RESUMO
BACKGROUND: Acute respiratory infections (ARIs) are one of the main causes of morbidity and mortality in children. Viruses are the main etiological agents, and their behavior tends to be seasonal and vary by geographical location. Human metapneumovirus (HMPV) has recently been described as a cause of severe acute respiratory infection and its prevalence and clinical behavior in children at moderate altitudes is unknown. METHODS: A cross-sectional study was carried out on patients seen at a university hospital in Bogotá, Colombia between October 2015 and December 2017 in a city at a moderate altitude above sea level. Children with acute respiratory infections who had had a multiplex RT-PCR assay were selected. The prevalence of HMPV infection, its clinical outcomes and its relationship to rainfall were evaluated. RESULTS: Out of a total of 14,760 discharged patients, multiplex RT-PCR was performed on 502 and a virus was detected in 420 children with acute respiratory infection (ARI). The study group had a median age of 21 months (IQR 7-60), with similar proportion of males and females (56.4 and 43.6% respectively) and 5.2% (CI 95 3.3-7.8%) prevalence of HMPV infection. The group with HMPV infection showed a greater frequency of viral coinfection (22.7% vs 14% P = 0.03) compared with ARI caused by other viruses. The rate of bacterial coinfection (P = 0.31), presence of comorbidities (p = 0.75), length of hospital stay (P = 0.42), need for mechanical ventilation (P = 0.75) and mortality (P = 0.22) were similar for HMPV and other viral infections. A moderate correlation was established between HMPV infection and rainfall peaks (Spearman's Rho 0.44 p = 0.02). CONCLUSIONS: Human metapneumovirus was the fifth most frequently isolated virus in children with ARI, had similar clinical behavior and severity to other viruses but a higher rate of viral coinfection. Its peaks seem to correlate to rainy seasons.
Assuntos
Altitude , Colômbia , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae/epidemiologia , Chuva , Infecções Respiratórias/epidemiologia , Doença Aguda , Criança , Pré-Escolar , Coinfecção/microbiologia , Coinfecção/virologia , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/virologia , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Reação em Cadeia da Polimerase Multiplex/estatística & dados numéricos , Infecções por Paramyxoviridae/terapia , Prevalência , Respiração Artificial/estatística & dados numéricos , Infecções Respiratórias/terapia , Infecções Respiratórias/virologia , Distribuição por Sexo , Resultado do TratamentoRESUMO
BACKGROUND: Human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) are among the leading causes of respiratory tract infections requiring admission to the pediatric intensive care unit (PICU). We evaluated the risk factors, clinical courses and outcomes of severe HMPV disease relative to severe RSV in children admitted to the PICU. METHODS: Retrospective chart review of children ≤18 years old admitted to a tertiary PICU between October 2008 through July 2010 with acute respiratory tract infection and positive direct antigen stain or polymerase chain reaction for RSV or HMPV. RESULTS: One hundred thirty-three patients met inclusion criteria: 107 (80.5%) with RSV and 26 (19.5%) with HMPV. HMPV-infected patients were older than RSV children (3.4 vs. 1.5 years, P = 0.002) and more likely to have congenital heart disease (34.6% vs. 10.3%, P = 0.002). Although HMPV children required longer duration of mechanical ventilation (11 vs. 7 days, P = 0.01), there were no other differences in hospital course. HMPV patients were more likely to be discharged receiving inhaled steroids (53.8% vs. 30.8%, P = 0.03), but there were no differences in other outcome assessments. CONCLUSIONS: Children admitted to the PICU with HMPV are significantly older and more likely to have congenital heart disease than those with RSV. The course of illness was similar between the 2 groups, but HMPV-infected children were more likely to be discharged with inhaled steroid therapy.
Assuntos
Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae/terapia , Infecções por Vírus Respiratório Sincicial/terapia , Vírus Sinciciais Respiratórios/isolamento & purificação , Bronquiolite Viral/terapia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Infecções por Paramyxoviridae/virologia , Respiração Artificial , Infecções por Vírus Respiratório Sincicial/virologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB). STUDY DESIGN: We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (<12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization. RESULTS: One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47). CONCLUSIONS: Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.
Assuntos
Anti-Inflamatórios/uso terapêutico , Azitromicina/uso terapêutico , Bronquiolite Viral/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Infecções por Paramyxoviridae/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Doença Aguda , Administração Oral , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/terapia , Terapia Combinada , Método Duplo-Cego , Esquema de Medicação , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Influenza Humana/terapia , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Oxigenoterapia , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/terapia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/terapia , Resultado do TratamentoRESUMO
Human metapneumovirus (hMPV) is a newly recognized virus associated with upper and lower respiratory tract infection (LRTI). A prospective - 2 - years study aimed to evaluate the circulation rate and the clinical features associated with hMPV infection was conducted in children hospitalized by a severe LRTI. Results: hMPV was found in 24 (10.5 percent) out of the 229 children enrolled. 42 percent> hMPV patients were under 12 months-old and 58 percent have at least one risk factor for severe course of the illness. The most common diagnosis was pneumonia (62.5 percent). Fourty two percent of the patients required assisted ventilation for severe respiratory failure. Co-infections with other respiratory viruses did not result in greater severity of illness. In conclusion our study supports the significant role of hMPV as a major pathogen in severe LRTI in children.
El metapneumovirus humano (hMPV) es un virus de reciente diagnóstico. Se asocia con infecciones respiratorias agudas altas y bajas (IRAb). Se efectuó un estudio prospectivo durante dos años con el objetivo de evaluar la tasa de circulación y los hallazgos clínicos asociados a la infección por hMPV en niños hospitalizados por una IRAb grave. Resultados: hMPV fue demostrado en 24 (10,5 por ciento) de los 229 niños enrolados. 42 por ciento de los pacientes con hMPV eran menores de 12 meses de edad y el 58 por ciento tenía al menos un factor de riesgo para evolución grave de la enfermedad. El diagnóstico más frecuente fue neumonía (62,5 por ciento). Un 42 por ciento de los pacientes requirieron ventilación mecánica asistida por falla respiratoria severa. La co-infección con otros virus respiratorios no significó una enfermedad más grave. En conclusión nuestro estudio confirma la importancia del hMPV como un agente importante en la IRAb grave en niños.