Respiratory syncytial virus and metapneumovirus in children over two seasons with a high incidence of respiratory infections in Brazil

Acute respiratory infections (ARI) are one of the most important causes of death in children. Human metapneumovirus (HMPV), a virus first described in 2001, has now been detected in almost all continents. HMPV causes bronchiolitis and pneumonia with a clinical spectrum similar to respiratory syncytial virus (RSV). We describe the incidence of HMPV and RSV during two consecutive seasons with a high incidence of ARI in Aracaju, Brazil. HMPV was responsible for 24% of cases of bronchiolitis in the 1st season (April-May 2002) but was not found in the 2nd year (April-May 2003). RSV was recovered from 61 (55%) children with ARI in 2002 and from 72 (68%) in 2003. Children with RSV bronchiolitis in 2002 had more hypoxia but less wheezing than in 2003. The incidence of HMPV and RSV genotypes causing bronchiolitis varied between the years. Long-term prospective studies are required to better describe the epidemiology of these viruses in children.     

Multiple viral respiratory pathogens in children with bronchiolitis

Aim: The aim of the study was to describe the frequency of viral pathogens and relative frequency of co-infections in nasal specimens obtained from young children with bronchiolitis receiving care at a children's hospital.
Methods: We conducted a study of nasal wash specimens using real-time PCR and fluorescent-antibody assay results from children less than two with an ICD-9-CM code for bronchiolitis. All specimens were collected for clinical care at Children's Hospital in Seattle, WA, USA, during the respiratory season from October 2003 to April 2004.
Results: Viruses were detected in 168 (93%) of the 180 children with bronchiolitis. A single virus was identified in 127 (71%) children and multiple viruses in 41 (23%). Respiratory syncytial virus (RSV) was the most common virus detected (77%), followed by adenovirus (15%), human metapneumovirus (11%), coronavirus (8%), parainfluenza (6%) and influenza (1%). Of the 139 samples with RSV detected, 34 (24%) were co-infected with another viral pathogen.
Conclusion: Molecular diagnostic techniques identified a high frequency of viruses and viral co-infections among children evaluated for bronchiolitis. Further study of the role of viral pathogens other than RSV and co-infections with RSV in children with bronchiolitis appears warranted.     

Respiratory syncytial virus and human metapneumovirus in children with acute respiratory infections in Yemen

A survey of 604 Yemeni children younger than 2 years with acute respiratory infections identified respiratory syncytial virus (RSV) in 244 (40%), human metapneumovirus (HMPV) in 41 (7%) and RSV/HMPV coinfection in 25 (4%) children. RSV infections occurred in younger children and were associated with more severe hypoxia than observed with HMPV. Both viruses are important causes of severe acute respiratory infection in Yemen.     

1788例社区获得性肺炎非细菌性病原体分布特征分析北大核心CSCD

目的探讨社区获得性肺炎患儿非细菌性病原体分布特点。方法回顾性选取2021年12月—2022年11月于沈阳市儿童医院住院的社区获得性肺炎患儿1788例,运用多重RT-PCR与毛细电泳联用技术对10种病毒病原体及2种非典型病原体进行检测,同时抽取静脉血行肺炎衣原体、肺炎支原体血清学抗体检测,分析不同病原体的分布特征。结果(1)1788例社区获得性肺炎患儿病原体阳性率为72.43%(1295/1788),其中病毒病原体阳性率为59.68%(1067/1788),非典型病原体阳性率为22.04%(394/1788)。阳性率由高到低依次为肺炎支原体、呼吸道合胞病毒、流感病毒B、偏肺病毒、鼻病毒、副流感病毒、流感病毒A、博卡病毒、腺病毒、肺炎衣原体、冠状病毒。(2)季节分布:春季以呼吸道合胞病毒、肺炎支原体为主要病原体;夏季以肺炎支原体阳性率最高,其次为流感病毒A;秋季偏肺病毒阳性率最高;冬季主要为流感病毒B、呼吸道合胞病毒。(3)性别、年龄分布:肺炎支原体阳性率女孩高于男孩(P<0.05),其他病原体性别比较差异无统计学意义(P>0.05)。部分病原体在不同年龄组间的阳性率不同(P<0.05):肺炎支原体阳性率在>6岁组最高;呼吸道合胞病毒和肺炎衣原体阳性率在<1岁组最高;偏肺病毒、流感病毒B阳性率在1~<3岁组最高。(4)疾病分布:重症肺炎患儿以呼吸道合胞病毒、肺炎支原体、鼻病毒、偏肺病毒为主;大叶性肺炎患儿的病原体主要为肺炎支原体;急性支气管肺炎前5位病原体为肺炎支原体、流感病毒B、偏肺病毒、呼吸道合胞病毒、鼻病毒。结论肺炎支原体、呼吸道合胞病毒、流感病毒B、偏肺病毒、鼻病毒为儿童社区获得性肺炎的主要病原体,呼吸道病原体阳性率在不同年龄阶段、季节和性别间存在一定差异。     

Human Metapneumovirus in hospitalized children - a review

The human Metapneumovirus (HMPV) has been discovered by von den Hoogen et al. in 2001 and seems to play an important role as etiologic agent in childhood respiratory tract infections in particular involving infants after the 6th month of life and toddlers. Duly considering the hitherto published studies and retrospective analysis of two HMPV seasons (2002-2004) at our institution this review focuses on children, who had to be hospitalized due to HMPV infection. The analysis confirmed, that among those patients there is a high proportion of children with pre-existing risk factors for a complicated clinical course, a high proportion of children with bronchiolitis or pneumonia and a relevant proportion of children with HMPV related apnoeas, most prevalent in the prematurely born. Although the first HMPV infection takes place somewhat later in infancy, the data do not show that HMPV infection is in general milder than RSV infection in hospitalized children. Clinical symptoms and radiological signs do not permit tentative conclusions on the causative agent. This underlines the necessity of specific diagnostic efforts (in case of HMPV with PCR). HMPV may cause lobar or segmental pneumonias difficult to distinguish from bacterial lower respiratory tract infection. Children admitted to the hospital with an acute exacerbation of asthma bronchiale or cystic fibrosis should not only be tested for RSV but also for HMPV. Prospective studies investigating specific therapeutic interventions or describing the impact and prevention of nosocomial HMPV in fection are awaited for. There has been one report of a meningoencephalitis possibly related to HMPV. Thus, liquor samples in such cases should be tested for HMPV too.     

225例支气管哮喘急性发作患儿呼吸道病原体检出及临床特征分析

目的 分析支气管哮喘急性发作患儿的呼吸道病原体检出情况及临床特征。方法 收集2017年8月至2019年8月门诊及住院支气管哮喘急性发作的225例 < 14岁患儿的鼻咽拭子,采用荧光定量PCR法检测12种病原体,包括呼吸道合胞病毒（RSV）、人鼻病毒（HRV）、流感病毒A（IFVA）、流感病毒B（IFVB）、副流感病毒1~3型（PIV1~3）、人偏肺病毒（HMPV）、腺病毒（ADV）9种病毒,以及百日咳杆菌（BP）、肺炎衣原体（CP）、肺炎支原体（MP）。结果 病毒总检出阳性率为46.2%（104/225）,共检出7种病毒,依次为HRV（19.6%,44/225）、ADV（16.0%,36/225）、IFVB（5.8%,13/225）、RSV（4.9%,11/225）、IFVA（3.6%,8/225）、PIV3（1.8%,4/225）、HMPV（0.4%,1/225）。所有病原体中BP检出率最高,为28.4%（64/225）,MP检出率为16.4%（37/225）,CP检出率为0.4%（1/225）。哮喘轻度发作组BP检出率高于重度发作组（P < 0.05）;重度发作组RSV和MP检出率高于轻度发作组（P < 0.05）。单纯BP感染、单纯病毒感染、单纯MP感染3组间阵发性咳嗽、痉挛样咳嗽、发热、肺部啰音的患儿比例及肺部影像阳性检出率的比较差异有统计学意义（P < 0.05）。结论 支气管哮喘急性发作患儿常见的呼吸道病原体为BP、HRV、MP;呼吸道病毒感染是儿童哮喘急性发作的重要病原体。不同病原体引起哮喘急性发作的临床特征及严重程度有一定差异。     

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目的了解北京地区门诊儿童急性呼吸道感染的病毒病原学特点。方法 2010年3月至2011年2月在北京儿童医院门诊就诊的急性呼吸道感染患儿540例,每例患儿采集咽拭子标本1份。采用多重PCR试剂检测常见呼吸道病毒核酸,包括呼吸道合胞病毒(RSV)A、B型,鼻病毒(RV),副流感病毒(PIV)1～4型,流感病毒(IFV)甲、乙型,腺病毒(ADV),人偏肺病毒(HMPV),人冠状病毒(HCoV),人博卡病毒(HBoV)及肠道病毒(EV)。结果 540例门诊采集的急性呼吸道感染患儿的咽拭子标本中,306例检出至少1种病毒,总阳性率56.7%。其中33例检出2种病毒,1例检出3种病毒,混合感染率为6.3%。各种病毒中,IFV检出率最高占16.7%,其次是ADV(12.8%),EV(7.8%),PIV(7.2%),。IFV中以甲型IFV为主(占95.6%),PIV中以PIV3型为主(占66.7%),RSV检出以RSVA型为主,占79.3%。结论病毒是引起儿童急性呼吸道感染的重要病原,北京儿童医院急性呼吸道感染的主要病毒病原是IFV、ADV、EV、PIV。     

多重PCR检测方法在儿童流感样病例病原检测中的临床价值（附94例报告）

目的　探讨多重聚合酶链反应（PCR）检测方法在儿童流感样病例病原检测中的临床应用价值,了解儿童流感样病例病原情况。方法　收集2018年11月至2019年2月北京地区94例儿童流感样病例咽拭子标本,采用多重PCR核酸检测技术测定甲型流感病毒（InfA）、 甲型流感病毒H1N1（InfA-H1N1）、 甲型流感病毒H3N2（InfA-H3N2）、 乙型流感病毒（InfB）、 人副流感病毒、 呼吸道合胞病毒（RSV）、 人腺病毒（HADV）、 人鼻病毒（HRV）、 人博卡病毒、 人偏肺病毒（HMPV）、 人冠状病毒（HCoV）和肺炎支原体（MP）、 衣原体13种病原核酸。结果　94例标本中78例（82.98%）可测出病原,其中69例（73.40%）检出1种病原,9例（9.57%）检出2种病原; 94例标本中52例（55.32%）检出流感病原,26例（27.66%）检出非流感病原。单一病原检出由多到少为InfA-H1N1 31例,InfA-H3N2 10例,RSV 9例,HMPV 7例,InfA、 HRV、 HADV各3例,InfB、 HCoV及MP各1例。9例检出2种病原的标本中,6例检出流感分别合并其他病毒（HRV、 HADV、 RSV、 HCoV、 HMPV）,1例检出甲流H1N1和H3N2,2例分别检出RSV、 HRV及HCoV、 HADV。结论　非流感病原微生物引起流感样病例并不少见,多重PCR检测有助于全面了解流感样病例的病原和混合感染情况。     

北京地区六岁以下儿童急性呼吸道偏肺病毒感染

目的 了解北京地区婴幼儿急性呼吸道感染与人类偏肺病毒(Human Metapneumovirus,HMPV)的关系。方法对2002年11月～2003年3月,收集的247份经过间接免疫荧光法和病毒分离排除了常见的呼吸道病毒感染的鼻咽洗液标本进行了HMPV基因的检测。用针对HMPV N基因序列设计的特异引物对这247份标本进行RT-PCR扩增,扩增片段经1.2％琼脂糖凝胶电泳检测。挑选10份阳性扩增产物直接进行核苷酸序列测定,并将所测序列在GeneBank中进行比较分析。结果 247份标本中共检测到74份RT-PCR阳性扩增产物,阳性率为30.0％(74／247)。74例中临床诊断为肺炎者36例,占48.6％;其次为毛细支气管炎21例,占28.4％;年龄2个月～5岁7个月不等,≤2岁者占83.8％。所挑选的10份N基因扩增产物与GeneBank中同源性最高的均为HMPV(87％～99％)。10份标本中9份标本的扩增产物之间的核苷酸和氨基酸同源性在95.8％～100％和98.6％～100％,1份标本的扩增产物与其他标本同源性较低,仅为87.3％～89.7％和95.8％～97.2％。结论 (1)北京地区部分儿科患者的急性呼吸道感染与HMPV有关;(2)北京地区的HMPV中可能存在不同的基因型。     

多重PCR检测方法在儿童流感样病例病原检测中的临床价值（附94例报告）

目的　探讨多重聚合酶链反应（PCR）检测方法在儿童流感样病例病原检测中的临床应用价值,了解儿童流感样病例病原情况。方法　收集2018年11月至2019年2月北京地区94例儿童流感样病例咽拭子标本,采用多重PCR核酸检测技术测定甲型流感病毒（InfA）、 甲型流感病毒H1N1（InfA-H1N1）、 甲型流感病毒H3N2（InfA-H3N2）、 乙型流感病毒（InfB）、 人副流感病毒、 呼吸道合胞病毒（RSV）、 人腺病毒（HADV）、 人鼻病毒（HRV）、 人博卡病毒、 人偏肺病毒（HMPV）、 人冠状病毒（HCoV）和肺炎支原体（MP）、 衣原体13种病原核酸。结果　94例标本中78例（82.98%）可测出病原,其中69例（73.40%）检出1种病原,9例（9.57%）检出2种病原; 94例标本中52例（55.32%）检出流感病原,26例（27.66%）检出非流感病原。单一病原检出由多到少为InfA-H1N1 31例,InfA-H3N2 10例,RSV 9例,HMPV 7例,InfA、 HRV、 HADV各3例,InfB、 HCoV及MP各1例。9例检出2种病原的标本中,6例检出流感分别合并其他病毒（HRV、 HADV、 RSV、 HCoV、 HMPV）,1例检出甲流H1N1和H3N2,2例分别检出RSV、 HRV及HCoV、 HADV。结论　非流感病原微生物引起流感样病例并不少见,多重PCR检测有助于全面了解流感样病例的病原和混合感染情况。     

225例支气管哮喘急性发作患儿呼吸道病原体检出及临床特征分析

目的 分析支气管哮喘急性发作患儿的呼吸道病原体检出情况及临床特征。方法 收集2017年8月至2019年8月门诊及住院支气管哮喘急性发作的225例 < 14岁患儿的鼻咽拭子,采用荧光定量PCR法检测12种病原体,包括呼吸道合胞病毒（RSV）、人鼻病毒（HRV）、流感病毒A（IFVA）、流感病毒B（IFVB）、副流感病毒1~3型（PIV1~3）、人偏肺病毒（HMPV）、腺病毒（ADV）9种病毒,以及百日咳杆菌（BP）、肺炎衣原体（CP）、肺炎支原体（MP）。结果 病毒总检出阳性率为46.2%（104/225）,共检出7种病毒,依次为HRV（19.6%,44/225）、ADV（16.0%,36/225）、IFVB（5.8%,13/225）、RSV（4.9%,11/225）、IFVA（3.6%,8/225）、PIV3（1.8%,4/225）、HMPV（0.4%,1/225）。所有病原体中BP检出率最高,为28.4%（64/225）,MP检出率为16.4%（37/225）,CP检出率为0.4%（1/225）。哮喘轻度发作组BP检出率高于重度发作组（P < 0.05）;重度发作组RSV和MP检出率高于轻度发作组（P < 0.05）。单纯BP感染、单纯病毒感染、单纯MP感染3组间阵发性咳嗽、痉挛样咳嗽、发热、肺部啰音的患儿比例及肺部影像阳性检出率的比较差异有统计学意义（P < 0.05）。结论 支气管哮喘急性发作患儿常见的呼吸道病原体为BP、HRV、MP;呼吸道病毒感染是儿童哮喘急性发作的重要病原体。不同病原体引起哮喘急性发作的临床特征及严重程度有一定差异。     

从北京地区急性呼吸道感染患儿的标本中分离到人偏肺病毒

目的 从北京患急性呼吸道感染患儿的临床标本中分离人偏肺病毒(HMPV),推动对该病毒的深入研究.方法 2008年5月至2009年4月收集门诊和病房因急性呼吸道感染患儿的标本,经逆转录-聚合酶链反应(RT-PCR)检测核酸和直接免疫荧光法检测抗原筛选到HMPV阳性标本后接种传代的恒河猴肾细胞(LLC-MK2),经37 ℃和33 ℃孵育后用直接免疫荧光法检测细胞内的HMPV抗原,得到阳性结果后经RT-PCR进一步确定基因型.结果 从1092例病房和门诊收集的急性呼吸道患儿标本中用RT-PCR技术检测到81例为HMPV阳性,总阳性率为7.4%(81/1092).取其中33例接种到LLC-MK2细胞进行HMPV分离,有5份标本的接种细胞中可检测到HMPV抗原,并经RT-PCR检测进一步证实,分离株与常见的呼吸道病毒抗体无交叉反应.24 h内新鲜接种的标本更易分离到病毒.分离到的毒株有4株为A基因型,1株为B基因型.结论 从北京急性呼吸道感染患儿的标本中分离到两种基因型的HMPV,将进一步推动对该病毒的研究.     

Effect of RSV bronchiolitis practice guidelines on resource utilization

We sought to determine whether institution of respiratory syncytial virus (RSV) practice guidelines decreased resource utilization for a heterogeneous population of children hospitalized with RSV bronchiolitis. Patients less than 24 months old with RSV bronchiolitis at a pediatric referral center were identified by retrospective chart review for consecutive RSV seasons. Before the guidelines were instituted patients were less likely to have a documented physician's assessment of response to albuterol, were more likely to have received supplemental oxygen and cardiorespiratory monitoring, and to be discharged on an albuterol regimen. Patients received more albuterol treatments. After the guidelines were in place fewer resources were utilized in the care of patients with RSV bronchiolitis. RSV practice guidelines may simplify and streamline the care of a heterogeneous population of children with bronchiolitis.     

Viral etiology of acute respiratory infections with cough in infancy: a community-based birth cohort study

BACKGROUND: Acute respiratory infections (ARI) are a major cause of morbidity in infancy worldwide, with cough and wheeze being alarming symptoms to parents. We aimed to analyze in detail the viral aetiology of ARI with such symptoms in otherwise healthy infants, including rhinoviruses and recently discovered viruses such as human metapneumovirus (HMPV), coronavirus NL63 and HKU1, and human bocavirus (HBoV). METHODS: We prospectively followed 197 unselected infants during their first year of life and assessed clinical symptoms by weekly standardized interviews. At the first ARI with cough or wheeze, we analyzed nasal swabs by sensitive individual real time polymerase chain reaction assays targeting 16 different respiratory viruses. RESULTS: All 112 infants who had an ARI had cough, and 39 (35%) had wheeze. One or more respiratory viruses were found in 88 of 112 (79%) cases. Fifteen (17%) dual and 3 (3%) triple infections were recorded. Rhino- (23% of all viruses) and coronaviruses (18%) were most common, followed by parainfluenza viruses (17%), respiratory syncytial virus (RSV) (16%), HMPV (13%), and HBoV (5%). Together rhinoviruses, coronaviruses, HMPV, and HBoV accounted for 60% (65 of 109) of viruses. Although symptom scores and need for general practitioner (GP) consultations were highest in infants infected with RSV, they were similar in infants infected with other viruses. Viral shedding at 3 weeks occurred in 20% of cases. CONCLUSIONS: Rhinoviruses, coronaviruses, HMPV, and HBoV are common pathogens associated with respiratory symptoms in otherwise healthy infants. They should be considered in the differential diagnosis of the aetiology of ARI in this age group.     

儿童人类偏肺病毒感染流行病学特征与诊治进展

人类偏肺病毒(HMPV)是一种新近发现的呼吸道致病病毒.HMPV感染主要发生在冬春季,各年龄阶段的人群都可受到感染,尤以儿童、老年人和免疫缺陷患者易患.世界各国报道其感染率不尽相同,感染症状可从轻微的上呼吸道病变到严重的细支气管炎和肺炎.对HMPV的检测有三种方法:病毒抗原抗体检测、病毒的细胞培养和荧光定量RT-PCR.治疗上以对症治疗为主.     

儿童呼吸道病毒感染的流行病学特点

呼吸系统感染是儿童门诊就诊最为常见的病因，也是造成＜5岁儿童死亡的首要原因。病毒是儿童时期呼吸道感染最为常见的病原，需要引起儿科医师关注。该文讨论了常见呼吸道病毒的流行病学特征，着重介绍了呼吸道合胞病毒、流感病毒、鼻病毒和腺病毒等较为常见的呼吸道病毒的好发年龄、好发季节、流行区域等流行病学特点。同时，也简要介绍了副流感病毒、偏肺病毒和冠状病毒等近期新发现的病毒的流行病学特征，并回顾了病毒共感染的相关信息。     

Human bocavirus infection in children with respiratory tract disease

BACKGROUND: Human bocavirus (HBoV) is a ubiquitous, newly described member of the Parvoviridae family frequently detected in the respiratory tract of children, but only few reports provide data proving the link between HBoV and respiratory tract disease (RTD). OBJECTIVES: To evaluate the incidence of HBoV infection in children with RTD; to analyze the clinical features of HBoV infection; and to clinically compare HBoV, respiratory syncytial virus (RSV), and human metapneumovirus (HMPV) infections. STUDY DESIGN: A prospective 1-year study was conducted in children <5 years of age hospitalized with RTD and in asymptomatic control children. RESULTS: Human bocavirus was detected in 55 (10.8%) of the 507 children tested and in none of the 68 asymptomatic control children (P = 0.01). About 80% of these infections occurred between November and March. Coinfection with another virus was observed in 22 (40%) of the HBoV-positive children. HBoV viral load was significantly higher in samples from children with HBoV monoinfection than in those with coinfection. Subsequent detection of HBoV more than 2 months after the initial detection could be documented in 3 children. Clinical features associated with HBoV infection were similar to those observed with either RSV or HMPV infections, but HBoV infections were less severe than RSV infections. CONCLUSIONS: The difference observed in HBoV prevalence between children with RTD and controls provides support for a role of this virus in RTD. The frequent associations of HBoV with other respiratory viruses might be explained by the persistence of HBoV in the respiratory tract. The significance of HBoV viral load in nasopharyngeal secretions as a marker of pathogenicity merits further investigation.     

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??Viral bronchiolitis is one of the most common health problems in children worldwide. The most common pathogen is respiratory syncytial virus??RSV????and other pathogens include rhinovirus??human metapneumovirus??bocavirus and so on. Infant hospitalized for viral bronchiolitis will have recurrent wheezing or asthma later??disease severity??virus type??atopy and genetic polymorphisms will increase the risk of asthma. The definition of viral bronchiolitis is not uniform??and the difficulty of defining wheezing and its frequency is a great obstacle to study the relationship between them. Future studies should give full consideration to the heterogeneity of bronchiolitis??and observe and compare the risk of asthma in different phenotypes of bronchiolitis.     

重庆地区婴幼儿重症肺炎呼吸道病毒病原分析

目的 了解重庆地区婴幼儿重症肺炎病毒病原的感染情况.方法 2006年12月至2008年3月,取ICU病房收集诊断为重症肺炎患儿的深部气道或机械通气气管导管内吸取物标本119例,采用RT-PCR或PCR方法 检测呼吸道合胞病毒(RSV)、人偏肺病毒(hMPV)、博卡病毒(HBoV)、腺病毒(ADV)、副流感病毒(PIV)1、2、3和流感病毒(IV)A、B等呼吸道病毒病原.结果 119例标本中病毒总检出例数为86例(72.3%),其中RSV检出率最高,为41.2%(49/119).有2种及以上病毒协同感染23例,占26.7%(23/86);RSV阳性中有19例存在协同感染,占38.8%(19/49).69例行细菌检测,其中53例为阳性,阳性率为76.8%.这69例标本中,病毒阳性率为76.8%;病毒细菌双阳性为41例,占59.4%.结论 (1)病毒感染仍是重庆地区婴幼儿重症肺炎的重要病因.(2)BSV是婴幼儿重症肺炎最常见病毒病原,其次为ADV和hMPV.(3)病毒的协同感染较在重症呼吸道患儿中可能较为普遍,但尚无证据说明病毒协同感染可加重病情.