2006-2007年苏州地区儿童呼吸道人类偏肺病毒感染的流行和临床特征

目的 了解苏州地区儿童人类偏肺病毒(hMPV)呼吸道感染的流行情况及临床特征.方法 收集2006年1月-2007年12月我院呼吸科4702例急性呼吸道感染住院患儿的呼吸道分泌物,用逆转录-聚合酶链反应法检测hMPV N基因,随机挑选部分阳性PCR扩增产物进行核苷酸测定并将所测序列在GenBank中进行比较分析.结果 4702例标本中,检测到376份RT-PCR阳性扩增产物,阳性率为8%;2006,2007年hMPV检测阳性率分别为8.4%、7.6%.hMPV检测阳性率分别在1、2、3月和11、12月呈现高峰,hMPV感染患儿的平均年龄为22.56个月,376例hMPV感染患儿中临床诊断为上呼吸道感染12例(3.2%);喉炎8例(2.1%);毛细支气管炎102例(27.1%);肺炎210例(55.9%);哮喘急性发作44例(11.7%).20份hMPV N基因部分核苷酸片断与GenBank中hMPVN基因序列同源性为99%～100%.结论 (1)苏州地区部分儿童的呼吸道感染与hMPV有关.(2)全年均存在hMPV感染,流行高峰在冬春季.(3)hMPV感染的临床特征无特异性.     

Comparison of human metapneumovirus and respiratory syncytial virus in children admitted to a paediatric intensive care unit

Aim: To describe the clinical presentation and course of children admitted to the paediatric intensive care unit (PICU) with human metapneumovirus (hMPV) infection, and compare them with children admitted to the PICU with respiratory syncytial virus (RSV) infection. Methods: hMPV was identified by immunofluorescence in 22 children admitted to the PICU over a 16‐month period. The medical records of these children were reviewed retrospectively, and their clinical and laboratory data were compared with 66 children admitted to the PICU with positive tests for RSV over the same period. Results: Children admitted to the PICU with hMPV were significantly older than children with RSV (P= 0.003). Children with hMPV presented more commonly with pneumonia or pneumonitis (29% vs. 16%), and less commonly with bronchiolitis (43% vs. 68%) than RSV (P= 0.13). Invasive ventilation was required in 10 patients (48%) with hMPV, and non‐invasive ventilation was required in a further 5 (28%), similar to patients with RSV. Children with hMPV were more likely to have an underlying co‐morbidity (P= 0.11). Conclusions: Children admitted to the PICU with hMPV have a similar disease presentation and severity as children admitted with RSV, including some with extremely severe disease who require additional ventilatory or cardiovascular support. Children with hMPV are likely to be older than those with RSV, and more likely to present with pneumonia and less likely to present with bronchiolitis.     

6岁以下儿童急性下呼吸道感染的病毒病原及临床研究

目的　了解北京地区 6岁以下儿童中急性下呼吸道感染 (ALRI)患儿的病毒感染状况 ;探讨人类偏肺病毒 (hMPV)感染在儿童ALRI中的作用及所致支气管肺炎的临床特征。方法　 (1)采集 2 0 0 1年 2月至 2 0 0 3年 3月就诊于首都儿科研究所 4 4 6例年龄 1个月至 5岁的ALRI住院患儿的鼻咽分泌物 ,同时应用间接免疫荧光 (IFA)及病毒分离方法进行人类呼吸道合胞病毒 (hRSV)、流感病毒 (甲、乙型 )、副流感病毒 (Ⅰ、Ⅱ、Ⅲ型 )及腺病毒等 7种常见呼吸道病毒的病原检测。 (2 )采用逆转录聚合酶链反应 (RT PCR)方法对 2 0 0 2年 11月至 2 0 0 3年 3月住我院内科的ALRI患儿中经 7种呼吸道常见病毒病原检测阴性的 2 16份鼻咽洗液 ,进行了hMPV基因检测 ,并分析hMPV感染患儿的临床资料。结果　 (1) 4 4 6例患儿中 7种常见呼吸道病毒总阳性例数为 2 0 9例 (46 86 % ) ,hRSV阳性者最多为 16 3例 (36 5 5 % )。 (2 )在 2 16份上述 7种呼吸道病原检测阴性的标本中 6 9份测到hMPV阳性扩增产物 (31 9% ) ,占同期送检标本的 19 17%。结论　 (1)hRSV是北京地区冬春季节婴幼儿ALRI的主要病原。 (2 )2 0 0 2年 11月至 2 0 0 3年 3月我院ALRI住院患儿中有 19 17%与hMPV感染有关     

Outbreak of human metapneumovirus infection in norwegian children

INTRODUCTION: Human metapneumovirus (hMPV) was recently discovered in children with acute respiratory tract infection. We have studied the occurrence of hMPV and report clinical findings of 50 hMPV-infected children who were hospitalized during an outbreak in Norway. METHODS AND POPULATION: During 5 months from November 15, 2002 to April 14, 2003 we collected nasopharyngeal aspirate specimens from 236 children admitted because of respiratory tract infection (RTI). Samples were analyzed for influenza virus A/B, parainfluenza viruses 1, 2 and 3 and respiratory syncytial virus by direct immunofluorescence assays and cell culture. Rhinovirus, adenovirus and hMPV were identified by polymerase chain reaction. RESULTS: Human metapneumovirus was identified in 50 of 236 children (21%). Most (41 of 50) hMPV-infected children were hospitalized between November 15 and January 15, and during these 2 months hMPV was the most common isolate (41 of 72 isolates; 57%). Respiratory syncytial virus was identified in 36 children (15%), among whom 34 were admitted after the hMPV outbreak.The median age of hMPV-infected children was 12 months (range, 1 to 115 months), and one-half of the children had an underlying chronic disease. The most common symptoms were fever (86%), cough (90%), dyspnea (80%), wheezing (56%), rhinorrhea (44%), anorexia (48%) and vomiting (36%). Eight (16%) had an upper respiratory tract infection (rhinopharyngitis, n = 6; laryngitis, n = 2), 24 (48%) had bronchiolitis and 17 (34%) had pneumonia. Two-thirds with a lower RTI also had signs of upper RTI. Fourteen (28%) children needed supplemental oxygen, 1 was treated with continuous positive airway pressure and 2 were ventilated mechanically. CONCLUSION: Human metapneumovirus was the most common virus isolate during the winter season 2002 to 2003 in children hospitalized for respiratory tract infection. Upper respiratory tract infections and mild to severe bronchiolitis were most common, but a relatively high proportion of hospitalized children developed severe pneumonia.     

偏肺病毒毛细支气管炎的临床研究

目的　了解人类偏肺病毒 (hMPV)感染情况及所致毛细支气管炎的临床特征。方法 (1)采用RT PCR方法 ,对 12 6例毛细支气管炎中经呼吸道常见病原检测阴性的 5 4份鼻咽洗液标本进行hMPV基因检测 (扩增 测序 ) ;(2 )分析hMPV感染患儿的临床资料。结果　 (1)共检测出 2 1份阳性hMPV扩增产物 ,阳性率为 16 7% ,占 5 4例呼吸道常见病原检测阴性患儿的 39%。 (2 ) 2 1例hMPV毛细支气管炎中幼婴 (1～ 6月龄 )占 6 2 % ;多为低 中度发热 (86 % ) ;外周血WBC <10 0× 10 9/L者占81% ;胸部X线表现为两肺野点片状影和 (或 )肺气肿影者分别为 6 8%和 6 2 %。经临床Lowell评分 5例评为重症。hMPV毛细支气管炎患儿组主要临床特征与A亚型呼吸道合胞病毒 (hRSV)毛细支气管炎组无区别 ,仅病程较B亚型hRSV毛细支气管炎组长 (P <0 0 1)。结论　 (1) 12 6例毛细支气管炎住院患儿中有 16 7%是由hMPV感染引起。 (2 )hMPV毛细支气管炎的主要临床特征与hRSV毛细支气管炎无明显差异。     

Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children's hospital in New Zealand

OBJECTIVE: Despite its decline in developed countries, bronchiectasis appeared to be a common diagnosis in Auckland, New Zealand children. The aims of this study were: to document the number of children in Auckland with bronchiectasis, their severity, clinical characteristics and possible aetiologies; to assess whether there was a relationship between ethnicity and poverty; and to estimate a crude bronchiectasis prevalence rate for New Zealand. METHODS: A retrospective review of the case histories of all children attending a tertiary children's hospital in Auckland with bronchiectasis diagnosed by high-resolution chest computed tomography (CT) scan, during the period 1998-2000 was undertaken. Data collected included patient demographics, number of hospitalizations pre- and post-diagnosis, lung function tests, radiology and investigations. The New Zealand deprivation 1996 index was applied to the data to obtain a measure of socio-economic status. RESULTS: Bronchiectasis was found to be common, with an estimated prevalence of approximately one in 6000 in the Auckland paediatric population. It was disproportionately more common in the Pacific Island and Maori children. In Pacific Island children, bronchiectasis not caused by cystic fibrosis was nearly twice as common in the general population than cystic fibrosis. Socio-economic deprivation and low immunization rates may be significant contributing factors. The bronchiectasis seen was extensive. Ninety-three percent had bilateral disease and 64% had involvement of four or more lobes on chest CT scan. A wide range of comorbidities and underlying aetiologies were evident. CONCLUSIONS: Paediatric bronchiectasis in Auckland, New Zealand, is common but underresourced. Only the most severe cases are being recognized, providing a significant challenge for paediatric health professionals.     

太原地区急性呼吸道人偏肺病毒和人博卡病毒感染患儿临床特征分析

目的了解太原地区急性呼吸道感染(ARTIs)儿童人偏肺病毒(hMPV)与人博卡病毒(HBoV)的感染情况及其临床和流行病学特征。方法采集2012年11月—2013年5月及2013年11月—2014年5月就诊的ARTIs患儿549例,采集咽拭子标本,应用实时PCR方法检测hMPV与HBoV。结果 549例患儿的咽拭子标本中hMPV阳性56例(10.2%),HBoV阳性15例(2.7%)。其中2012年11月—2013年5月hMPV与HBoV检出率分别为12.3%和2.0%,2013年11月—2014年5月hMPV与HBoV检出率分别为6.5%和4.0%,两时间段hMPV检出率差异有统计学意义(P0.05),HBoV检出率差异无统计学意义(P0.05);不同月份hMPV、HBoV检出率差异无统计学意义(P0.05)。hMPV与HBoV均在2岁组中检出率最高。hMPV在喘息性支气管炎与毛细支气管炎患儿中检出率最高。结论太原地区hMPV和HBoV与部分儿童尤其是婴幼儿ARTIs有关,hMPV是诱发部分婴幼儿喘息性疾病的重要病原体之一。     

Presence of the new human metapneumovirus in French children with bronchiolitis

We developed a polymerase chain reaction (PCR) to detect human metapneumovirus (hMPV) in French children hospitalized for acute respiratory tract disease during the winter of 2001 to 2002. This assay showed that 19 (6.6%) of 337 respiratory specimens that were negative for other respiratory viruses were positive for hMPV. Seven hMPV infections were also detected in the previous winter. The patients had the following clinical syndromes: bronchiolitis, 16; acute exacerbation of asthma, 4; bronchitis, 1; laryngitis, 1; high fever with diarrhea, 2; high fever with rhinopharyngitis, 1; rhinopharyngitis with conjunctivitis and otitis, 1. The sequences of the seven amplified products were similar for all cases and had 99% homology with the previously described N gene sequence.     

Use of complementary treatment by those hospitalised with acute illness.

AIM: To determine the frequency of use of complementary treatment and measure its impact on clinical outcomes in a hospitalised general paediatric population. METHODS: A population based random sample of children admitted to the general paediatric service at a metropolitan children's hospital in Auckland, New Zealand from February to July 1998. Children with asthma, pneumonia, bronchiolitis, gastroenteritis, or fever were eligible. Data collected by personal interview with parents and by review of the medical records of these children. RESULTS: 251 of 511 eligible children admitted during the study period were enrolled. Forty four children (18%) had received complementary treatment during the hospitalising illness. Most children (77%) had been seen in primary care before hospitalisation. The proportion that were seen in primary care and the number of primary care visits before hospitalisation did not vary with receipt of complementary treatment. The proportion of children who were prescribed medications before hospitalisation was significantly greater for those who had received complementary treatment compared with those who had not (59% v 39%). There was no significant difference between users and non-users of complementary treatment in the severity of the illness at presentation, investigations performed, treatment administered, or length of inpatient stay. CONCLUSION: A substantial proportion of children hospitalised with acute medical illnesses have received complementary treatment. Alternative health care is used as an adjunct rather than an alternative to conventional health care. Receipt of complementary treatment has no significant effect on clinical outcomes for children hospitalised with common acute medical illnesses.     

Tuberculosis in New Zealand, 1992-2001: a resurgence.

OBJECTIVE: To describe the recent epidemiology and clinical features of paediatric tuberculosis (TB) in New Zealand (NZ). METHODS: A retrospective review was conducted of clinical, laboratory, and radiology records of children <16 years old diagnosed with TB between January 1992 and June 2001 in nine NZ health districts. RESULTS: A total of 274 patients <16 years old were identified; the average annual TB rate was 4.8 per 100,000. Rates rose over time reaching a peak of 10.1 in 1999. Rates were highest in under-5 year olds, at 6.2 per 100,000, and varied by ethnicity: African 575.2, Pacific Island 15.2, Maori 6.4, Asian 5.6, and European 0.6. Seventy two cases (26%) were foreign born. Thirty six per cent of cases were not detected until they presented with symptoms and of these 44% had no known TB contact. Most cases were identified by contact tracing (48%) or immigrant screening (11%); 43% were part of outbreaks. Miliary TB or meningitis occurred in 8% of patients, two of whom died. Drug resistance was found in 7% of culture positive cases and no HIV co-infection was found. CONCLUSIONS: A resurgence of TB occurred among children in NZ between 1992 and 2001 predominantly involving non-European and immigrant groups. Despite established contact tracing and immigrant screening programmes, many cases were part of outbreaks, remained unidentified until symptoms arose, or had no known TB contact. These findings point to an unrecognised burden of adult disease, ongoing community transmission, and missed opportunities for prevention. Further study is required to confirm these hypotheses.     

Ten years of pneumococcal‐associated haemolytic uraemic syndrome in New Zealand children

Aim: To describe the epidemiology, clinical features, management and outcome of pneumococcal‐associated haemolytic‐uraemic syndrome (P‐HUS) in New Zealand over the past decade. Methods: A retrospective chart review of children with P‐HUS from 1998 to 2007 that were prospectively reported to the New Zealand Paediatric Surveillance Unit. P‐HUS was defined as microangiopathic haemolytic anaemia (Hb <100 g/L with fragmented red blood cells), thrombocytopaenia (platelet count <130 × 10⁹/L), acute renal impairment with oliguria and elevated plasma creatinine, and confirmed or suspected pneumococcal infection. Results: Eleven children (nine male, two female), predominately Maori and Polynesian (10 children) were studied. The median age was 8.5 months. The median duration of hospitalisation was 25 days. Of the infections, 10 were confirmed pneumococcal (six pneumonia, four meningitis) and one pneumonia was suspected pneumococcal (culture negative, however T activation positive). Nine patients required dialysis for a median duration of 13 days. One child with meningitis died after therapy was withdrawn because of severe neurological injury. One patient developed end stage kidney disease and two further children had evidence of persisting renal sequelae at follow‐up. Conclusions: Pneumococcal disease remains an important public health problem in New Zealand children, particularly those of Maori and Pacific Island ethnicity. P‐HUS should be considered in pneumococcal disease associated with severe haematological and renal abnormalities. These children should be monitored long‐term, as they are at risk of permanent renal injury.     

Variations in bronchiolitis management between five New Zealand hospitals: Can we do better?

OBJECTIVES: To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement. METHODS: Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed. RESULTS: Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001). CONCLUSIONS: Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.     

急性呼吸道感染住院儿童人偏肺病毒感染的流行情况及临床特征

目的了解急性呼吸道感染住院患儿人偏肺病毒(hMPV)呼吸道感染的流行情况及临床特征。方法收集2006年11月～2007年2月本院儿科中心的112例急性呼吸道感染住院患儿的鼻咽分泌物标本,对其中65例用直接免疫荧光法(DFA)检测常见7种呼吸道病毒特异性抗原阴性患儿鼻咽分泌物用间接免疫荧光法(IFA)检测hMPV抗原。结果1.IFA能检测到鼻咽分泌物中hMPV抗原;2.阳性8例,阳性率为12.31%,112例中单一hMPV感染率为7.14%;3.hMPV的检出高峰主要在11月份及次年1月份;4.在≤5岁年龄组阳性率为15%(6/40例),>5岁年龄组阳性率为8%(2/25例),二组hMPV感染阳性率差异无统计学意义(P>0.05);5.hMPV感染的临床表现无特征性。结论西安地区儿童急性呼吸道感染与hMPV感染有关;咳嗽、发热是hMPV感染后的主要临床症状。     

Antibiotic treatment of pneumonia and bronchiolitis. A prospective randomised study.

Routine administration of antibiotics in the treatment of pneumonia and bronchiolitis in infants and small children was evaluated in an open randomised prospective trial. From 1979-82 136 children between the age of 1 month and 6 years were allocated to one of two treatment groups shortly after their admission to a paediatric ward. Group A patients were to be given antibiotics but those in group B were not. None of the children had received antibiotics before hospital admission. A viral infection was diagnosed in 38 of the 72 patients from group A and in 34 of the 64 patients from group B. Respiratory syncytial virus was detected in 84% of these patients. Samples of tracheal secretions showed no differences between the groups in respect of cytology and bacterial flora. Nor were there any significant differences in the course of acute disease, the frequency of fever relapse and pulmonary complications. Fifteen patients from group B were subsequently treated with antibiotics: two of these developed secondary purulent infections of the middle ear and one showed a slight pleural effusion. These results do not support the routine use of antibiotics in infants and small children admitted to hospital with pneumonia and bronchiolitis.     

Detection of antigenuria for diagnosis of invasive Haemophilus influenzae type b disease

BACKGROUND: Haemophilus influenzae type b (Hib) diseases are responsible for an estimated 400,000 childhood deaths, mostly in developing countries. OBJECTIVES: To determine the value of the Wellcogen quantitative latex agglutination test (LA) in urine for the diagnosis of Hib pneumonia and meningitis. METHODS: Healthy and sick children aged <5 y were enrolled in Dhaka Shishu (Children's) Hospital. Boiled and non-concentrated urine specimens underwent LA testing. In vaccinated subjects, urine was tested by LA at 24 h, 4-6 and 7-10 d after vaccination. RESULTS: Of 1302 enrolled cases, 201 were healthy (90 Hib vaccine recipients and 111 provided NP) and 1101 were sick with either pneumonia (n=974) or meningitis (n=127). Among the healthy children enrolled, 41 (41/111, 37%) were colonised with Hib and two (2/41, 5%) were positive by LA test. Hib antigenuria among the children who had received Hib vaccination was mainly detected only on day 1 (7/90, 8%) of vaccination. Among the sick children, LA test for Hib antigen was positive for all confirmed cases of Hib pneumonia (10) and meningitis (35). In contrast, none of the urine specimens from the cases with a known aetiology other than Hib (n=104) was positive. Quantitative analysis of antigenuria of sick children showed that it is positive at least up to 1:8 and 1:16 dilutions for pneumonia and meningitis, respectively, in contrast with or=1:8 dilutions. CONCLUSIONS: The Wellcogen LA test for Hib using boiled and non-concentrated urine is more sensitive than blood culture alone and is highly specific.