苏州地区急性呼吸道感染住院患儿病毒病原学分析

目的：了解苏州地区急性呼吸道感染（ARI）住院患儿的病毒病原学情况。方法：采集1 668例7岁以下ARI住院患儿鼻咽分泌物,直接免疫荧光法检测呼吸道合胞病毒（RSV）,流感病毒A,B型（IV A,B）,副流感病毒1,2,3型（PIV 1,2,3）及腺病毒A(ADA)等7种常见呼吸道病毒,用RT-PCR法检测人类偏肺病毒（hMPV）N基因。结果：① 1 668例患儿中,病毒检测阳性597例（35.8%）。单项病毒感染561例（33.6%）,其中7种常见呼吸道病毒检出率为23.1%,以RSV为主（17.6%）,好发于冬春季,主要见于1岁以下婴幼儿;② hMPV阳性率为10.6%,3~5月份为检出高峰期。③ 36例混合感染中,22例为RSV合并hMPV感染,主要见于1岁以下婴幼儿。结论：RSV是该地区ARI的主要病毒病原,RSV感染好发于冬春季,多见于1岁以下婴幼儿,hMPV是3~5月份ARI患儿的主要病毒病原,混合感染多见于1岁以下婴幼儿。［中国当代儿科杂志,2009,11（7）：529-531］     

Clinical findings and unusual epidemiologic characteristics of human metapneumovirus infections in children in the region of Basel, Switzerland

Human metapneumovirus (hMPV) worldwide causes respiratory tract infections with features similar to those of RSV infection. We describe features of hMPV infections in children and compare some of the characteristics with those of RSV infections. From October 2004 to February 2006, 75 patients, 34 hospitalized and 41 outpatients, were diagnosed with hMPV infections by multiplex PCR applied to nasopharyngeal specimens. While hMPV was found rarely in the early phase of the study, a significant increase occurred in the second winter of the study period. Patients with hMPV infections were older than those with RSV infection; clinical characteristics were similar as was the rate of serious disease among hospitalized patients (intensive care treatment: 18% versus 8%). In conclusion, hMPV leads to endemic and epidemic respiratory disease with features similar to those of RSV and should be considered in the differential diagnosis of upper and lower respiratory tract disease.     

Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections

Human metapneumovirus (hMPV) is a recently discovered pathogen in respiratory tract infection. The published literature suggests milder illness severity in hMPV compared with respiratory syncytial virus (RSV) infection. In two consecutive seasons, 637 nasopharyngeal aspirates from pediatric patients were tested by hMPV polymerase chain reaction, and risk factors and clinical and laboratory items were analyzed. The hMPV patients were compared with hMPV-negative but RSV-positive patients by matched pair analysis. HMPV was detected in 17.9% of all samples. In total, 88 hMPV-infected patients with complete datasets were considered. More than half of all hMPV patients were older than 12 months, 45.5% had at least one risk factor for a severe course of viral respiratory tract infection, and 27.3% were born prematurely, 15.9% with a birth weight <1,500 g. At least one other virus was also detected in 39 patients (44.3%; RSV in 29.5%). Coinfection did not result in greater severity of illness. On matched pair analysis (hMPV-positive/RSV-negative vs. hMPV-negative/RSV-positive), the epidemiological and clinical features of hMPV infection were similar to those of RSV infection, as in the hMPV group higher proportions of patients with hypoxemia on admission (33% vs. 21%) and of intensive care treatment (20.8% vs. 10.4%) were observed. More hMPV patients showed lobar infiltrates in radiological chest examination. In 60% of all hMPV infections, the attending physicians prescribed antimicrobial chemotherapy. We conclude that in hospitalized children, hMPV infection is as serious as RSV infection and therefore deserves the same attention. Virologic diagnosis from respiratory secretions is mandatory because clinical, laboratory, and radiological signs cannot sufficiently discriminate between viral and bacterial respiratory tract infection in infants and children.The first two authors contributed equally to this work.     

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.     

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.     

Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three‐year prospective study

Aim: We have designed a study with the objective of describing the clinical impact of other viruses different from the respiratory syncytial virus (RSV) in hospitalized infants with bronchiolitis. Methods: A 3 year prospective study was conducted on infants admitted to the Paediatrics Department of the Severo Ochoa Hospital (Spain). We studied the frequency of 16 respiratory viruses. Clinical characteristics of RSV‐only infections were compared with other single agent viral infections. Results: Positive results were confirmed in 275 (86.5%) of the 318 children studied. A single virus was detected in 196 patients and 79 were dual or multiple viral infections. RSV was detected in 61.3% of total bronchiolitis. Rhinovirus (RV) was 17.4% of the identified virus, followed by human bocavirus (HBoV), adenovirus and metapneumovirus (hMPV). Only RV, HBoV and hMPV were significant as single infections. RSV patients were younger than HBoV (p > 0.0001) and hMPV (p = 0.025). Seasonality was clearly different between them. Children with RSV infection needed treatment in the intensive care unit more frequently than others. Conclusions: In hospitalized infants, RSV was the most frequent agent in bronchiolitis in winter, but other viruses were present in 47% of the patients. RV, HBoV and hMPV had a significant proportion of single infections. Clinical characteristics were similar amongst them, but seasonality was clearly different.     

Human metapneumovirus infections—biannual epidemics and clinical findings in children in the region of Basel,Switzerland

Human metapneumovirus (hMPV) epidemics vary in time and severity. We report findings for PCR for hMPV and respiratory syncytial virus (RSV) performed on nasopharyngeal aspirates (NPA) of hospitalized and outpatient children with respiratory tract infections between October 2004 and April 2008. A total of 3,934 NPAs were tested for hMPV and 3,859 for RSV. Of these, 198 (5%) were hMPV positive and 869 (23%) were RSV-positive. Median age was 17 months and 9 months for hMPV and RSV, respectively. Fifty-nine percent of hMPV and 58% of RSV patients were hospitalized. Proportions of hMPV positive samples for the four winter seasons were 0.4%, 11%, 0.2%, and 14%. For RSV, they were 28%, 15%, 28%, and 28%. HMPV epidemics follow a biannual variation in our area. Major epidemics were observed in winter seasons starting in odd years (2005/06 and 2007/08), minor epidemics in those starting in even years (2004/05 and 2006/07). RSV epidemics usually follow a reciprocal biannual pattern, leading to annually alternating major RSV and hMPV epidemics.     

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.     

粤东地区住院小儿急性下呼吸道感染病毒病原学研究

目的：了解2007年粤东地区住院小儿下呼吸道感染患儿的病毒病原现状并比较各个年龄组、不同季节、不同病种的病毒检出情况。方法：选择因急性下呼吸道感染住院治疗的小儿345例,取其鼻咽抽吸物采用多重PCR方法以筛查呼吸道合胞病毒,腺病毒,流感病毒A型、B型,副流感病毒1型、3型,鼻病毒,博卡病毒及人类偏肺病毒。结果：①病毒总检出率为51.6%(178/345),其中呼吸道合胞病毒占首位,病毒检出率为19.3%（66/345）,而人类偏肺病毒为3.2%(11/345),博卡病毒为3.2%(11/345)。②1～3月份(阳性率为61.9%)、毛细支气管炎患儿(阳性率为72.6%)、1～6个月婴幼儿(阳性率为71.3%)病毒检出率较高,4～6月份(阳性率为40.2%)、3岁以上儿童(阳性率为19.0%)病毒检出率较低,呼吸道感染病毒病原的总阳性率与性别无关。结论：粤东地区小儿下呼吸道感染的主要病毒病原为呼吸道合胞病毒等常见病毒,此外博卡病毒及人类偏肺病毒等也是重要的病原体;年龄越小,阳性率越高,不同季节的呼吸道病毒检出率不同,毛细支气管炎患儿的病毒总检出率最高。［中国当代儿科杂志,2009,11（3）：203-206］     

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     

南京地区急性呼吸道感染儿童支原体、衣原体和常见呼吸道病毒病原学分析

目的：了解南京地区急性呼吸道感染（acute respiratory infection, ARI）儿童除细菌外的其他病原微生物感染情况,指导临床诊断和治疗。方法应用荧光定量PCR法检测肺炎支原体（MP）和沙眼衣原体（CT）,直接免疫荧光法检测呼吸道合胞病毒（RSV）、腺病毒（ADV）、甲型和乙型流感病毒（IVA和IVB）、副流感病毒1、2、3型（PIV-1、2、3）、人偏肺病毒（hMPV）。结果1 592例标本中,MP和CT阳性率分别为25.7%、2.4%;总呼吸道病毒阳性率为40.9%,其中RSV最常见,占阳性病毒株的61.3%,其次为PIV-3、hMPV,分别为6.7%、4.9%。病原体的混合感染率为6.7%,混合感染主要发生在1岁以内婴儿,有68例,占混合感染的63.6%。结论病毒感染是南京地区婴幼儿ARI的主要原因,RSV是首要病毒病原,MP也是常见的ARI病原体,1岁以内婴儿混合感染率高。［中国当代儿科杂志,2010,12（6）：450-454］     

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.     

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。