Real-Time Polymerase Chain Reaction ile Tespit Edilen Viral Akut Alt Solunum Yolu Enfeksiyonlarının Değerlendirilmesi

Öz

Objective: Acute lower respiratory tract infection (ALRTI) is the most frequent cause of hospitalization in infantsyounger than 5 years. In the main, alveolar and bronchial infections are responsible for 90% of deaths from respiratory disease.The aim of this study was to investigate the epidemiology, clinical findings, and treatment modalities of respiratory viruses detected with real-time polymerase chain reaction (PCR).

Material and Methods: A total of 235 children between the age of 1 and 24 months who were hospitalized due to ALRTI between January 2014 and December 2018 and who had positive PCR results for respiratory viruses were included in the study. Demographics, clinical findings, laboratory tests, treatment modalities, need for the high-frequency nasal cannula (HFNC) or mechanical ventilation, length of hospital stay, and the requirement for treatment within a pediatric intensive care unit (PICU) were recorded.

Results: In total, 55.5% of the children were male with a mean age of 6.1±6 months. Respiratory syncytial virus (RSV) was present in 106, rhinovirus in 35, influenza in 23, and other viruses in the remaining 71. There was a significant seasonal difference among the various etiologies. Fever was present in patients with influenza, multiple viral infections, adenovirus, and human metapneumovirus (HMPV). There was no significant difference in the physical examination among patients presenting with a pertussis-like cough, feeding difficulty, or lethargy. The white blood cell (WBC) count increased due to adenovirus and HMPV infection; however, differences in C-reaktif protein(CRP), mean platelet volume (MPV), and eosinophilia were not significant. There was no significant difference between the chest X-ray findings and medical treatment based on the viral etiology. Fifty-four patients were followed up in the PICU. Although influenza was only the third most common etiology, it was the most common cause of PICU admission.

Conclusion: RSV continues to be an important viral etiology for hospitalization in children below 2 years old. Influenza was the most frequent virus requiring admission to the PICU. Widespread immunization against influenza has been related to the decline of the LRTI in children.

Anahtar Kelimeler

• Acute lower respiratory tract infection
• Children
• Viruses

Evaluation of Viral Acute Lower Respiratory Tract Infections Detected with Real-Time Pcr

Öz

Amaç: Akut alt solunum yolu enfeksiyonu (ALRTI), 5 yaşından küçük bebeklerde en sık hastaneye yatış nedenidir. Çoğunlukla, alveolar ve bronşiyal enfeksiyonlar, solunum hastalıklarından kaynaklanan ölümlerin %90'ından sorumludur. Bu çalışmanın amacı, real-time PCR ile saptanan solunum yolu virüslerinin epidemiyolojisini, klinik bulgularını ve tedavi yöntemlerini incelemektir.

Gereç ve Yöntemler: Ocak 2014 - Aralık 2018 tarihleri arasında ALRTI nedeniyle hastaneye yatırılan ve solunum yolu virüsleri için pozitif PCR sonuçları olan 1-24 aylık toplam 235 çocuk çalışmaya dahil edildi. Demografik veriler, klinik bulgular, laboratuvar testleri, tedavi modaliteleri, yüksek frekanslı nazal kanül (HFNC) veya mekanik ventilasyon ihtiyacı, hastanede kalış süresi ve çocuk yoğun bakım ünitesinde (ÇYBB) tedavi gereksinimi kaydedildi.

Bulgular: Toplamda çocukların% 55.5'i erkekti ve yaş ortalaması 6.1±6 aydı. Respiratuvar sinsityal virüs (RSV) 106'da, rinovirüs 35'te, influenza 23'te ve diğer virüsler kalan 71'de mevcuttu. Çeşitli etiyolojiler arasında önemli bir mevsimsel farklılık vardı. Ateş influenza, çoklu viral enfeksiyonlar, adenovirüs ve human metapnömovirüs (HMPV) hastalarında vardı. Boğmaca benzeri öksürük, beslenme güçlüğü veya letarji ile başvuran hastalar arasında fizik muayenede anlamlı fark yoktu. Adenovirüs ve HMPV enfeksiyonu nedeniyle WBC sayısı arttı; ancak CRP, MPV ve eozinofilideki farklılıklar anlamlı değildi. Viral etiyolojiye göre akciğer grafisi bulguları ile medikal tedavi arasında anlamlı bir fark yoktu. ÇYBB'de elli dört hasta izlendi. İnfluenza sadece üçüncü en yaygın etiyoloji olmasına rağmen, ÇYBB'ye kabulün en yaygın nedeniydi.

Sonuç: RSV iki yaşın altındaki çocuklarda hastaneye yatış için önemli bir viral etiyoloji olmaya devam etmektedir. İnfluenza, ÇYBB'de izlenmeyi gerektiren en sık görülen virüstür. İnfluenzaya karşı yaygın aşılama, çocuklarda ASYE'nin azalmasıyla ilişkilidir.

Anahtar Kelimeler

• Alt solunum yolu enfeksiyonu
• Çocuk
• Virüsler

Kaynakça

1. REFERENCES 1. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to the respiratory syncytial virus in young children: a systematic review and meta-analysis. The Lancet. 2010;375(9725):1545-55.
2. 2. Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, et al. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Italian journal of pediatrics. 2014;40(1):65.
3. 3. Schroeder AR, Mansbach JM. Recent evidence on the management of bronchiolitis. Current opinion in pediatrics. 2014;26(3):328.
4. 4. Derrar F, Izri K, Kaddache C, Boukari R, Hannoun D. Virologic study of acute lower respiratory tract infections in children admitted to the pediatric department of Blida University Hospital, Algeria. New microbes and new infections. 2019, 30: 100536
5. 5. Tregoning JS, Schwarze J. Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clinical microbiology reviews. 2010;23(1):74-98.
6. 6. Liu W, Chen D, Tan W, Xu D, Qiu S, Zeng Z, et al. Epidemiology and clinical presentations of respiratory syncytial virus subgroups A and B detected with multiplex real-time PCR. PloS one. 2016;11(10):e0165108.
7. 7. Picone S, Fabiano A, Roma D, Paolillo P. Comparing of two different epidemic seasons of bronchiolitis. Italian journal of pediatrics. 2018;44(1):11.
8. 8. Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, et al. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Archives of pediatrics & adolescent medicine. 2012;166(8):700-6.

9. 9. Calvo C, García-García ML, Pozo F, Paula G, Molinero M, Calderón A, et al. Respiratory syncytial virus coinfections with rhinovirus and human bocavirus in hospitalized children. Medicine. 2015;94(42).
10. 10. Aslanzadeh J, Zheng X, Li H, Tetreault J, Ratkiewicz I, Meng S, et al. Prospective evaluation of rapid antigen tests for diagnosis of respiratory syncytial virus and human metapneumovirus infections. Journal of clinical microbiology. 2008;46(5):1682-5.
11. 11. Ralston S, Lieberthal A, Meissner H. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis Pediatrics. 2014;134(5):e1474-e502.
12. 12. Lieberthal AS, Bauchner H, Hall CB, Johnson DW, Kotagal U, Light MJ, et al. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774-93.
13. 13. Akçalı S, Yılmaz N, Güler Ö, Şanlidağ T, Anıl M. Alt solunum yolu enfeksiyonu olan çocuklarda solunum yolu viral etkenlerinin sıklığı. (Frequency of respiratory viral agents in children with lower respiratory tract infection. Turkish Archives of Pediatrics) Türk Pediatri Arşivi. 2013;48(3):215-20.
14. 14. Mahony JB. Detection of respiratory viruses by molecular methods. Clinical microbiology reviews. 2008;21(4):716-47.
15. 15. Mansbach JM, McAdam AJ, Clark S, Hain PD, Flood RG, Acholonu U, et al. Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Academic Emergency Medicine. 2008;15(2):111-8.
16. 16. García-García ML, Calvo C, Pozo F, Villadangos PA, Pérez-Breña P, Casas I. Spectrum of respiratory viruses in children with community-acquired pneumonia. The Pediatric infectious disease journal. 2012;31(8):808-13.
17. 17. Richard N, Komurian-Pradel F, Javouhey E, Perret M, Rajoharison A, Begnaud A, et al. The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. The Pediatric infectious disease journal. 2008;27(3):213-7.
18. 18. Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Archives of pediatrics & adolescent medicine. 2011;165(10):951-6.
19. 19. Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics-Springfield-. 2004;113(6; ISSU 1):1728-34.
20. 20. García-García ML, Calvo C, Rey C, Díaz B, del Mar Molinero M, Pozo F, et al. Human metapnuemovirus infections in hospitalized children and comparison with other respiratory viruses. 2005-2014 prospective study. PloS one. 2017;12(3):e0173504.
21. 21. Midulla F, Scagnolari C, Bonci E, Pierangeli A, Antonelli G, De Angelis D, et al. Respiratory syncytial virus, human bocavirus, and rhinovirus bronchiolitis in infants. Archives of disease in childhood. 2010;95(1):35-41.
22. 22. Johnson LW, Robles J, Hudgins A, Osburn S, Martin D, Thompson A. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines. Pediatrics. 2013;131(Suppl 1):103-S9.
23. 23. Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. The Journal of pediatrics. 2007;150(4):429-33.
24. 24. Hasegawa K, Tsugawa Y, Brown DF, Mansbach JM, Camargo Jr CA. Trends in bronchiolitis hospitalizations in the United States, 2000–2009. Pediatrics. 2013;132(1):28.
25. 25. Ricart S, Marcos MA, Sarda M, Anton A, Muñoz‐Almagro C, Pumarola T, et al. Clinical risk factors are more relevant than respiratory viruses in predicting bronchiolitis severity. Pediatric pulmonology. 2013;48(5):456-63.
26. 26. Schibler A, Pham T, Dunster K, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive care medicine. 2011;37(5):847-52.
27. 27. Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. 2013;131(3):e939-44.
28. 28. Asner SA, 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.
29. 29. Scotta MC, Chakr VCBG, de Moura A, Becker RG, de Souza APD, Jones MH, et al. Respiratory viral coinfection and disease severity in children: a systematic review and meta-analysis. Journal of Clinical Virology. 2016;80:45-56.
30. 30. Mussman GM, Parker MW, Statale A, Sucharew H, Brady PW. Suctioning and length of stay in infants hospitalized with bronchiolitis. JAMA pediatrics. 2013;167(5):414-21.
31. 31. Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, et al. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews. 2011(6).
32. 32. Ralston S, Garber M, Narang S, Shen M, Pate B, Pope J, et al. Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics network. Journal of hospital medicine. 2013;8(1):25-30.
33. 33. Jacobs JD, Foster M, Wan J, Pershad J. 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial. Pediatrics. 2014;133(1):e8-e13.
34. 34. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews. 2010(10).
35. 35. Kotaniemi-Syrjänen A, Vainionpää R, Reijonen TM, Waris M, Korhonen K, Korppi M. Rhinovirus-induced wheezing in infancy—the first sign of childhood asthma? Journal of Allergy and Clinical Immunology. 2003;111(1):66-71.