Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study.

BACKGROUND: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. METHODS: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at -70°C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. RESULTS: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1-4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. CONCLUSIONS: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

Rhinovirus is an important pathogen in upper and lower respiratory tract infections in Mexican children.

BACKGROUND: Most of the studies characterizing the incidence of rhinovirus (RV) have been carried out in hospitalized children and in developed countries. In those studies, RV-C has been associated with more severe respiratory tract infections than RV species A and B. In this study we determined the frequency and diversity of RV strains associated with upper and lower respiratory tract infections (URTI, LRTI) in Mexico, and describe the clinical characteristics of the illness associated with different RV species. METHODS: A prospective surveillance of 526 and 250 children with URTI and LRTI was carried out. Respiratory samples were analyzed by RT-PCR for viruses. The 5' untranslated region of the RV genome was amplified and sequenced. RESULTS: In the case of URTI, 17.5% were positive for RV, while this virus was found in 24.8% of LRTI. The RV species was determined in 73 children with URTI: 61.6% were RV-A, 37% RV-C and, 1.4% RV-B; and in 43 children with LRTI: 51.2% were RV-A, 41.8% RV-C, and 7% RV-B. No significant differences in clinical characteristics were found in patients with RV-A or RV-C infections. A high genetic diversity of RV strains was found in both URTI and LRTI. CONCLUSIONS: Both RV-A and RV-C species were frequently found in hospitalized as well as in outpatient children. This study underlines the high prevalence and genetic diversity of RV strains in Mexico and the potential severity of disease associated with RV-A and RV-C infections.

Is there still room for novel viral pathogens in pediatric respiratory tract infections?

Viruses are the most frequent cause of respiratory disease in children. However, despite the advanced diagnostic methods currently in use, in 20 to 50% of respiratory samples a specific pathogen cannot be detected. In this work, we used a metagenomic approach and deep sequencing to examine respiratory samples from children with lower and upper respiratory tract infections that had been previously found negative for 6 bacteria and 15 respiratory viruses by PCR. Nasal washings from 25 children (out of 250) hospitalized with a diagnosis of pneumonia and nasopharyngeal swabs from 46 outpatient children (out of 526) were studied. DNA reads for at least one virus commonly associated to respiratory infections was found in 20 of 25 hospitalized patients, while reads for pathogenic respiratory bacteria were detected in the remaining 5 children. For outpatients, all the samples were pooled into 25 DNA libraries for sequencing. In this case, in 22 of the 25 sequenced libraries at least one respiratory virus was identified, while in all other, but one, pathogenic bacteria were detected. In both patient groups reads for respiratory syncytial virus, coronavirus-OC43, and rhinovirus were identified. In addition, viruses less frequently associated to respiratory infections were also found. Saffold virus was detected in outpatient but not in hospitalized children. Anellovirus, rotavirus, and astrovirus, as well as several animal and plant viruses were detected in both groups. No novel viruses were identified. Adding up the deep sequencing results to the PCR data, 79.2% of 250 hospitalized and 76.6% of 526 ambulatory patients were positive for viruses, and all other children, but one, had pathogenic respiratory bacteria identified. These results suggest that at least in the type of populations studied and with the sampling methods used the odds of finding novel, clinically relevant viruses, in pediatric respiratory infections are low.

Frecuencia de factores de riesgo para bacteremia en niños con cáncer, neutropenia y fiebre en un hospital de tercer nivel del occidente de México / Frequency of risk factors for bacteremia in children with cancer, neutropenia and fever in a tertiary level hospital in western Mexico

Introducción. Los pacientes pediátricos con enfermedades oncológicas frecuentemente presentan neutropenia. Esta citopenia condiciona un estado de inmunosupresión que incrementa la probabilidad de adquirir procesos infecciosos. El identificar factores de riesgo para bacteremia en niños con cáncer, neutropenia y fiebre ayuda a establecer diagnósticos más oportunos. Métodos. Se realizó estudio transversal sobre factores de riesgo para bacteremia en niños con cáncer, neutropenia y fiebre. Se calculó la razón de prevalencia de bacteremia con intervalos de confianza al 95% y análisis multivariado para identificar condiciones que incrementan la probabilidad del diagnóstico de bacteremia. Resultados. Se incluyeron 149 pacientes con cáncer, neutropenia y fiebre. La edad promedio fue de 7.3 años y 45% fueron del sexo femenino. La enfermedad de base fue leucemia (n =113) o tumores sólidos (n =36). El 25.5% presentaron bacteremia. De las bacterias aisladas, 65% fueron bacilos gram negativos. Las variables asociadas a bacteremia identificadas mediante análisis multivariado fueron plaquetopenia (OR 2.3, IC 95% 1.02-5.4; p =0.04), catéter venoso central (OR 2.6, IC 95% 1.16-5.9; p =0.02) y antecedente de quimioterapia con vincristina (OR 2.8, IC 95% 1.22-6.4; p =0.01). Conclusiones. Utilizando un modelo multivariado, los factores que se asociaron con mayor probabilidad de bacteremia en niños con cáncer, neutropenia y fiebre fueron presentar un conteo plaquetario ≤50,000/mm³, tener catéter venoso central y el uso de vincristina.

Background. We undertook this study to Identify risk factors (RF) for bacteremia in children with cancer, neutropenia and fever in order to establish more timely diagnoses. Methods. We conducted a cross-sectional study in regard to RF for bacteremia in pediatric patients with cancer, neutropenia and fever (CNF). We compared the prevalence of bacteremia depending on the presence or absence of independent variables and calculated the prevalence ratio (PR) with 95% confidence intervals. Multivariate analysis was performed to identify conditions that increase the likelihood of the diagnosis of bacteremia.t Results. We included 149 patients with CNF. Average age was 7.3 years; 45% were females. The underlying disease was leukemia (n =113) or solid tumors (n =36). Of the patients, 25.5% suffered from bacteremia; 65% of isolated bacteria were gram negative. Variables associated with bacteremia identified by multivariate analysis were thrombocytopenia (OR 2.3, 95% CI 1.02-5.4, P 0.04), central venous catheter (OR 2.6, 95% CI 1.16-5.9, P 0.02) and history of chemotherapy with vincristine (OR 2.8, 95% CI 1.22-6.4, P 0.01). Conclusions. In a multivariate model, platelet count ≤50,000/mm³, central venous catheter and the use of vincristine were associated with an increased likelihood of diagnosis of bacteremia in children with CNF.