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Winters Are Always Harsh: Factors Affecting Prognosis in Children Diagnosed with Lower Respiratory Tract Infection

Year 2025, Volume: 15 Issue: 1, 51 - 58, 03.01.2025

Abstract

Aim: A significant proportion of patients with acute lower respiratory tract infections (ALRTIs) require hospitalization. This study aims to determine the prognostic factors affecting morbidity and mortality by comparing respiratory infection panels, demographic characteristics, and laboratory findings of patients diagnosed with ALRTI who required hospitalization and those treated on an outpatient basis.
Material and Methods: Ninety-three patients diagnosed with ALRTI based on history, physical examination, chest radiography, and laboratory tests, who presented to our pediatric health and diseases clinics, were included. The patients' chest radiographs, demographic data, and laboratory and clinical findings were compared.
Results: Of the cases included in our study, 56 (60.22%) were treated through hospitalization. The respiratory infection panel identified RSV in 44 (47.31%) cases and Influenza A in 20 (21.5%) cases. It was found that the infectious agents had no significant effect on the length of hospital stay. In our study, patients infected with Influenza had a longer disease duration compared to other cases, but their fever degree, WBC, and neutrophil count were lower. When comparing cases infected with bacterial, viral, and co-infection agents, it was found that the co-infected cases had significantly higher fever degrees and plasma C-reactive protein (CRP) levels. Viral and co-infected cases had significantly lower sPO2 levels.
Conclusion: It was observed that plasma vitamin levels and infectious agents did not affect the need for hospitalization. Co-infected cases had significantly higher fever degrees and plasma CRP levels, while viral and co-infected cases had significantly lower sPO2 levels.

References

  • Alves MS, da Silva Cariolano M, Dos Santos Ferreira HL, Sousa de Abreu Silva E, Felipe KKP, Monteiro SG, et al. High frequency of Chlamydia pneumoniae and risk factors in children with acute respiratory infection. Braz J Microbiol. 2020; 51(2): 629-36.
  • Lanata CF, Rudan I, Boschi-Pinto C, Tomaskovic L, Cherian T, Weber M, et al. Methodological and quality issues in epidemiological studies of acute lower respiratory infections in children in developing countries. Int J Epidemiol. 2004; 33(6): 1362-72.
  • Xavier-Souza G, Vilas-Boas AL, Fontoura MS, Araújo-Neto CA, Andrade SC, Cardoso MR, et al; PNEUMOPAC-Efficacy Study Group. The inter-observer variation of chest radiograph reading in acute lower respiratory tract infection among children. Pediatr Pulmonol. 2013; 48(5): 464-9.
  • Rabha AC, Fernandes FR, Solé D, Bacharier LB, Wandalsen GF. Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID-19. Pediatr Allergy Immunol. 2021; 32(7): 1577-80.
  • Seidu AA, Dickson KS, Ahinkorah BO, Amu H, Darteh EKM, Kumi-Kyereme A. Prevalence and determinants of Acute Lower Respiratory Infections among children under-five years in sub-Saharan Africa: Evidence from demographic and health surveys. SSM Popul Health. 2019; 8: 100443.
  • GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017; 17(11): 1133-61.
  • Nascimento-Carvalho CM. Community-acquired pneumonia among children: the latest evidence for an updated management. J Pediatr (Rio J). 2020; Suppl 1(Suppl 1): 29-38.
  • Vos LM, Bruyndonckx R, Zuithoff NPA, Little P, Oosterheert JJ, Broekhuizen BDL, et al. Lower respiratory tract infection in the community: associations between viral aetiology and illness course. Clin Microbiol Infect. 2021; 27(1): 96-104.
  • Ahmed S, Sultana S, Khan AM, Islam MS, Habib GM, McLane IM, et al. Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review. J Glob Health. 2022; 12: 04033.
  • Miller WT Jr, Mickus TJ, Barbosa E Jr, Mullin C, Van Deerlin VM, Shiley KT. CT of viral lower respiratory tract infections in adults: comparison among viral organisms and between viral and bacterial infections. AJR Am J Roentgenol. 2011; 197(5): 1088-95.
  • Ding Q, Xu L, Zhu Y, Xu B, Chen X, Duan Y, et al. Comparison of clinical features of acute lower respiratory tract infections in infants with RSV/HRV infection, and incidences of subsequent wheezing or asthma in childhood. BMC Infect Dis. 2020; 20(1): 387.
  • Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens). 2019;18(4): 353-63.
  • Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 2004; 58(4): 563-7.
  • Ahmed P, Babaniyi IB, Yusuf KK, Dodd C, Langdon G, Steinhoff M, Dawodu A. Vitamin D status and hospitalisation for childhood acute lower respiratory tract infections in Nigeria. Paediatr Int Child Health. 2015; 35(2): 151-6.
  • Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (update)-executive summary. Otolaryngol Head Neck Surg. 2019; 160(2): 187-205.
  • Flores AR, Caserta MT. Pharyngitis. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 2015: 753-9.
  • Haak BW, Brands X, Davids M, Peters-Sengers H, Kullberg RFJ, van Houdt R, et al. Bacterial and viral respiratory tract microbiota and host characteristics in adults with lower respiratory tract ınfections: a case-control study. Clin Infect Dis. 2022; 74(5): 776-84.
  • Grant CC, Emery D, Milne T, Coster G, Forrest CB, Wall CR, Scragg R, Aickin R, Crengle S, Leversha A, Tukuitonga C, Robinson EM. Risk factors for community-acquired pneumonia in pre-school-aged children. J Paediatr Child Health. 2012; 48(5): 402-12.
  • Simoes EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr. 2003; 143(5 Suppl): S118-26.
  • Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, Johnston SL. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002; 359(9309): 831-4.
  • Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021; 126(5): 569-75.
  • Eşki A, Öztürk GK, Gülen F, Çiçek C, Demir E. Risk factors for ınfluenza virus related severe lower respiratory tract ınfection in children. Pediatr Infect Dis J. 2019; 38(11): 1090-5.
  • Vlacha V, Feketea G. Thrombocytosis in pediatric patients is associated with severe lower respiratory tract inflammation. Arch Med Res. 2006; 37(6): 755-9.
  • Kainth MK, Goenka PK, Williamson KA, Fishbein JS, Subramony A, Barone S, et al; Northwell Health COVID-19 Research Consortium. Early experience of COVID-19 in a US children's hospital. Pediatrics. 2020; 146(4): e2020003186.
  • Asner SA, Science ME, Tran D, Smieja M, Merglen A, Mertz D. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis. PLoS One. 2014; 9(6): e99392.
  • Brealey JC, Sly PD, Young PR, Chappell KJ. Viral bacterial co-infection of the respiratory tract during early childhood. FEMS Microbiol Lett. 2015; 362(10): fnv062.
  • Regina Malveste Ito C, Santos MO, de Oliveira Cunha M, de Araújo KM, de Souza GRL, Rézio GS, et al. Rhinovirus infection and co-infection in children with severe acute respiratory infection during the COVID-19 pandemic period. Virulence. 2024; 15(1): 2310873.
  • Losol P, Park HS, Song WJ, Hwang YK, Kim SH, Holloway JW, Chang YS. Association of upper airway bacterial microbiota and asthma: systematic review. Asia Pac Allergy. 2022; 12(3): e32.
  • Berce V, Unuk S, Duh D, Homsak M, Vicic M. Clinical and laboratory characteristics of viral lower respiratory tract infections in preschool children. Wien Klin Wochenschr. 2015; 127 Suppl 5(Suppl 5): S255-62.

Kışlar Hep Çetin Geçer: Çocuklarda Alt Solunum Yolu Enfeksiyonu Etkenleri ve Prognozu Etkileyen Faktörler

Year 2025, Volume: 15 Issue: 1, 51 - 58, 03.01.2025

Abstract

Amaç: Akut alt solunum yolu enfeksiyonlarının (ASYE) önemli bir kısmının hastaneye yatış ihtiyacı olmaktadır. Bu çalışmada yatış ihtiyacı olan ve ayaktan tedavi edilen ASYE tanılı hastaların solunum yolu enfeksiyon panellerini, demografik özelliklerini, laboratuvar bulgularını karşılaştırarak morbidite ve mortaliteyi etkileyen prognostik faktörleri belirlemeyi amaçladık.
Gereç ve Yöntemler: Çocuk sağlığı ve hastalıkları kliniğimize başvuran, öykü, fizik muayene, akciğer radyogramı ve tetkikler sonucu ASYE tanısı konan 93 hasta çalışmaya dahil edildi. Hastaların akciğer radyografileri, demografik verileri, laboratuvar ve klinik bulguları karşılaştırıldı.
Bulgular: Çalışmamıza katılan olguların 56’sı (%60,22)’sı hastaneye yatırılarak tedavi edildi. Solunum yolu enfeksiyon panelinde 44 (%47,31) olguda RSV, 20 (%21,5) olguda ise İnfluenza A PCR pozitifti. Enfeksiyon etkenlerinin yatış süresi üzerine anlamlı etkisi olmadığı saptandı. Çalışmamızda İnfluenza A ile enfekte olguların diğer olgulara göre semptomların daha uzun sürdüğü ancak, ateş derecesi, WBC ve nötrofil sayısının daha düşük olduğu saptandı. Bakteriyel, viral ve ko-enfeksiyon etkenlerle enfekte olgular karşılaştırıldığında ise ko-enfekte olguların ateş derecesi ve plazma C-reaktif protein düzeylerinin anlamlı düzeyde yüksek olduğu saptandı. Viral ve ko-enfekte olguların sPO2 düzeylerinin anlamlı düzeyde düşük olduğu saptandı.
Sonuç: Hem plazma vitamin düzeylerinin, hem de enfeksiyon etkenlerinin hastaneye yatış ihtiyacını etkilemediği saptanmıştır. Ayrıca Ko-enfekte olguların ateş derecesi ve plazma CRP düzeyleri anlamlı düzeyde yüksek, viral ve ko-enfekte olguların sPO2 düzeylerinin anlamlı düzeyde düşük olduğu saptanmıştır.

Ethical Statement

Düzce Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylandı (Karar no:2024/132).

References

  • Alves MS, da Silva Cariolano M, Dos Santos Ferreira HL, Sousa de Abreu Silva E, Felipe KKP, Monteiro SG, et al. High frequency of Chlamydia pneumoniae and risk factors in children with acute respiratory infection. Braz J Microbiol. 2020; 51(2): 629-36.
  • Lanata CF, Rudan I, Boschi-Pinto C, Tomaskovic L, Cherian T, Weber M, et al. Methodological and quality issues in epidemiological studies of acute lower respiratory infections in children in developing countries. Int J Epidemiol. 2004; 33(6): 1362-72.
  • Xavier-Souza G, Vilas-Boas AL, Fontoura MS, Araújo-Neto CA, Andrade SC, Cardoso MR, et al; PNEUMOPAC-Efficacy Study Group. The inter-observer variation of chest radiograph reading in acute lower respiratory tract infection among children. Pediatr Pulmonol. 2013; 48(5): 464-9.
  • Rabha AC, Fernandes FR, Solé D, Bacharier LB, Wandalsen GF. Asthma is associated with lower respiratory tract involvement and worse clinical score in children with COVID-19. Pediatr Allergy Immunol. 2021; 32(7): 1577-80.
  • Seidu AA, Dickson KS, Ahinkorah BO, Amu H, Darteh EKM, Kumi-Kyereme A. Prevalence and determinants of Acute Lower Respiratory Infections among children under-five years in sub-Saharan Africa: Evidence from demographic and health surveys. SSM Popul Health. 2019; 8: 100443.
  • GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017; 17(11): 1133-61.
  • Nascimento-Carvalho CM. Community-acquired pneumonia among children: the latest evidence for an updated management. J Pediatr (Rio J). 2020; Suppl 1(Suppl 1): 29-38.
  • Vos LM, Bruyndonckx R, Zuithoff NPA, Little P, Oosterheert JJ, Broekhuizen BDL, et al. Lower respiratory tract infection in the community: associations between viral aetiology and illness course. Clin Microbiol Infect. 2021; 27(1): 96-104.
  • Ahmed S, Sultana S, Khan AM, Islam MS, Habib GM, McLane IM, et al. Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review. J Glob Health. 2022; 12: 04033.
  • Miller WT Jr, Mickus TJ, Barbosa E Jr, Mullin C, Van Deerlin VM, Shiley KT. CT of viral lower respiratory tract infections in adults: comparison among viral organisms and between viral and bacterial infections. AJR Am J Roentgenol. 2011; 197(5): 1088-95.
  • Ding Q, Xu L, Zhu Y, Xu B, Chen X, Duan Y, et al. Comparison of clinical features of acute lower respiratory tract infections in infants with RSV/HRV infection, and incidences of subsequent wheezing or asthma in childhood. BMC Infect Dis. 2020; 20(1): 387.
  • Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens). 2019;18(4): 353-63.
  • Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 2004; 58(4): 563-7.
  • Ahmed P, Babaniyi IB, Yusuf KK, Dodd C, Langdon G, Steinhoff M, Dawodu A. Vitamin D status and hospitalisation for childhood acute lower respiratory tract infections in Nigeria. Paediatr Int Child Health. 2015; 35(2): 151-6.
  • Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (update)-executive summary. Otolaryngol Head Neck Surg. 2019; 160(2): 187-205.
  • Flores AR, Caserta MT. Pharyngitis. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 2015: 753-9.
  • Haak BW, Brands X, Davids M, Peters-Sengers H, Kullberg RFJ, van Houdt R, et al. Bacterial and viral respiratory tract microbiota and host characteristics in adults with lower respiratory tract ınfections: a case-control study. Clin Infect Dis. 2022; 74(5): 776-84.
  • Grant CC, Emery D, Milne T, Coster G, Forrest CB, Wall CR, Scragg R, Aickin R, Crengle S, Leversha A, Tukuitonga C, Robinson EM. Risk factors for community-acquired pneumonia in pre-school-aged children. J Paediatr Child Health. 2012; 48(5): 402-12.
  • Simoes EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr. 2003; 143(5 Suppl): S118-26.
  • Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, Johnston SL. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002; 359(9309): 831-4.
  • Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021; 126(5): 569-75.
  • Eşki A, Öztürk GK, Gülen F, Çiçek C, Demir E. Risk factors for ınfluenza virus related severe lower respiratory tract ınfection in children. Pediatr Infect Dis J. 2019; 38(11): 1090-5.
  • Vlacha V, Feketea G. Thrombocytosis in pediatric patients is associated with severe lower respiratory tract inflammation. Arch Med Res. 2006; 37(6): 755-9.
  • Kainth MK, Goenka PK, Williamson KA, Fishbein JS, Subramony A, Barone S, et al; Northwell Health COVID-19 Research Consortium. Early experience of COVID-19 in a US children's hospital. Pediatrics. 2020; 146(4): e2020003186.
  • Asner SA, Science ME, Tran D, Smieja M, Merglen A, Mertz D. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis. PLoS One. 2014; 9(6): e99392.
  • Brealey JC, Sly PD, Young PR, Chappell KJ. Viral bacterial co-infection of the respiratory tract during early childhood. FEMS Microbiol Lett. 2015; 362(10): fnv062.
  • Regina Malveste Ito C, Santos MO, de Oliveira Cunha M, de Araújo KM, de Souza GRL, Rézio GS, et al. Rhinovirus infection and co-infection in children with severe acute respiratory infection during the COVID-19 pandemic period. Virulence. 2024; 15(1): 2310873.
  • Losol P, Park HS, Song WJ, Hwang YK, Kim SH, Holloway JW, Chang YS. Association of upper airway bacterial microbiota and asthma: systematic review. Asia Pac Allergy. 2022; 12(3): e32.
  • Berce V, Unuk S, Duh D, Homsak M, Vicic M. Clinical and laboratory characteristics of viral lower respiratory tract infections in preschool children. Wien Klin Wochenschr. 2015; 127 Suppl 5(Suppl 5): S255-62.
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Fatih Kurt 0000-0003-1975-6492

Ramazan Cahit Temizkan 0000-0001-8821-6292

Emel Akbaş 0000-0001-6589-7734

Abdulkadir Kaya 0000-0003-1725-1220

Mukaddes Kılıç Sağlam 0000-0002-7231-5461

Kenan Kocabay 0000-0002-4030-1145

Publication Date January 3, 2025
Submission Date June 14, 2024
Acceptance Date October 17, 2024
Published in Issue Year 2025 Volume: 15 Issue: 1

Cite

Vancouver Kurt F, Temizkan RC, Akbaş E, Kaya A, Kılıç Sağlam M, Kocabay K. Kışlar Hep Çetin Geçer: Çocuklarda Alt Solunum Yolu Enfeksiyonu Etkenleri ve Prognozu Etkileyen Faktörler. VHS. 2025;15(1):51-8.