Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical characteristics of acute lower respiratory tract infections due to 13 respiratory viruses detected by multiplex PCR in children

소아에서 13종 호흡기 바이러스에 의한 급성 하기도 감염의 임상 양상

  • Lim, Jeong-Sook (Department of Pediatrics, College of Medicine, Chungbuk National University) ;
  • Woo, Sung-Il (Chuncheong Respiratory Disease Center, Chungbuk National University Hospital) ;
  • Baek, Yun-Hee (Department of Microbiology, College of Medicine, Chungbuk National University) ;
  • Kwon, Hyuk-Il (Department of Microbiology, College of Medicine, Chungbuk National University) ;
  • Choi, Young-Ki (Department of Microbiology, College of Medicine, Chungbuk National University) ;
  • Hahn, Youn-Soo (Department of Pediatrics, College of Medicine, Chungbuk National University)
  • 임정숙 (충북대학교 의과대학 소아과학교실) ;
  • 우성일 (충북대학교병원 권역호흡기전문진환센터) ;
  • 백윤희 (충북대학교 의과대학 미생물학교실) ;
  • 권혁일 (충북대학교 의과대학 미생물학교실) ;
  • 최영기 (충북대학교 의과대학 미생물학교실) ;
  • 한윤수 (충북대학교 의과대학 소아과학교실)
  • Received : 2009.12.10
  • Accepted : 2010.02.18
  • Published : 2010.03.15
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Abstract

Purpose : This study was performed to investigate the epidemiologic and clinical features of 13 respiratory viruses in children with acute lower respiratory tract infections (ALRIs). Methods : Nasopharyngeal aspirates were prospectively obtained from 325 children aged 15 years or less from May 2008 to April 2009 and were tested for the presence of 13 respiratory viruses by multiplex real-time-polymerase chain reaction (RT-PCR). Results : Viruses were identified in 270 children (83.1%). Co-infections with ${\geq}2$ viruses were observed in 71 patients (26.3 %). Respiratory syncytial virus (RSV) was the most common virus detected (33.2%), followed by human rhinovirus (hRV) (19.1%), influenza virus (Flu A) (16.9%), human metapneumovirus (hMPV) (15.4%), parainfluenza viruses (PIVs) (8.3%), human bocavirus (hBoV) (8.0%), adenovirus (ADV) (5.8%), and human coronavirus (hCoV) (2.2%). Clinical diagnoses of viral ALRIs were bronchiolitis (37.5%), pneumonia (34.5%), asthma exacerbation (20.9%), and croup (7.1%). Clinical diagnoses of viral bronchiolitis and pneumonia were frequently demonstrated in patients who tested positive for RSV, hRV, hMPV, or Flu A. Flu A and hRV were most commonly identified in children older than 3 years and were the 2 leading causes of asthma exacerbation. hRV C was detected in 14 (4.3%) children, who were significantly older than those infected with hRV A ($mean{\pm}SD$, $4.1{\pm}3.5$ years vs. $1.7{\pm}2.3$ years; P =0.009). hBoV was usually detected in young children ($2.3{\pm}3.4$ years) with bronchiolitis and pneumonia. Conclusion : This study described the features of ALRI associated with 13 respiratory viruses in Korean children. Additional investigations are required to define the roles of newly identified viruses in children with ALRIs.

목 적 : 급성 하기도 감염으로 입원하는 소아에서 최근 알려진 hRV C 및 hBoV를 포함하여 13종 호흡기 바이러스의 임상 양상 및 역학을 알아보고자 하였다. 방 법 : 2008년 5월부터 2009년 4월까지 충북대학교병원 소아과에 급성 하기도 감염으로 입원한 소아 중 325명을 대상으로 비인두 흡인물에서 multiplex RT-PCR법을 이용하여 총 13종의 바이러스를 검출하였으며, 대상 소아의 의무기록을 검토하였다. 결 과 : 대상 소아 중 270례(83.1%)에서 호흡기 바이러스가 검출되었으며, 혼합 감염은 71례(26.3%)에서 관찰되었다. 바이러스 검출 빈도는 RSV 108례(33.2%), hRV 62례(19.1%), Flu A 55례(16.9%), hMPV 50례(15.4%), PIV 27례(8.3%), hBoV 26례(8.0%), ADV 19례(5.8%), hCoV 7례(2.2%)였다. 임상진단은 세기관지염 37.5%, 폐렴 34.5%, 급성 천식 악화 20.9%, 크룹 7.1%이었으며, 세기관지염과 폐렴으로 진단된 소아에서 가장 높은 빈도로 검출된 호흡기 바이러스는 RSV, hRV, hMPV, Flu A였다. Flu A와 hRV는 3세 이상의 천식 악화로 진단된 소아에서 가장 높은 빈도로 검출되었다. hRV A와 hRV C는 각각 48명(14.8%)와 14명(4.3%)에서 검출되었으며, hRV C가 검출된 소아의 평균 연령은 $4.1{\pm}3.5$세로 hRV A가 검출된 소아에서의 $1.7{\pm}2.3$세에 비해 유의하게 높았다(P =0.009). hBoV는 세기관지염 또는 폐렴으로 진단된 소아에서 주로 검출되었고, 이들의 평균 연령은 $2.3{\pm}3.4$세였다. 결 론 : 본 연구에서는 한국 소아에서 13종의 바이러스에 의한 하기도 감염의 양상을 관찰하였다. 소아 하기도 감염에서 새로 알려진 바이러스들의 역할을 명확히 알기 위해서는 향후 지속적인 연구가 필요하다.

Keywords

Acknowledgement

Supported by : Chungbuk National University

References

  1. Jung BS, Oh JS, Cho B, Kim HH, Lee JS. A clinical study of respiratory tract infection. Pediatr Allergy Respir Dis (Korea) 1996;6:60-3
  2. Elliot SP, Ray CG. Viral infections of the lower respiratory tract. In Taussig LM, Landau LI, editors. Pediatric respiratory medicine. 2nd ed. Philadelphia: Mosby Elsevier Co, 2008:481-9
  3. Henrickson KJ, Hoover S, Kehl KS, Hua W. National disease burden of respiratory viruses detected in children by polymerase chain reaction. Pediatr Infect Dis J 2004;23:S11-8 https://doi.org/10.1097/01.inf.0000108188.37237.48
  4. Pettemore PK, Jennings LC. Epidemiology of respiratory infections. In: Taussig LM, Landau LI, editors. Pediatric respiratory medicine. 2nd ed. Philadelphia: Mosby Elsevier Co, 2008:435-52
  5. Templeton KE. Why diagnose respiratory viral infection. J Clin Virol 2007;40 Suppl 1:S2-4
  6. Williams JV. The clinical presentation and outcomes of children infected with newly identified respiratory tract viruses. Infect Dis Clin North Am 2005;19:569-84 https://doi.org/10.1016/j.idc.2005.05.009
  7. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA. et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis 2006;43:585-92 https://doi.org/10.1086/506350
  8. Kim KH, Lee JH, Sun DS, Kim YB, Choi YJ, Park JS, et al. Detection and clinical manifestations of twelve respiratory viruses in hospitalized children with acute lower respiratory tract infections: focus on human metapneumovirus, human rhinovirus and human coronavirus. Korean J Pediatr 2008;51:834-41 https://doi.org/10.3345/kjp.2008.51.8.834
  9. Chung JY, Han TH, Kim SW, Hwang ES. Respiratory picornavirus infections in Korean children with lower respiratory tract infections. Scand J Infect Dis 2007;39:250-4 https://doi.org/10.1080/00365540600999126
  10. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719–24 https://doi.org/10.1038/89098
  11. D$\phi$llner H, Risnes K, Radtke A, Nordb$\phi$ SA. Outbreak of human metapneumovirus infection in norwegian children. Pediatr Infect Dis J 2004;23:436-40 https://doi.org/10.1097/01.inf.0000126401.21779.74
  12. Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung-Lindell A, Andersson B. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci U S A 2005;102:12891–6 https://doi.org/10.1073/pnas.0504666102
  13. Peiris JS, Lai ST, Poon LL, Guan Y, Yam LY, Lim W, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003;361:1319–25 https://doi.org/10.1016/S0140-6736(03)13077-2
  14. Han TH, Chung JY, Hwang ES, Koo JW. Detection of human rhinovirus C in children with acute lower respiratory tract infections in South Korea. Arch Virol 2009;154:987-91 https://doi.org/10.1007/s00705-009-0383-z
  15. Chung JY, Han TH, Kim CK, Kim SW. Bocavirus infection in hospitalized children, South Korea. Emerg Infect Dis 2006;12:1254-6 https://doi.org/10.3201/eid1708.060261
  16. Chung JY, Han TH, Kim SW, Kim CK, Hwang ES. Detection of viruses identified recently in children with acute wheezing. J Med Virol 2007;79:1238-43 https://doi.org/10.1002/jmv.20926
  17. Rho EJ, Jin YM, Chung EH, Rheem I, Kim JK. The prevalence of respiratory viral infection in exacerbation of asthma in hospitalized children. Korean J Asthma Allergy Clin Immunol 2007;27:241-7
  18. Denny FW, Clyde WA Jr. Acute lower respiratory tract infections in nonhospitalized children. J Pediatr 1986;108:635-46 https://doi.org/10.1016/S0022-3476(86)81034-4
  19. American Thoracic Society and European Respiratory Society Task Force, Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948–68 https://doi.org/10.1183/09031936.05.00035205
  20. Guilbert TW, Morgan WJ, Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec M, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol 2004;114:1282-7 https://doi.org/10.1016/j.jaci.2004.09.020
  21. Lin JH, Chiu SC, Lin YC, Chen HL, Lin KH, Shan KH, et al. Clinical and genetic analysis of Human Bocavirus in children with lower respiratory tract infection in Taiwan. J Clin Virol 2009;44:219-24 https://doi.org/10.1016/j.jcv.2008.12.018
  22. Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM, et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 2004;350:443–50 https://doi.org/10.1056/NEJMoa025472
  23. Park GO, Kim JH, Lee JH, Lee JJ, Yun SW, Lim IS, et al. Epidemiologic and clinical features in children with acute lower respiratory tract infection caused by human metapneumovirus in 2006-2007. Korean J Pediatr 2009;52:330-38 https://doi.org/10.3345/kjp.2009.52.3.330
  24. Sykes A, Johnston SL. Etiology of asthma exacerbation. J Allergy Clin Immunol 2008;122:685-8 https://doi.org/10.1016/j.jaci.2008.08.017
  25. Johnston SL, Pattemore PK, Sanderson G, Smith S, Lampe F, Josephs L, et al. Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. BMJ 1995;310:1225-8
  26. Carroll KN, Hartert TV. The impact of respiratory viral infection on wheezing illnesses and asthma exacerbations. Immunol Allergy Clin N Am 2008;28:539-61 https://doi.org/10.1016/j.iac.2008.03.001
  27. Miller EK, Griffin MR, Edwards KM, Weinberg GA, Szilagyi PG, Staat MA, et al: New Vaccine Surveillance Network. Influenza burden for children with asthma. Pediatrics 2008;121:1-8 https://doi.org/10.1542/peds.2007-1053
  28. Glezen WP, Greenberg SB, Atmar RL, Piedra PA, Couch RB. Impact of respiratory virus infections on persons with chronic underlying conditions. JAMA 2000;283:499-505 https://doi.org/10.1001/jama.283.4.499
  29. Miller EK, Edwards KM, Weinberg GA, Iwane MK, Griffin MR, Hall CB, et al: New Vaccine Surveillance Network. A novel group of rhinoviruses is associated with asthma hospitalizations. J Allergy Clin Immunol 2009;123:98-104 https://doi.org/10.1016/j.jaci.2008.10.007

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