流感嗜血杆菌b型与急性呼吸道感染关系的研究

目的进一步了解急性呼吸道感染中流感嗜血杆菌（ＨＩ）感染的发病情况。方法采用单克隆抗体夹心酶联免疫吸咐法，对３６例上呼吸道感染、３２例支气管炎、７０例肺炎患儿及４５例健康对照组的血、尿进行ｂ型ＨＩ外膜蛋白（ＨｉｂＯＭＰ）抗原的检测，并对７０例肺炎患儿的血清进行ＨｉｂＯＭＰ抗体检测。结果３６例上呼吸道感染患儿中有４例为ＨｉｂＯＭＰ抗体阳性，３２例支气管肺炎患儿中有４例阳性，７０例肺炎患儿中有１８例为阳性；４５例健康对照组中仅１例为ＨｉｂＯＭＰ抗原阳性。肺炎组抗原检出率高于对照组（χ２＝１０．９６０，Ｐ＜０．０１）。７０例肺炎中１８例ＨｉｂＯＭＰ抗体阳性。抗原、抗体检测共有２４例（包括抗原、抗体均阳性１２例，仅抗原或抗体阳性各６例）肺炎获得阳性结果。结论１１．１％的上呼吸道感染、１２．５％支气管炎和３４．３％的肺炎患儿为Ｈｉｂ感染；抗原、抗体联合检测可使Ｈｉｂ检出率提高。     

Chlamydial etiology of acute lower respiratory tract infections in children in the Sudan

The role of Chlamydia pneumoniae in 110 Sudanese children with signs of acute lower respiratory tract infections (ALRI) was investigated. Four (3.6%) had evidence of C. pneumoniae infection, of whom 3 were culture-positive, while 1 had an antibody response suggesting a recent infection. IgG antibodies at a titer of ≥1:32 to C. pneumoniae, Chlamydia psittaci and Chlamydia trachomatis were detected in 27 (24.5%), 27 (24.5%) and 7 (6.4%) of the 110 ALRI cases, respectively. C. pneumoniae, C. trachomatis or C. psittaci were not detected in nasopharyngeal secretions from any of 110 patients when fluorescence-labeled specific monoclonal antibodies were used. In a seroepidemiological survey, 318 healthy Sudanese persons aged between 1 month and 67 years were studied for C. pneumoniae antibodies.     

Respiratory Infections and Vascular Rings

ABSTRACT. Recurrent respiratory infections after the first years of life are not easily related to vascular rings as the cause of these infections. Therefore six cases of older children are presented in whom a vascular ring was the cause of their respiratory problems. None of them ever had stridor or swallowing problems in early infancy, and recurrent respiratory infections occurred later in life as a symptom of a vascular ring. Unfamil iarity with this association caused a delay in diagnosis and treatment in two patients and persistent lung damage in one child. Five of the 6 children recovered well after operation. The diagnosis can be made at an early stage if close inspection of the outline of the trachea on the chest radiograph shows an impression from the right side.     

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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.     

儿童急性下呼吸道合胞病毒单一感染与混合感染对照研究

目的 了解呼吸道病毒混合感染所致急性下呼吸道感染（ALRTI）患儿的临床特征。方法 2007年10月至2011年9月,在首都医科大学附属北京儿童医院住院治疗的临床诊断为ALRTI的患儿1722例,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、腺病毒、肠道病毒、冠状病毒、偏肺病毒及博卡病毒。将单一RSV感染与RSV混合多种病毒感染患儿临床资料进行比较。结果 1722例患儿标本中,370例检出RSV病毒,总检出率21.5%。单一RSV感染206例,RSV与一种病毒混合感染124例,RSV与2种以上病毒混合感染40例。RSV与一种病毒混合感染的124例标本中,RSV/RV感染68例（54.8%）,其次为RSV/PIV感染24例（19.3%）。双重病毒混合感染组与RSV单一病毒感染组比较,双重病毒混合感染组患儿住院时间更长（P＜0.001）。多重病毒感染组与RSV单一病毒感染组相比,患儿发热比例更高（P＝0.017）、发热持续时间更长（P＝0.015）、住院天数延长（P＜0.001）、并且在住院期间接受了更多的静脉激素治疗（P＝0.005）。而在喘息症状、出现合并症（心力衰竭、呼吸衰竭、肝功损害、心肌损害、腹泻）方面差异无统计学意义。在氧疗、呼吸支持治疗及使用支气管扩张剂方面差异亦无统计学意义。结论 与单一RSV感染组相比,RSV合并多重病毒感染患儿发热比例更高、发热持续时间及住院天数更长,且住院期间接受了更多的静脉激素治疗。提示多病毒混合感染可能影响患儿临床进程, RSV感染时应重视混合感染。     

A Prospective Study of Respiratory Infections in 12-Year-Old Children Actively Engaged in Sports

ABSTRACT. Data on the incidence of respiratory tract infections, antimicrobial treatment, days with fever and absence from school on account of these infections were studied in children participating in extracurricular sports activities with regular supervised training and competitive events. Swimmers, ice-hockey players and apparatus gymnasts were compared to a control group of children. Their mean age was 12.7 years at the end of the one year study. The children were examined three times during the year. More information was collected by a nurse who contacted the mothers of the children every two months. The girls had contracted more respiratory tract infections than the boys during the study. This difference was only seen regarding common colds, not regarding major bacterial respiratory infections, i.e. otitis media, tonsillitis, sinusitis and pneumonia. Because of this difference the results were analysed separately for the sexes. No differences between the sports and the control groups were seen in any respect regarding respiratory infections. Contrary to general opinion, sports participation does not seem to have a preventive effect on the occurrence of respiratory infections in children.     

Lower respiratory tract infections and gastrointestinal infections among mature babies in Japan

Background: Epidemiologic evidence regarding the background factors of childhood infections in Japan is scarce. The aim of the present study was therefore to investigate the rates and associated factors of hospitalization for lower respiratory tract infections (LRTI) and gastrointestinal infections (GII) among children with birthweight ≥2500 g and ≥37 weeks of gestational age. Method: The data for the study were collected at 18‐month health checkups in one city in Japan. The community database included information on the main outcome (past hospitalization) and 16 host, environmental, and parenting factors. The Kaplan–Meier method and log–rank test were used to determine sex differences in hospital admission for infection, and the Cox regression model to analyze sex‐specific factors associated with the hospitalization. Results: The proportion of children who were admitted to hospital before their 18‐month checkup was 7.1% for LRTI and 2.2% for GII. Hospital admission for LRTI among boys was higher than girls. Multivariate analysis indicated the following LRTI‐associated factors: child‐care attendance (hazard ratio [HR]= 1.97) and three or more adults living together (HR = 2.63) for boys; and child‐care attendance (HR = 4.30) and two or more children living together (HR = 4.57) for girls. GII‐associated factors were maternal age <25 years (HR = 3.45) for boys, and hand washing by caregivers after lavatory use and diaper changing (HR = 6.93) for girls. Conclusions: One out of 11 children was hospitalized because of LRTI or GII during their first 18 months, which was associated with a biologic factor (sex), environmental factors (child‐care attendance and family size), and parenting practices (shorter duration of exclusive breast‐feeding and caregivers' unfavorable hygiene practices).     

Eleven consecutive years of respiratory syncytial virus outbreaks in Croatia

Background:  Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infections (LRTI) in infants. The aim of the present study was to analyze the epidemiologic characteristics of RSV outbreaks in Croatian children.
Methods:  Over a period of 11 consecutive years (1994–2005), 3435 inpatients with acute respiratory infections (ARI) aged from birth to 10 years and were residing in Zagreb County were tested for infection with RSV and other respiratory viruses at the Virology Department, Croatian National Institute of Public Health. RSV was identified in nasopharyngeal secretions by isolation on cell culture and/or detection with monoclonal antibodies using a direct fluorescence assay.
Results:  RSV was the most common causative agent of ARI (42.2%; 658/1559) for the infants 0–6 months of age. It was also the etiologic agent of LRTI in 49% (495/1010) of infants of similar age. RSV was demonstrated in 56.5% (382/676) of infants with bronchiolitis, and in 36.5% (49/134) of those with pneumonia in this age group.
Conclusion:  The overall prevalence of RSV infection in Croatian children with acute respiratory illness, and its occurrence in various age groups, has remained stable over the past decade. RSV was found to be the most common cause of bronchiolitis occurring throughout childhood (52.7%; 482/913).     

Serodiagnosis of acute respiratory infections in children in Georgia

Objective To investigate the etiology of acute respiratory infections in hospitalized children. Methods A total of 808 children were studied. Investigation ofRSV, Adenovirus, Parainfluenza, Influenza A and B, C.trachomatis, C.pneumoniae, M. pneumonia andLegionella were performed with an ELISA for IgM, IgG and IgA antibodies detection. Results There were 496 males and 312 females giving a male: female ratio of 1.6∶1. Ages range from 1 month to 15 years. The overall detection rate was 57.9%. The most frequently detected were:parainfluenza 12.6%,adenovirus 11.2%,influenza A 7.3%,RSV 6%,M. pneumoniae 5.4%,C.trachomatis 3.5% and mixed-infections 9.2%. Pneumonia was associated most frequently withadenovirus and mixed-infections; wheezing bronchitis—withadenovirus, RSV andM. pneumoniae; bronchitis —withparainfluenza andadenovirus, diseases of upper respiratory tract—withparainfluenza andadenovirus. Peak of the virus activity was during winter (influenza, parainfluenza, adenovirus, RSV) and autumn (parainfluenza, RSV). Conclusion Viruses are the main causes of ARI in Georgian children. A better understanding of the etiology of ARI in all of the regions of the world may be helpful for timely decision of specific therapy, which can help pediatricians to estimate and manage children with ARI.     

Breastfeeding and infant hospitalisation: analysis of the UK 2010 Infant Feeding Survey

To investigate the contributions of overall breastfeeding duration and exclusive breastfeeding in reducing the risk of hospitalisation for infectious causes, we analysed data from a three‐stage survey on infant feeding practices and health outcomes in over 10 000 UK women in 2010–2011. The main outcome measures were risk of overnight hospital admission in the first 8–10 months of infancy. A graded beneficial effect was found between longer duration of any breastfeeding and hospital admission for infectious causes and for respiratory tract infections, with a significantly lower risk in infants breastfed for at least 3 months compared with those never breastfed. The effects were stronger in the subgroup who was also exclusively breastfed. For example, among infants breastfed for 3–6 months, the reduction in risk for infectious causes for those who were also exclusively breastfed for at least 6 weeks was 0.42 (95% CI: 0.22–0.81) and for those not exclusively breastfed for 6 weeks 0.79 (95% CI: 0.49–1.26). Likewise, among infants breastfed for 6 months or more, the odds ratio for those who were also exclusively breastfed for at least 6 weeks was 0.48 (95% CI: 0.32–0.72) and for those not exclusively breastfed for 6 weeks 0.72 (95% CI: 0.48–1.08). The apparent protective effect of any breastfeeding for a long duration may in part be driven by a prolonged period of exclusive breastfeeding. Exclusive breastfeeding in the initial weeks after childbirth and continuing to breastfeed (either exclusively or partially) for at least 3 months, preferably 6 months, may reduce morbidity due to infectious illness in infants.     

Recurrent respiratory infections and phagocytosis in childhood

BACKGROUND: About 10% of pre-school children has recurrent respiratory infections (RRI), which could be related to environmental and/or immunological factors. The aim of the present study has been to evaluate the impact of phagocytosis (FAG) and reactive oxygen intermediates (ROI) production deficiencies on pediatric RRI by the measurement of FAG and ROI activity of the polymorphonuclear neutrophils. METHODS: Serum immunoglobulins, IgG subclasses, lymphocytic subpopulations, FAG and ROI tests were measured in 90 children with RRI, in a moment of well-being and off all medications for at least 4 weeks. FAG and ROI tests were also measured in 19 healthy children. RESULTS: FAG (91.4 +/- 11.5%) and ROI (81.8 +/- 17.5%) of patients resulted in significantly decreased measurements compared to the control values (95.2 +/- 1.8% and 89.7 +/- 4.8%, respectively). No significant difference was manifest between the mean values of FAG and ROI tests among the patients when they were divided for age (above and below 6 years). A significant decreased likelihood of abnormal ROI (odds ratio, 0.3; 95% confidence interval, 0.07-0.97) was found in the patients with low IgA. CONCLUSIONS: The authors' results permit only to suppose an etiological role of FAG and ROI deficiencies of polymorphonuclear neutrophils in the genesis of pediatric RRI, irrespective of the age of the patients, and further studies are necessary for confirmation.     

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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%)。     

Adenovirus type 7h respiratory infections: a report of 29 cases of acute lower respiratory disease

Twenty-nine cases of pediatric acute lower respiratory disease associated with adenovirus genome type 7h were evaluated retrospectively. They constituted 2.4% of 1233 cases of acute respiratory infections treated in five hospitals in Buenos Aires, between September 1984 and September 1988. Pneumonia and bronchiolitis were the principal diagnoses. The mean age of patients was 8.8 months and 82.7% of the children were less than one year of age. None of the patients had previously been exposed to measles or was immunocompromised. A mixed infection, viral or bacterial, was demonstrated in 8 of the 29 patients. Sixteen children developed a severe pulmonary disease which required intensive care. Ten with a clinical diagnosis of multifocal pneumonia and necrotizing bronchiolitis died. Extrapulmonary manifestations were observed in the most severe cases. Observations suggest a possible high pathogenicity of adenovirus type 7h and emphasize the need for adequate control and case management programs.     

Recognition and management of ARI—A KAP study on private medical practitioners

We interviewed 113 private medical practitioners (PMPs) of all system of medicine in Ambedkar Nagar area of South Delhi to determine as to how they recognise and treat Acute Respiratory tract Infections (ARI) in children, in particular, pneumonia. Allopathic PMPs reported viruses and bacteria as causes of ARI as compared to PMPs of other system of medicine who often reported exposure to cold, change in weather and dietary habits as a cause of ARI. Sixty-eight PMPs out of 113 did not count the respiratory rate (RR) in children with ARI and among those who counted, only 19.5% PMPs could correctly tell the normal RR in children aged less than two months. In children aged 2–12 months, the percentage of PMPs responding correctly was 15.0%. Relatively greater proportion of PMPs (31.8%) could correctly tell the normal respiratory rate in children aged 1–5 years. X-ray to diagnose pneumonia was suggested by 102 (90.3%) PMPs. Majority of PMPs prescribed some form of medication including antibiotics for the treatment of cough and cold. Eighty-seven (77%) PMPs prescribed antibiotics, 53 (46.9%) antihistaminics and 49 (43.4%) prescribed allopathic cough syrups to treat cough and cold. For pneumonia, 108 (96.4%) PMPs prescribed antibiotics and 31 (27.7%) PMPs prescribed steroids among other things.     

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??Objective??In order to understand the epidemiological and virologic characteristics of WU Polyomaviruses ??WUPyV?? and KI Polyomaviruses ??KIPyV?? infection in hospitalized children with acute respiratory tract infection ??ARTI?? in Changsha. Methods??A total of773 nasopharyngeal aspirates ??NPA?? specimens were collected from hospitalized children with ARTI between September 2007 and March 2008 inChangsha. Specimens were screened for WUPyV and KIPyV by nested polymerase chain reaction. All positive amplification products were confirmedby sequencing and compared with those in GenBank. Results??Polyomaviruses were detected in 53 patients ??6.8%?? out of the 773 children ??WUPyV was 5.0%??KIPyV was 1.8%??. The patients were from 20 days to 5 years. Similarity of WUPyV and KIPyV with those published in the GenBank at nucleotide levels was 93%??100% and 95%??100%?? respectively. Conclusion??WUPyV and KIPyV may be important pathogens in children with acute lower respiratory tract infection and associated with lower respiratory diseases.     

Hospitalization of infants for infections in Western Australia, 1980–91

Rates of hospitalization of Aboriginal infants in Western Australia from 1980 through 1991 for infections were much higher than for other infants and were consistently higher in rural areas than in metropolitan areas. There were substantial declines in rates of hospital admissions and bed occupancy of rural Aboriginal infants for respiratory and gastrointestinal infections during the study period; changes in rates for other infections were less marked and less consistent. Despite recent improvements, Aboriginal infants are hospitalized much more frequently and for longer than other infants because of these diseases. Hospitalization rates reflect many factors including disease incidence and severity but also are affected by isolation, climatic and physical conditions, and access to medical and nursing care. Preventive health programmes need to be maintained and intensified in order to improve health standards of young Aborigines and to lessen their need for hospital care.     

TRANSFER FACTOR IN CHRONIC AND RECURRENT RESPIRATORY TRACT INFECTIONS IN CHILDREN

Abstract Gröhn, P. (The Institute of Biomedical Sciences, School of Medicine, University of Tampere, and the Children's Department, Tampere Central Hospital, Tampere, Finland). Transfer factor in chronic and recurrent respiratory tract infections in children. Acta Paediatr Scand, 66:211, 1977.—Five cases with abnormal sensitivity to respiratory tract infections are described. The cases showed a marked impairment in their cell mediated immunity state. Administration of a chromatographically purified transfer factor component increased the skin test sensitivity to common recall antigens. Interestingly, a similar effect in skin reactivity was observed with repeated skin tests alone, when antigen concentrations, initially high enough to cause a positive reaction, were used. Neither the administration of transfer factor nor skin testing with high antigen concentrations had an effect on blast transformation percentages. The therapy with chromatographically purified transfer factor appeared promising on the clinical condition of the patients.     

呼吸道感染常见细菌病原的变迁及对策

呼吸道感染依然是小儿最常见的感染性疾病,其中肺炎仍是威胁儿童健康的第一杀手.呼吸道感染细菌病原及其耐药的变迁是动态的,肺炎链球菌是呼吸道感染的首位病原菌,其对青霉素、大环内酯类等抗生素的耐药性急剧上升.流感嗜血杆菌是又一重要病原菌,感染人群主要是婴幼儿和有基础肺部疾病者.卡他莫拉菌高产β-内酰胺酶,给抗生素的选择带来困难.金黄色葡萄球菌是社区和院内呼吸道感染的重要致病菌,大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌等革兰阴性杆菌是院内呼吸道感染的重要病原菌,这些病原菌耐药机制的多重性和复杂性值得临床关注.