人鼻病毒C型在呼吸道感染住院患儿中的流行病学研究

目的 了解苏州地区人鼻病毒C型 （HRV-C）在呼吸道感染 （RTIs）住院患儿中的检出情况、流行特点及临床特征。方法 选取2014年1~12月RTIs住院患儿1702例为研究对象,采集所有患儿鼻咽深部吸取物1702份。采用RT-PCR法检测HRVmRNA;实时荧光定量PCR+高分辨熔链曲线分析对HRV-C进行检测。结果 1702例RTIs患儿中,检出HRV感染244例 （14.34%）,其中HRV-C型69例 （69/244,28.3%）。HRV-C混合感染率为61% （42/69）。HRV-C在每个月份均有检出,其中秋季阳性检出率显著高于春、夏、冬三季 （P < 0.05）;2~5岁患儿HRV-C检出率显著高于其他年龄组 （P < 0.05）。HRV-C感染致大叶性肺炎和哮喘急性发作的比例显著高于HRV-A/B感染 （P < 0.05）;HRV-C感染所致中性粒细胞、CRP升高比例显著高于HRV-A/B感染 （P < 0.05）,但在性别分布和其他临床表现上差异均无统计学意义 （P > 0.05）。结论 HRV-C感染约占HRV感染的1/3,秋季高发,混合感染率高,以2~5岁患儿检出率最高,HRV-C感染患儿的临床表现基本与HRV-A/B感染患儿相似。     

Equal virulence of rhinovirus and respiratory syncytial virus in infants hospitalized for lower respiratory tract infection

Respiratory syncytial virus (RSV) and rhinovirus (RV) are predominant viruses associated with lower respiratory tract infection in infants. We compared the symptoms of lower respiratory tract infection caused by RSV and RV in hospitalized infants. RV showed the same symptoms as RSV, so on clinical grounds, no difference can be made between these pathogens. No relation between polymerase chain reaction cycle threshold value and length of hospital stay was found.     

Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections

BACKGROUND: At Driscoll Children's Hospital (Corpus Christi, Tex), we observed that most infants and children hospitalized for treatment of respiratory syncytial virus (RSV) bronchiolitis and/or pneumonia received broad-spectrum intravenous antibiotics despite having typical RSV signs and symptoms and positive RSV-rapid-antigen tests on admission. Physicians were concerned about the possibility of concurrent serious bacterial infections, especially in infants younger than 3 months and in those with infiltrates present on the chest x-ray films. OBJECTIVE: To report the frequency of concurrent serious bacterial infections in infants and children hospitalized for treatment of RSV lower respiratory tract infections. METHODS: The medical records of 2396 infants and children admitted to Driscoll Children's Hospital with RSV bronchiolitis and/or pneumonia during 7 RSV seasons from July 1, 1991, through June 30, 1998, were reviewed. RESULTS: There were positive cultures obtained from initial sepsis/meningitis workups on admission in 39 infants and children (1.6%). Of these, 12 (31%) were positive blood cultures and 27 (69%) were positive urine cultures. There were no positive cerebrospinal fluid cultures. All of the positive blood cultures contained either Staphylococcus epidermidis, Staphylococcus warneri, or Bacillus species, which are common contaminants. None of the patients received a standard 10-day course of intravenous antibiotic therapy. All of the positive urine cultures were typical urinary tract pathogens. All of the patients were treated. CONCLUSIONS: Concurrent serious bacterial infections are rare in infants and children hospitalized with RSV lower respiratory tract infections and the empiric use of broad-spectrum intravenous antibiotics is unnecessary in children with typical signs and symptoms of RSV bronchiolitis.     

Hypoxaemia in infants with respiratory tract infections

Nineteen infants who were graduates from special care baby units underwent two overnight tape recordings of oxygen saturation (SaO2) and breathing movements; one during an upper (n = 12) or lower (n = 7) respiratory tract infection and the other when free of infection. Baseline SaO2 was lower during infection (median 99.6 vs 100%, p less than 0.01), with four patients having values (84.3-95.5%) below the normal lower limit for full-term infants (97%). The median number of apnoeic pauses was also lower during respiratory tract infection (4.7 vs 15.7/h, p less than 0.02). The median number of episodic desaturations (SaO2 less than or equal to 80%) did not change significantly (1.3 vs 1.9/h, p greater than 0.05), with the exception of one patient who had extremely increased values during infection for both apnoeic pauses (63/h) and desaturations (112/h). No infant, however, was considered clinically hypoxaemic. Clinically unsuspected hypoxaemia may thus occur during respiratory tract infection in a proportion of infants graduating from special care baby units. Such hypoxaemia may have potentially deleterious effects.     

鼻病毒致儿童下呼吸道感染

从1956年Pelon用组织培养方法分离出第一株人鼻病毒(Iauman rhinovirus,HRV)后,先后有多种HRV细胞株被分离,鉴定出的HRV血清型已超过120种.HRV是人类血清型最多的病毒之一,也是人类普通感冒的最主要病毒.既往认为,HRV不能引起下呼吸道感染,原因在于下呼吸道温度达37℃,在此温度下HRV不能生长及复制.后来.通过体内外实验发现,HRV能在37℃环境下于支气管上皮细胞中复制,通过原位杂交及逆转录PCR(RT-PCR)检测支气管肺泡灌洗液后发现,HRV能感染人类下呼吸道,引起肺炎、儿童喘息、哮喘加重以及成人慢性阻塞性肺疾病(COPD)等.且有越来越多的证据表明,HRV是引起婴儿及儿童下呼吸道感染的重要病原之一[1-4].     

急性呼吸道感染住院患儿副流感病毒的检测及分析

目的分析温州地区急性呼吸道感染(ARI)患儿副流感病毒(PIV)的流行情况。方法采集2003年1月～2006年12月急性呼吸道感染住院患儿的鼻咽分泌物,应用直接免疫荧光法检测副流感病毒1、2、3型抗原。结果5731例标本中PIV阳性348例(6.1%),其中PIV165例(1.1%)、PIV26例(0.1%)、PIV3250例(4.4%)、混合感染27例(0.5%);2003～2006年PIV检出率分别为9.1%、5.7%、8.9%、2.0%(χ2=88.47,P<0.01);PIV3在≤1岁组检出率高于>1岁组(χ2=9.03,P<0.01)。结论2003年1月～2006年12月,温州地区ARI患儿中有PIV1、PIV2、PIV3及混合感染不同程度的流行,婴儿期易感。PIV3为优势流行株,2003～2005年几乎呈全年的流行态势,并且年度流行高峰不同,以夏季为多。     

单中心1 726例住院婴儿急性下呼吸道感染临床流行病学调查

目的 调查复旦大学附属儿科医院（我院）住院婴儿急性下呼吸道感染（ALRIs）的流行情况及临床表现,比较分析不同严重程度ALRIs的临床特征。方法对入住我院的≤1岁的ALRIs患儿进行回顾性调查,分为重症组和轻中症组,采集人口学特征、临床表现、辅助检查、病原学、治疗情况、预后和疾病负担等信息。结果 ①2011年3月1日至2012年2月29日1 726例ALRIs病例进入本文分析,占同期≤1岁住院患儿的25.3%,流行高峰主要集中在秋冬两季。重症组<6个月患儿、低出生体重儿和早产儿比例高于轻中症组。②主要临床表现为咳嗽 (70.3%)、发热 (12.2%),重症组气促、发绀、呼吸暂停的发生率高,分别为18.1%、8.2%、24.6%。③血气分析发现重症组较轻中症组患儿存在高PaCO2,低PaO2和SaO2;91.3%的ALRIs婴儿X线胸片出现不同部位渗出性病变和(或)局限性气肿或心缘模糊。④72.4%ALRIs患儿病原体检查阳性,以呼吸道合胞病毒（RSV）为主 (52.9%) ,重症组RSV、细菌及混合感染比例高。⑤重症组69.5%患儿合并基础疾病,主要为先天性心脏病、高胆红素血症、支气管肺发育不良、呼吸道畸形及营养不良。⑥ALRIs患儿住院天数中位数为9 d,住院费用中位数为6 864元。重症组住院天数及住院费用均高于轻中症组。结论 重症ALRIs在小婴儿中发生率高,RSV为主要病原;多存在基础疾病,疾病负担较重。     

Concurrent serious bacterial infections in 912 infants and children hospitalized for treatment of respiratory syncytial virus lower respiratory tract infection

The objective of this study was to report the frequency of concurrent serious bacterial infections in infants and young children hospitalized for treatment of respiratory syncytial virus (RSV) lower respiratory tract infection. Data were collected through a retrospective review of the medical records of all 912 patients with a discharge diagnosis of RSV bronchiolitis or pneumonia between July 1, 2000 and June 30, 2002. Two (0.43%) of 470 patients tested had a positive blood culture; both patients were >90 days of age. None of 101 patients tested had a positive cerebrospinal fluid culture, and 28 of 234 (12.0%) patients tested had a positive urine culture. Routine sepsis and meningitis workups are not necessary in non-toxic-appearing infants and young children with RSV lower respiratory tract infection.     

Interferon in nasal secretions from infants with viral respiratory tract infections

Interferon levels in nasal secretions of infants under one year of age, and hospitalized with lower repiratory tract disease, were measured during two respiratory infection seasons. In the first year serial secretions from 50 infants with respiratory syncytial virus infection were examined. Undetectable or low levels of interferon were found in all samples, and mean levels did not fluctuate significantly in relation to disease and recovery. This was in contrast to anti-RSV IgA, which appeared and increased in concentration as virus shedding decreased and stopped. In the second year secretions were obtained from nine infants with influenza A virus infection as well as from 13 with RSV. All those with influenza developed measurable interferon in secretions (geometric mean titer 138 units/ml), which was acid and heat stable, and trypsin sensitive (type I interferon). RSV infection again stimulated very low levels (geometric mean 5 units/ml). The lack of correlation of interferon concentration with cessation of RSV shedding suggests either that it is not involved in recovery or that low levels are adequate. On the other hand, it appears that the young infant is fully capable of a brisk local interferon response, at least to infection by influenza A.     

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.     

Viral etiology of lower respiratory tract infections in hospitalized children in Mexico

BACKGROUND: Respiratory viruses are the main cause of lower respiratory tract infections (LRTI) reported worldwide. The contribution of viral infections to respiratory infections in Mexico has not been fully determined. OBJECTIVE: To determine the contribution of viral infections in hospitalized children with LRTI. METHODS: Children younger than 15 years of age with the admission diagnosis of LRTI were eligible for this study. A nasal wash specimen for virus identification by direct immunofluorescent assay (DFA) was obtained as soon as possible after admission. Clinical and radiographic findings of children with positive and negative detection of viruses were compared. RESULTS: Of 285 subjects admitted to the hospital with LRTI, 265 (93%) had an appropriate specimen for DFA. A viral agent was detected in 125 (47.2%) specimens. Viruses that were identified included respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and pneumonia (91). Of the subjects included in the study, 71.3% were younger than 1 year of age. Children with a confirmed viral etiology for their LRTI were younger, had higher respiratory rates on admission and were more likely to present with bronchiolitis than subjects with a negative DFA result. CONCLUSIONS: Respiratory viruses are responsible for at least 47.2% of LRTI requiring hospitalization at our hospital. Respiratory syncytial virus was the most important respiratory agent identified.     

婴幼儿初次下呼吸道感染与血清IgG亚类缺陷

目的：研究婴幼儿初次下呼吸道感染患者中血清IgG亚类变化情况。方法：随机抽取185例初次下呼吸道感染病儿，用ELISA法检测血清IgG及IgG亚类浓度。并与该地区健康小儿血清浓度进行比较。以低于参考值下限(-1.96s)者为IgG或IgG亚类缺陷，而高于(+1.96s)者视为IgG亚类增高。结果：185例共检出43例IgG缺陷，均有IgG亚类缺陷，而余下的142例IgG正常者，发现IgG亚类缺陷120例，检出率高达 84.5%。其中0～3月4项、3项缺陷合计29例，占该年龄段缺陷总数的 85.3%，在各年龄段中为最高比例。而IgG亚类缺陷中以IgG3缺陷最高，占 47.6%。结论：婴幼儿初次下呼吸道感染伴有IgG亚类缺陷。年龄越小，越易出现IgG亚类联合缺陷。因而在检测Ig时，除注意总IgG外，还应注意IgG亚类水平。     

Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections

BACKGROUND: Aseptic meningitis associated with urinary tract infection (UTI) in young infants has not been described in detail in the literature. We performed a retrospective study to determine the incidence and clinical features of aseptic meningitis accompanying UTI. METHODS: We retrospectively reviewed the medical records of all infants younger than 6 months of age hospitalized with a UTI at Miller Children's Hospital from March 1995 through March 2000. UTI was defined as a urine culture growing > or =10,000 colony-forming units/ml of a single organism from a catheterized specimen or > or =100,000 colony-forming units/ml of a single organism from a bagged urine specimen. Meningitis was defined as a positive cerebrospinal fluid culture or cerebrospinal fluid with >35 white blood cells/mm3 in infants < or =30 days of age or with >10 white blood cells/mm3 in infants >30 days of age. RESULTS: Of 386 infants with UTI, a lumbar puncture was performed in 260, and 31 (11.9%) had aseptic meningitis. One infant had bacterial meningitis. None of the 26 infants with UTI and bacteremia had aseptic meningitis. Two infants with meningitis had confirmed enteroviral infections, but aseptic meningitis did not occur more frequently in any particular month or during times of peak enteroviral activity. CONCLUSIONS: A cerebrospinal fluid pleocytosis is relatively common in hospitalized infants <6 months of age who have a UTI and usually does not reflect bacterial meningitis. Knowledge of this may prevent unnecessary courses of antibiotics for presumed bacterial meningitis and lead to evaluation for other possible causes of aseptic meningitis including viral or congenital infections.     

Viral infections in hospitalized children affected by acute lower respiratory tract disease

OBJECTIVE: To evaluate the frequency of the main respiratory viruses in hospitalized children affected by acute lower respiratory tract disease at a university hospital. METHODS: This is a prospective trial that included two cohorts of hospitalized children in the period from April to July 1996. The groups were selected according to the presence of lower respiratory tract disease on admission: Group A- with acute disease (history of less than 7 days) and B- without present or recent respiratory disease. The parameters for defining lower respiratory tract disease included physical and/or radiological pulmonary changes. Clinical and radiological criteria were established for the classification of lower respiratory tract diseases in group A. Nasopharyngeal swab was collected from all children on admission for viral detection by cellular cultures and direct immunofluorescence. RESULTS: 201 cases were selected, 126 in group A and 75 in group B. Viruses were identified in 71 children from groupA(56.4%) and only in 3 from group B (4.0%). The predominant agent in group A was respiratory syncytial virus, identified in 66 cases; adenovirus (4) and influenza (1) were detected in other patients. In group B two patients with respiratory syncytial virus and one with adenovirus were identified. The patients from group A affected by respiratory syncytial virus were younger (median age 3 months versus 13 months) and more wheezy on physical examination (78.7%) than the other patients of the group (33.3%). This virus was associated to most of the bronchiolitis cases (84%) and to half of the pneumonia cases (46.4%). CONCLUSION: The authors found a significant presence of viruses in the majority of children hospitalized with acute lower respiratory tract disease. The respiratory syncytial virus was the predominant agent identified. These results are similar to others previously reported both in developed and some developing countries. The authors emphasize that the present study evaluated only partially the possibility of simultaneous infection by other pathogens and that the present protocol was conducted during the season with the highest incidence of respiratory syncytial virus.     

Role of anaerobic beta-lactamase-producing bacteria in upper respiratory tract infections

Bacteroides sp. (Bacteroides melaninogenicus, Bacteroides oralis and Bacteroides fragilis), peptostreptococci and Fusobacterium sp. are important pathogens in upper respiratory tract infections. A recent increase in numbers of beta-lactamase-producing strains of anaerobic Gram-negative bacteria in upper respiratory tract infections has been associated with increased failure rates of penicillins in eradication of these infections. These infections include chronic otitis media, chronic sinusitis and mastoiditis, chronic recurrent tonsillitis and lung abscesses. The indirect pathogenicity of these organisms is apparent through their ability not only to survive penicillin therapy but also to protect penicillin-susceptible pathogens from the drug. These direct and indirect virulence characteristics of anaerobic bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections.     

急性呼吸道感染住院儿童人类博卡病毒感染的临床特征

目的 了解西安地区以急性呼吸道感染住院患儿的人类博卡病毒(HBoV)感染的临床特征.方法 将2008年1月-12月以急性呼吸道感染住院患儿的咽拭及痰液标本252例分成2份,1份应用直接免疫荧光法检测RSV,甲、乙型流感病毒,Ⅰ、Ⅱ、Ⅲ型副流感病毒和腺病毒常见的7种呼吸道病毒;另1份用于提取HBoV DNA,分析HBoV感染的临床特点及流行病学特征.随机抽取1份HBoV DNA阳性扩增产物进行序列测定,并通过Clustal W软件与GenBank中其他HBoV序列进行多序列比对分析.结果 252份标本共检测到15份(6.0%)HBoV PCR阳性扩增产物.HBoV感染全年均有发生,冬春季多发;73.3%HBoV感染患儿的年龄为6个月至3岁;53.3%的患儿诊断为支气管肺炎(包括毛细支气管炎);53.3%患儿合并有其他呼吸道病毒的感染.HBoV单独感染与合并其他呼吸道病毒感染在临床特征方面无明显差别.HBoV NS1测序的291 bp与GenBank中2个原型株HBoV Stockholm 1(stl,No.DQ00495)、HBoY Stockholm2(st2,No.DQ00496)和北京的2株(No.DQ988934.2及No.DQ988933.1)的同源性为99.0%.结论 HBoV在15例以急性呼吸道感染住院患儿的咽拭及痰液标本中检出,HBoV感染以下呼吸道感染为著,与其他呼吸道病毒有较高的合并感染,HBoV单独感染与合并其他呼吸道病毒感染在临床特征方面无明显差别.     

Clinical manifestations of respiratory tract infections due to respiratory syncytial virus and rhinoviruses in hospitalized children

From September 1984 to May 1986, nasopharyngeal secretions were obtained from 519 children with some form of respiratory tract infection. The nasal secretions were screened for respiratory syncytial virus (RSV), rhinoviruses, adenoviruses, parainfluenza virus types 1, 2, 3, influenza virus types A and B, and enteroviruses by tissue culture virus isolation technique and/or enzyme-linked immunosorbent assay. A uniform questionnaire gave information about age, sex, individual signs and symptoms, findings of the physical examination and clinical diagnosis of the patients. RSV was detected in 119 (23%) specimens and was thus the most frequent causative agent of respiratory infections. After RSV, rhinoviruses were the most frequently recovered pathogens accounting for 60 (12%) cases of acute respiratory disease. A comparison of the individual signs and symptoms, the findings of the physical examination and the clinical diagnosis of RSV and rhinovirus infected children revealed that there was no characteristic clinical pattern associated with either of the two viral respiratory pathogens. According to our results, rhinovirus infections were a major cause of lower respiratory tract infections in hospitalized children less than or equal to 3 years old.