Viral Etiology of Severe Pneumonia Among Kenyan Infants and Children

Berkley, James A.; Munywoki, Patrick K.; Ngama, Mwanajuma; Kazungu, Sidi; Abwao, John; Bett, Anne; Lassaunière, Ria; Kresfelder, T.L.; Cane, Patricia A.; Venter, Marietjie; Scott, J. Anthony G.; Nokes, D. James

doi:10.1001/jama.2010.675

Cited by 275 publications

(317 citation statements)

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“…PIV, hMPV, and RSV were associated with high relative risks for ARI and were only rarely detected in control subjects, which is concordant with previous studies. 11,17 These viruses all seem to be rapidly cleared from the respiratory tract after an infection, making qPCR a suitable diagnostic method. 8 Interestingly, hMPV was associated with severe disease presentations such as fever, decreased O 2 saturation, increased respiratory rate, and tachycardia.…”

Section: Discussionmentioning

confidence: 99%

“…7 Sensitive methods, such as quantitative real-time polymerase chain reaction (qPCR) analyses on nasopharyngeal samples, for a number of viruses have been introduced in the clinic as a sensitive diagnostic tool among children with respiratory tract infection. 8 However, whereas detection of some viruses, such as influenza virus and respiratory syncytial virus (RSV), clearly is predictive for respiratory disease, [9][10][11] the clinical significance upon detection of several other viruses needs further investigation. The interpretation of a viral detection is complicated by the fact that infections with multiple viruses are common in children with ARI and that many viruses have lately been reported to be found also in asymptomatic children.…”

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confidence: 99%

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Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Quantitative real-time polymerase chain reaction allows sensitive detection of respiratory viruses. The clinical significance of detection of specific viruses is not fully understood, however, and several viruses have been detected in the respiratory tract of asymptomatic children. WHAT THIS STUDY ADDS:Our results indicate that quantitative real-time polymerase chain reaction is limited at distinguishing acute infection from detection in asymptomatic children for rhinovirus, bocavirus, adenovirus, enterovirus, and coronavirus. abstract BACKGROUND: Acute respiratory illness (ARI) accounts for a large proportion of all visits to pediatric health facilities. Quantitative real-time polymerase chain reaction (qPCR) analyses allow sensitive detection of viral nucleic acids, but it is not clear to what extent specific viruses contribute to disease because many viruses have been detected in asymptomatic children. Better understanding of how to interpret viral findings is important to reduce unnecessary use of antibiotics. OBJECTIVE:To compare viral qPCR findings from children with ARI versus asymptomatic control subjects.METHODS: Nasopharyngeal aspirates were collected from children aged #5 years with ARI and from individually matched, asymptomatic, population-based control subjects during a noninfluenza season. Samples were analyzed by using qPCR for 16 viruses. RESULTS:Respiratory viruses were detected in 72.3% of the case patients (n 5 151) and 35.4% of the control subjects (n 5 74) (P 5 .001). Rhinovirus was the most common finding in both case patients and control subjects (47.9% and 21.5%, respectively), with a population-attributable proportion of 0.39 (95% confidence interval: 0.01 to 0.62). Metapneumovirus, parainfluenza viruses, and respiratory syncytial virus were highly overrepresented in case patients. Bocavirus was associated with ARI even after adjustment for coinfections with other viruses and was associated with severe disease. Enterovirus and coronavirus were equally common in case patients and control subjects.CONCLUSIONS: qPCR detection of respiratory syncytial virus, metapneumovirus, or parainfluenza viruses in children with ARI is likely to be causative of disease; detection of several other respiratory viruses must be interpreted with caution due to high detection rates in asymptomatic children. Although acute respiratory illness (ARI) in childrenaccountsfora large part ofall visits to pediatric health facilities and is a great economic burden on society, 1,2 our tools to diagnose the etiologic agents have until recently been limited. 3 Treatment with antibiotics induces development of antibiotic resistance in bacteria 4 and has a negligible effect on most ARIs, which generally are of viral origin. 5,6 Nevertheless, antibiotics are frequently prescribed due to lack of clinically valid diagnostic tests verifying a viral etiology. 7 Sensitive methods, such as quantitative real-time polymerase chain reaction (qPCR) analyses on nasopharyngeal samples, for a number of viru...

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Section: Discussionmentioning

confidence: 99%

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Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

et al. 2014

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“…Studies have shown that respiratory viruses can be detected in up to 36% of samples from asymptomatic children. 33,34 Another contradiction in the literature was the association of the HRV C strain with severe cases. 4,5 Some of the HRV samples we sequenced belonged to the C strain.…”

Section: Discussionmentioning

confidence: 99%

Human Rhinovirus and Disease Severity in Children

Costa¹,

Queiróz²,

Silveira

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Human rhinovirus has been known as the common cold agent. Recently, studies have reported that this virus is responsible for severe infections of the lower respiratory tract in children. Reports of factors that increase disease severity have been contradictory. WHAT THIS STUDY ADDS:This study identifies some of the factors involved in disease severity in HRV infections in children. We expect that children at risk for developing severe disease could be identified sooner and appropriate measures could be taken. abstract OBJECTIVE: To evaluate retrospectively human rhinovirus (HRV) infections in children up to 5 years old and factors involved in disease severity.METHODS: Nasopharyngeal aspirates from 434 children presenting a broad range of respiratory infection symptoms and severity degrees were tested for presence of HRV and 8 other respiratory viruses. Presence of host risk factors was also assessed.RESULTS: HRV was detected in 181 (41.7%) samples, in 107 of them as the only agent and in 74 as coinfections, mostly with respiratory syncytial virus (RSV; 43.2%). Moderate to severe symptoms were observed in 28.9% (31/107) single infections and in 51.3% (38/74) coinfections (P = .004). Multivariate analyses showed association of coinfections with lower respiratory tract symptoms and some parameters of disease severity, such as hospitalization. In coinfections, RSV was the most important virus associated with severe disease. Prematurity, cardiomyopathies, and noninfectious respiratory diseases were comorbidities that also were associated with disease severity (P = .007).CONCLUSIONS: Our study showed that HRV was a common pathogen of respiratory disease in children and was also involved in severe cases, causing symptoms of the lower respiratory tract. Severe disease in HRV infections were caused mainly by presence of RSV in coinfections, prematurity, congenital heart disease, and noninfectious respiratory disease. Pediatrics 2014;133:e312-e321 AUTHORS:

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“…[28][29][30] There are recent studies that also used molecular techniques to identify viral pathogens in lower respiratory infections (LRTI) in infants in sub-Saharan Africa, although they do not specifically report by infant HIV-infection and feeding strategy . [31][32][33][34][35][36][37][38] Several studies found that RSV was the most frequent pathogen, particularly in infants under 1 year. 35,36 Our study, and one from Mozambique, 34 found that adenovirus and rhinovirus were the two most common viral potential pathogens and were commonly found together in infants with pneumonia.…”

Section: Discussionmentioning

confidence: 99%