause pandemics or global spread of a severe disease, as exemplified by severe acute respiratory syndrome and avian influenza. Antiviral therapy of viral respiratory infections is often unnecessary in the competent hosts because most of them are selflimiting and effective agents are not always available. In the immunocompromised individuals or for infections caused by highly pathogenic viruses, such as avian influenza viruses (AIV), antiviral treatment is highly desirable, despite the fact that many of the agents may not have undergone stringent clinical trials. In immunocompetent hosts, antiviral therapy can be stopped early because adaptive immune response can usually be mounted within 5-14 days. However, the duration of antiviral therapy in immunosuppressed hosts depends on clinical and radiological resolution, the degree and duration of immunosuppression, and therefore maintenance therapy is sometimes needed after the initial response. Immunotherapy and immunoprophylaxis appear to be promising directions for future research. Appropriate and targeted immunomodulation may play an important adjunctive role in some of these infections by limiting the extent of end-organ damage and multi-organ failure in some fulminant infections.     

305例上呼吸道真菌感染的回顾性分析

目的探讨上呼吸道真菌感染的诊治方法和经验。方法回顾性分析1984年6月至2003年10月所治疗的单纯与合并存在的上呼吸道真菌感染305例,所有患者经采用真菌培养、病变组织病理活检及影像学检查等综合诊断方法而确诊。采用局部清洁、清除肉芽及分泌物,保障引流通畅,并结合药物治疗。结果305例中,鼻及鼻窦真菌感染93例,咽部真菌感染190例,喉部真菌感染22例。其中重症患者12例,包括侵及颅底的侵袭性真菌病7例,真菌性败血症5例。结论真菌感染的危害性不容忽视,真菌感染的诊断和治疗需采取综合措施,反复真菌培养是减少漏诊与误诊的好办法。     

小儿支气管哮喘与反复呼吸道感染相关性研究

目的探讨小儿支气管哮喘与反复呼吸道感染的相关性。方法收集在该院诊疗87例小儿支气管哮喘患者(试验组)及同期门诊体检儿童73例(对照组)作为研究对象,对所有患儿检测病毒、支原体衣原体以及细菌感染情况,并行对比分析。结果试验组患儿合并呼吸道感染占35.63%明显高于对照组的6.85%(P0.01)。试验组呼吸道感染病原检出率为74.71%高于对照组24.66%,(P0.01);试验组病毒检出率为37.93%高于对照组12.33%(P0.01);试验组支原体、衣原体检出率为24.14%高于对照组9.59%(P0.05);试验组细菌检出率为12.64%高于对照组2.74%(P0.05)。结论哮喘发作与反复呼吸道感染有密切相关性,呼吸道病毒感染、支原体、衣原体和细菌感染是小儿哮喘急性发作和加重的主要诱因。     

Non-invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders

Non-invasive ventilation (NIV) has been shown to improve gas exchange and survival in patients with chronic neuromuscular disorders. Little is known about its influence on respiratory tract infections (RTIs). Twenty-four patients with regular use of NIV and 11 patients without NIV with neuromuscular disorders answered a questionnaire concerning the use of NIV and assisted coughing techniques, the status of influenza and pneumococcus vaccination, and the frequency and severity of RTIs. Additionally, we performed a retrospective chart review of twelve patients who were ventilated over a period of at least 5 years. In the first year of NIV consultations of a general practitioner due to RTI decreased from 9.2+/-20.8 to 3.2+/-5.3 per year (P<0.005), the number of antibiotic treatment due to RTI decreased from 4.1+/-3.4 to 1.9+/-2.2 per year (P<0.005) and the number of hospital admissions due to RTI decreased from 1.6+/-1.7 to 0.7+/-1.3 per year (P<0.005). Vaccinations against influenza and/or pneumococcus did not have a significant influence on the rate of infections. In 12 patients using NIV for more than 5 years the incidence of RTI requiring hospital admission decreased from 0.54+/-0.41/year in the pre-ventilation period to 0.12+/-0.09/year in the NIV period (P<0.005). NIV had a favorable impact on respiratory infectious complications in children with neuromuscular disorders.     

Crystal structure of NL63 respiratory coronavirus receptor-binding domain complexed with its human receptor

NL63 coronavirus (NL63-CoV), a prevalent human respiratory virus, is the only group I coronavirus known to use angiotensin-converting enzyme 2 (ACE2) as its receptor. Incidentally, ACE2 is also used by group II SARS coronavirus (SARS-CoV). We investigated how different groups of coronaviruses recognize the same receptor, whereas homologous group I coronaviruses recognize different receptors. We determined the crystal structure of NL63-CoV spike protein receptor-binding domain (RBD) complexed with human ACE2. NL63-CoV RBD has a novel β-sandwich core structure consisting of 2 layers of β-sheets, presenting 3 discontinuous receptor-binding motifs (RBMs) to bind ACE2. NL63-CoV and SARS-CoV have no structural homology in RBD cores or RBMs; yet the 2 viruses recognize common ACE2 regions, largely because of a “virus-binding hotspot” on ACE2. Among group I coronaviruses, RBD cores are conserved but RBMs are variable, explaining how these viruses recognize different receptors. These results provide a structural basis for understanding viral evolution and virus–receptor interactions.     

WU多瘤病毒在儿童急性呼吸道感染中的作用

目的了解急性呼吸道感染儿童中WU多瘤病毒(WUPyV)的感染情况及其作用。方法采集天津市儿童医院急性下呼吸道感染住院儿童的鼻咽吸取物(NPA)标本174份,急性上呼吸道感染的咽拭子标本68份以及无呼吸道症状的对照咽拭子标本43份,用PCR法进行WUPyV基因检测,对NPA阳性标本采用PCR和多重PCR同时检测其他常见呼吸道病毒。结果174份NPA标本中共28份检出WUPyV核酸,占16.1%。患者平均年龄为11.7个月(12 d~39个月),其中≤6个月10例(35.7%),6个月~1岁10例(35.7%),1~2岁7例(25.0%),2~5岁1例(3.6%);男19例(67.9%),女9例(32.1%);与其他呼吸道病毒混合感染20例,占71.4%,50%为两种病毒混合感染,混合感染率最高的为RSVB(32.1%),其次为HboV(21.4%)和Rhino、PIV3(均为14.3%)。检查68例急性上呼吸道感染者的咽拭子标本,3例为WUPyV阳性,其中2例患儿为3岁,1例2岁;女2例,男1例。43例无呼吸道症状者的咽拭子标本均为WUPyV阴性。结论急性呼吸道感染儿童中存在WUPyV感染,下呼吸道感染患儿中检...     

婴幼儿支原体肺炎后反复发作性呼吸道感染因素分析

目的探讨婴幼儿支原体肺炎感染后反复呼吸道感染的影响因素分析。方法选取2013年6月~2013年12月我院儿科收治的150例支原体肺炎患儿作为研究对象,跟踪患儿治愈出院前后的MP-Ig M、MP-Ig G双抗体滴度及免疫功能,并记录呼吸道感染情况及一年内的用药情况。采用统计学方法进行多因素分析。结果 150例支原体肺炎患儿中,发生RRTI 45例,发生率为30.0%。多因素结果显示,年龄为3~6岁(OR=2.31,95%CI:1.23~4.68)、HP抗体阳性或转阳(OR=4.51,95%CI:1.56~13.27)、CD_4~+/CD_8~+下降(OR=10.33,95%CI:3.45~32.02)及Ig A下降(OR=1.96,95%CI:1.12~3.47)是诱发RRTI的危险因素;使用免疫增强剂(OR=0.31,95%CI:0.14~0.82)是有效预防反复呼吸道感染的保护因素。结论年龄3~6岁、HP抗体阳性或转阳、CD_4~+/CD_8~+下降及Ig A下降是RRTI发生的危险因素;MP肺炎治愈后发生免疫功能障碍的患儿易发生RRTIs;免疫增强剂的使用可有效减少RRTI的发生,提高患儿的生活质量。     

The national burden of influenza‐like illness and severe respiratory illness overall and associated with nine respiratory viruses in South Africa, 2013–2015

BackgroundEstimates of the disease burden associated with different respiratory viruses are severely limited in low‐ and middle‐income countries, especially in Africa.MethodsWe estimated age‐specific numbers and rates of medically and non‐medically attended influenza‐like illness (ILI) and severe respiratory illness (SRI) that were associated with influenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus, adenovirus, enterovirus and parainfluenza virus types 1–3 after adjusting for the attributable fraction (AF) of virus detection to illness in South Africa during 2013–2015. The base rates were estimated from five surveillance sites and extrapolated nationally.ResultsThe mean annual rates per 100,000 population were 51,383 and 4196 for ILI and SRI, respectively. Of these, 26% (for ILI) and 46% (for SRI) were medically attended. Among outpatients with ILI, rhinovirus had the highest AF‐adjusted rate (7221), followed by influenza (6443) and adenovirus (1364); whereas, among inpatients with SRI, rhinovirus had the highest AF‐adjusted rate (400), followed by RSV (247) and influenza (130). Rhinovirus (9424) and RSV (2026) had the highest AF‐adjusted rates among children aged <5 years with ILI or SRI, respectively, whereas rhinovirus (757) and influenza (306) had the highest AF‐adjusted rates among individuals aged ≥65 years with ILI or SRI, respectively.ConclusionsThere was a substantial burden of ILI and SRI in South Africa during 2013–2015. Rhinovirus and influenza had a prominent disease burden among patients with ILI. RSV and influenza were the most prominent causes of SRI in children and the elderly, respectively.     

呼吸道感染病原菌的变化及耐药性分析

目的分析我院呼吸道感染病原菌的变化及耐药性趋势,为临床治疗和控制院内感染提供依据。方法收集我院2008～2009年患者呼吸道分泌物中病原菌的结构和耐药情况。结果 4464例呼吸道标本中分离出病原菌2451例,占54.9%。其中革兰阴性杆菌为主,占63.7%,位列前五位依次是：肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌、阴沟肠杆菌;革兰阳性菌占13.2%,前二位是缓症链球菌、金黄色葡萄球菌;真菌占19.5%,以白假丝酵母为主。药敏结果提示碳青霉烯类抗生素对革兰阴性杆菌作用最强,万古霉素对革兰阳性球菌高度敏感,其它抗生素均存在不同程度的耐药。结论革兰阴性杆菌是呼吸道感染的主要致病菌,且细菌的种类和耐药性在不断的发生变化,应根据微生物实验室检测合理用药,以抑制细菌耐药性的发展并提高感染性疾病的治疗效果。     

3种用药方案治疗下呼吸道感染的成本-效果分析

目的探讨3种不同治疗方案用于下呼吸道感染的经济效果。方法运用药物经济学成本-效果分析法对A组(左氧氟沙星口服)、B组(阿奇霉素口服)、C组(左氧氟沙星 阿奇霉素口服)进行回顾性分析评价。结果3种药物治疗方案成本分别为34.8元、56元、59.3元;细菌清除率分别为85.19%、80.77%、92.8%(P>0.05);痊愈率分别为65.6%、59.4%、75%(P>0.05);成本-效果比分别为(细菌清除率)0.41、0.69、0.64;(痊愈率)0.40、0.72、0.63;有效率分别为87.5%、78.125%、93.75%(P<0.05);3种方案治疗下呼吸道感染在痊愈率、细菌清除率上无显著差异,在有效率上有显著差异。结论综合考虑,C方案为较佳方案。     

Severe acute respiratory syndrome in children

Severe acute respiratory syndrome (SARS) is a newly described and highly contagious respiratory infection. Many adult patients will develop progressive hypoxia, and a large proportion will develop respiratory distress syndrome (RDS), possibly related to massive and uncontrolled activation of the immune system. The mortality has been reported to be quite high, especially in the elderly with comorbid conditions. The causative agent has been identified as a novel coronavirus, and children appear to acquire the infection by close-contact household exposure to an infected adult. However, the severity is much milder and the clinical progression much less aggressive in young children. The exact pathophysiology of SARS is still unclear, and the medical treatment of SARS remains controversial. The main treatment regime used in Hong Kong is a combination of ribavirin and steroid. To date, there have been no reported case fatalities in children with this disease. The success of reducing the burden of this infection in children will depend on proper isolation of infected adults early in the course of illness. Strict public health policy and quarantine measures are the key in controlling the infection in the community.     

炎琥宁与病毒唑治疗小儿急性上呼吸道感染的疗效比较

目的观察炎琥宁与病毒唑治疗小儿急性上呼吸道感染的临床疗效。方法 56例急性上呼吸道感染患儿随机分为两组,观察组(n=28)采用炎琥宁治疗,对照组(n=28)采用病毒唑治疗,两组疗程均为2周,治疗结束后比较两组的疗效。结果观察组治疗总有效率为92.6%,对照组治疗总有效率为78.6%,两组治疗总有效率比较有明显差异性(P<0.05);观察组临床症状和血常规恢复正常时间明显较对照组缩短(P<0.05)。结论炎琥宁治疗小儿急性上呼吸道感染疗效显著,可明显改善患儿的临床症状,值得临床推广应用。     

呼吸重症监护室机械通气患者下呼吸道感染病原菌分布及耐药性特点

目的了解呼吸重症监护室(RICU)机械通气患者下呼吸道感染的病原菌分布及耐药性特点,以指导临床用药。方法对中南大学湘雅二医院呼吸科2000年1月至2007年2月RICU病房178例机械通气患者的临床资料及其下呼吸道感染病原菌构成及药物敏感性结果进行分析。抗生素敏感性测定采用Kribry-Bauer(KB)纸片法,最低抑菌浓度(MIC)测定采用琼脂二倍稀释法。结果178例患者共分离出菌株326株。培养结果以革兰阴性杆菌为主(255株,78.2%),其中铜绿假单胞菌、不动杆菌为主要革兰阴性病原菌。真菌占第二位,共54株,占16.6%,以白色念珠菌为主。革兰阳性球菌占第3位(17株,5.2%),以金黄色葡萄球菌为主。同时获得2种以上细菌的107例,占42%。对革兰阴性杆菌敏感性在70%以上的有美洛培南、亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星。万古霉素对革兰阳性球菌的敏感性为100%。结论RICU患者年龄大,多有基础疾病;革兰阴性杆菌(铜绿假单胞菌、不动杆菌)和真菌为机械通气患者主要致病菌;美洛培南、亚胺培南、头孢哌酮/舒巴坦、阿米卡星等抗生素是治疗RICU下呼吸道感染的有效抗生素;我院RICU患者混合病原菌感染较多,且存在多重耐药,应动态监测细菌的耐药性,合理选择抗生素。     

老年下呼吸道感染病原菌耐药性分析

目的了解老年下呼吸道感染常见病原菌的感染现状及耐药性规律。方法采用API鉴定细菌及真菌,纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性。结果痰培养阳性率为15.7%,检出率前三位病原菌：铜绿假单胞菌（27.7%）、肺炎克雷伯菌（19.7%）及不动杆菌（15.6%）,耐药性分析：葡萄球菌属未发现万古霉素耐药株,但对其它多种抗菌药物耐药;肠杆菌科细菌对碳青霉烯类、头孢哌酮舒巴坦和哌拉西林他唑巴坦较敏感,铜绿假单胞菌药物敏感性为碳青霉烯类〉头孢他定〉哌拉西林他唑巴坦〉头孢哌酮舒巴坦。结论我院老年下呼吸道感染病原菌以杆菌为主,且耐药率较高,应引起重视并合理选择抗菌药物。