Epidemiology and clinical presentation of the four human parainfluenza virus types

Abstract

BackgroundHuman parainfluenza viruses (HPIVs) are important causes of upper respiratory tract illness (URTI) and lower respiratory tract illness (LRTI). To analyse epidemiologic and clinical characteristics of the four types of human parainfluenza viruses (HPIVs), patients with acute respiratory tract illness (ARTI) were studied in Guangzhou, southern China.MethodsThroat swabs (n=4755) were collected and tested from children and adults with ARTI over a 26-month period, and 4447 of 4755 (93.5%) patients’ clinical presentations were recorded for further analysis.ResultsOf 4755 patients tested, 178 (3.7%) were positive for HPIV. Ninety-nine (2.1%) samples were positive for HPIV-3, 58 (1.2%) for HPIV-1, 19 (0.4%) for HPIV-2 and 8 (0.2%) for HPIV-4. 160/178 (88.9%) HPIV-positive samples were from paediatric patients younger than 5 years old, but no infant under one month of age was HPIV positive. Seasonal peaks of HPIV-3 and HPIV-1 occurred as autumn turned to winter and summer turned to autumn. HPIV-2 and HPIV-4 were detected less frequently, and their frequency of isolation increased when the frequency of HPIV-3 and HPIV-1 declined. HPIV infection led to a wide spectrum of symptoms, and more “hoarseness” (p=0.015), “abnormal pulmonary breathing sound” (p<0.001), “dyspnoea” (p<0.001), “pneumonia” (p=0.01), and “diarrhoea” (p<0.001) presented in HPIV-positive patients than HPIV-negative patients. 10/10 (100%) HPIV-positive adult patients (≥14 years old) presented with systemic influenza-like symptoms, while 90/164 (54.9%) HPIV-positive paediatric patients (<14 years old) presented with these symptoms (p=0.005). The only significant difference in clinical presentation between HPIV types was “Expectoration” (p<0.001). Co-infections were common, with 33.3%–63.2% of samples positive for the four HPIV types also testing positive for other respiratory pathogens. However, no significant differences were seen in clinical presentation between patients solely infected with HPIV and patients co-infected with HPIV and other respiratory pathogens.ConclusionsHPIV infection led to a wide spectrum of symptoms, and similar clinical manifestations were found in the patients with four different types of HPIVs. The study suggested pathogenic activity of HPIV in gastrointestinal illness. The clinical presentation of HPIV infection may differ by patient age.

Viral Respiratory Infections in Patients with Cancer

“…HPIVs 1 -3 had been identified in about one-third of these infections (85)(86)(87). Most children with the age of 6 -10 years have evidence of past infection (92). 3% -18% of all admissions to pediatric hospitals are due to acute respiratory infections (ARTI) and HPIV infection was detected in 9% -30% of these patients (87)(88)(89).…”

“…HPIV infection usually causes otitis media, pharyngitis, conjunctivitis, and coryza. More severe symptoms include croup (acute laryngotracheobronchitis), Tracheobronchitis, Bronchiolitis, pneumonia and Neurologic diseases (89,(91)(92)(93)(94).…”

“…The types 1 and 3 fall into respirovirus genus but types 2 and 4 are categorized in rubulavirus genus. This virus is a pleomorphic virus that is 150 -250 nm in diameter with a lipid envelope covering helical nucleocapside (91)(92)(93)(94).…”

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“…Human metapneumovirus (HMPV), respiratory syncytial virus (RSV), and parainfluenza virus (PIV) infections are responsible for severe acute respiratory illnesses mainly in young children, but also in immunocompromised and elderly individuals, and are-together with the influenza viruses (family Orthomyxoviridae)-the primary viral causes of hospitalizations for severe respiratory tract disease (2)(3)(4)(5). No licensed vaccines or effective antiviral treatments are available for these viruses.…”

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“…Human parainfluenza virus 3 (hPIV-3) can cause serious respiratory illnesses including pediatric croup, bronchiolitis, and pneumonia in the human pediatric population worldwide [1,2,3]. At present, no licensed vaccines or antiviral agents are available for hPIV-3.…”