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??Objective To investigate the clinical relevance of multiple viral infections in children with acute lower respiratory disease. Methods A total of 1722 children with clinical diagnosis of lower respiratory tract infection ??ALRTI?? during the period of October 2007 to September 2011 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. ??RT?? PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus ??RSV?? ?? rhinovirus ??RV?? ?? influenza virus type A and B?? parainfluenza virus ??PIV?? type 1-4?? adenovirus ??enterovirus?? human coronavirus?? human metapneumonia virus and human bocavirus. Results Totally 206 children had single RSV infection?? 124 children had dual infections ??RSV co-infected with an additional virus?? and 40 children had multiple infections along with a RSV infection. Out of the 124 patients?? 68??54.8%?? were co-infected with RV?? 24 with PIV. There was a statistically significant difference between the dual viral infections group and the RSV-infected group in hospital stay??P??0.001??. Compared to patients in the single RSV infected group?? patients in the multiple viral infection group had significantly more frequency in fever ??P??0.017???? duration of fever longer??P??0.015???? hospital stay also longer??P??0.001????and they received more intravenous steroid therapy during hospitalization??P??0.005??. There was no significant difference in oxygen therapy?? respiratory support and use of bronchodilators. Conclusion Multiple viral infections are linked to more frequency in fever?? longer fever days?? longer hospital stay?? and more frequent use of intravenous steroid therapy during hospitalization. Mixed respiratory virus infection may affect the patient's disease severity and prognosis.     

Current challenges in lower respiratory infections in children

PURPOSE OF REVIEW: Lower respiratory infections threaten the health of children worldwide. Streptococcus pneumoniae remains the most common bacterial cause of lower respiratory infection in children, whereas viral pathogens dominate as a more common cause of lower respiratory infection illness in infants and children overall. The diagnosis and clinical management of lower respiratory infections pose challenges to pediatric health providers as new technology is developed and new pathogens emerge in the spectrum of clinical disease. RECENT FINDINGS: Human metapneumovirus is now recognized as a cause of lower respiratory infection disease in children, and coronavirus has been linked to epidemics of severe acute respiratory syndrome. Respiratory syncytial virus continues to be a major source of viral lower respiratory infection illness in children and can lead to childhood asthma. Treatment for respiratory syncytial virus bronchiolitis depends largely on the severity of disease and the course of clinical symptoms. The diagnosis of bacterial lower respiratory infection disease remains a clinical challenge, but new methods to detect S. pneumoniae, or Chlamydia pneumoniae and Mycoplasma pneumoniae may facilitate the clinical management of these illnesses. As immunization against S. pneumoniae becomes more widely used, the complications of bacterial lower respiratory infections will diminish markedly. SUMMARY: Future progress in the clinical management of lower respiratory infection diseases will entail improved methods of early diagnosis, broader options for treatment, and better defined clinical parameters for triage and follow-up of children with lower respiratory infections.     

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??Respiratory tract infection is one of the most common diseases in pediatric patients with various clinical presentation and severity ranges from mild upper respiratory tract illnesses to serious or fatal lower respiratory tract disease. Virus is one of the most common respiratory pathogens??especially in infants and young children. Rapidly establishing the viral etiology of a respiratory illness with high sensitivity and specificity is of important. In recent years??more and more new techniques and methods for viral etiological diagnosis have been developed. Advantages and short comes for various diagnostic techniques and methods in clinical practice are compared and discussed here for reference.     

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??Viral lower respiratory tract infections??LRTIs?? are common causes of critical illness in children. Recent advances in viral detection techniques over the past decade have demonstrated the rates of morbidity??mortality??and medical burden of LRTIs caused by viruses are comparable to those of bacterial community-acquired and nosocomial pneumonias. In the paper??it described the relationship between viral LRTIs and critical illness??and discuss relevant clinical features and management strategies of the more prevalent respiratory viral pathogens. Early diagnostic and treatment strategies are required to effectively treat these infections and prevent complications.     

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目的 了解昆明地区呼吸道合胞病毒(RSV)在小儿急性下呼吸道感染中的发生率和临床特征.方法 对昆明市儿童医院2006年4月至2007年4月临床诊断为急性下呼吸道感染的住院患儿1112例行痰间接免役荧光法检测呼吸道合胞病毒抗原.结果 1112例标本中,阳性276例,阳性率24.82%,其中男190例(17.09%),女86例(7.73%),男女发病比例为2.21∶1.全年均可检出RSV,发生率最高的是10～12月份(30.15%),最低的是4～6月份(10.93%).RSV感染多见于3岁以下,尤以6个月以下患儿感染率最高(36.22%).结论 呼吸道合胞病毒是引起昆明地区小儿急性下呼吸道感染的主要病原,特别是婴幼儿感染率最高.     

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目的分析住院急性呼吸道感染(ARI)患儿病毒病原检测结果,为临床儿童急性呼吸道感染提供病毒病原学诊断依据。方法选择2003年4月至2005年3月重庆医科大学儿童医院呼吸内科住院治疗的急性呼吸道感染患儿,取其鼻咽分泌物做免疫荧光检测筛查7种常见呼吸道病毒抗原,包括呼吸道合胞病毒(RSV)、腺病毒、流感病毒A及B型、副流感病毒Ⅰ、Ⅱ、Ⅲ型,对检测标本阳性的病例进行统计分析。结果1052份标本中,阳性标本409份,占38.88%。其中RSV阳性标本360份,占总阳性标本例数的88.02%,副流感病毒Ⅲ37份占9.05%;RSV发病高峰时期在12月至次年2月和7、8月两个时期;RSV感染多见于3岁以下,发病高峰年龄为2～6个月,男女发病比例为2.24∶1。结论2003～2005年重庆地区急性呼吸道感染的病毒病原体仍以RSV为主。     

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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(PIVⅢ)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PIVⅢ混合感染3例(0.3%),RSV和PIVⅠ混合感染3例(0.3%),PIVⅡ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%)。     

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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.     

常见儿童呼吸道病毒感染性疾病的临床特征

儿童急性呼吸道感染是临床的常见病， 是导致儿童死亡的一个重要原因， 病毒感染在其中占有重要地位。绝大多数病毒感染无特异性临床特征， 但也有部分病毒感染临床表现特征性较强。熟悉不同病毒感染的临床特征对于临床早期及时的明确病原以及合理用药有着深远的意义。     

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??Airway mucus hypersecretion is an important feature of chronic respiratory diseases. Viral infection is a common factor inducing airway mucus hypersecretion. Understanding the relationship between the viral infection and airway mucus hypersecretion and mechanism is very important to preventing and reducing airway mucus hypersecretion??decreasing the mortality of chronic respiratory diseases. The increase of MUC5AC expression is the major pathological basis of airway mucus hypersecretion??so it is necessary to discuss the signal transduction pathway of MUC5AC secretion caused by common respiratory virus infection.