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Objective To investigate and study epidemiological characteristics and risk factors of rotavirus lower respiratory tract infection in preschool children. Methods The preschool children with rotavirus enteritis and lower respiratory tract infection admitted to the hospital were retrospectively analyzed January 2021 and June 2022. The situations and risk factors of lower respiratory tract infection were evaluated by chest X-ray, serological examination and throat swab culture. Results In the 155 preschool children with rotavirus enteritis, there were 59 (38.06%) cases with lower respiratory tract infection. The results of pathogens culture showed that proportion of Haemophilus influenzae was the highest (28.81%), followed by Streptococcus pneumoniae and Klebsiella pneumoniae (18.64%, 15.25%). There were significant differences between infection group and non-infection group in age, histories of family members smoking, children's aggregated activities and family members' respiratory diseases, family members' and children' attention to hand hygiene, pregnancy outcomes, age at the first usage of antibiotics and onset seasons (P0.05). Logistic regression analysis showed that age <3 years (OR=2.962, P=0.031), history of family members' smoking (OR=2.869, P=0.035), history of family members' respiratory diseases (OR=2.354, P=0.039) and the age at the first usage of antibiotics <1 year (OR=2.622, P=0.033) were all independent risk factors of rotavirus lower respiratory tract infection in preschool children. Conclusion The preschool children with rotavirus are prone to lower respiratory tract infection. Clinically, more attentions should be payed to children with age <3 years, history of family members' smoking, history of family members' respiratory diseases and the age at the first usage of antibiotics <1 year. The targeted measures should be actively taken to prevent the risk of lower respiratory tract infection.
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Objective To analyze the epidemiological characteristics and drug resistance of pathogenic bacteria in 276 hospitalized children with lower respiratory tract infection to facilitate prevention and treatment. Methods Among of 276 hospitalized children with lower respiratory tract infection from January 2019 to December 2021 were analyzed. Data on the distribution of pathogenic bacteria were collected and analyzed. At the same time, the information on drug resistance was collected, and the potential relationship between pathogen distribution and drug resistance was briefly analyzed and discussed. Results A total of 532 strains of pathogenic bacteria were detected in the blood samples from 276 patients in this study. There were 207 strains of Gram-positive bacteria, including 104 strains of Staphylococcus aureus, 96 strains of Staphylococcus epidermidis and 7 strains of others. Gram negative bacteria (325 strains) were 172 strains of Klebsiella and 153 strains of Escherichia coli. The distribution of pathogenic bacteria in different gender and age groups (under 5 years old, 5-10 years old, and over 10 -14 years old) was calculated separately. The results showed that the distribution of pathogenic bacteria in female children under 5 years old (n=49 cases) was different from the total population: the infection of Gram-positive bacteria was higher than that of Gram-negative bacteria, and the proportion of Staphylococcus epidermidis was the highest (P<0.05). The distribution characteristics of children of other ages and sexes were consistent with the total distribution characteristics. The resistance rate of Gram-positive bacteria to penicillin, erythromycin and clarithromycin was high, while the resistance rate of Gram-negative bacteria to ampicillin, cefazolin and cefuroxime was high. The distribution characteristics were the same in children of different sex and age. Conclusion The pathogenic bacteria in children with lower respiratory tract infection in pediatric ward are mainly Gram-negative bacteria, and the main pathogenic bacteria have a high resistance rate to common drugs. The distribution of pathogenic bacteria in female children under 5 years old is unique: the infection of Gram-positive bacteria is higher than that of Gram-negative bacteria, and the proportion of Staphylococcus epidermidis is the highest, which deserves attention. The clinical drug sensitivity test can be used as an important reference for the treatment of drugs to guide the rational selection of antibiotics.
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As per 2019 report of the National Health Portal of India, 41,996,260 cases and 3,740 deaths from respiratory infections were recorded across India in 2018. The main aim of the study was to assess the effectiveness of balloon therapy on increased level of oxygenation of patients with lower respiratory tract disorders. Quasi experimental design was used for this study. Balloon therapy improves pulmonary functions. Daily practice of blowing up balloon, once a day, 10 times per day for 10 days will steadily increase lung capacity. The data pertaining to lung capacity was collected using self-administered questionnaire. Respiratory assessment viz Vital, Tidal and Lung capacity were measured using balloon therapy. The pre-test mean and SD were 6.83 & 1.30 respectively where as posttest mean & SD were 7.16 & 1.26, with t-test value of 6.12. These reading indicate the effectiveness of Balloon therapy on lung capacity in patients with lower respiratory tract infections. The result of this study guides that regular practice of balloon therapy can improve the lung capacity to a greater extent among patients with lower respiratory tract infection. Off course, large sample size is recommended for generalization.
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Objective:To analyze common respiratory pathogens epidemiology in hospitalized children with lower respiratory tract infection (LRTI) in a single center in Shanghai, and to provide the basic data support for clinical diagnosis and treatment of children with LRTI in Shanghai.Methods:Children with LRTI in Children′s Hospital of Fudan University were enrolled from January 1, 2015 to December 31, 2019, and respiratory samples were collected and tested by direct immunofluorescence assay and real time polymerase chain reaction. The epidemiological characteristics of different respiratory pathogens were analyzed. Chi-square test was used for statistical analysis.Results:A total of 18 716 children were included, the total detection rate of respiratory pathogens was 36.96% (6 918/18 716), and the most frequent detected pathogen was Mycoplasma pneumoniae (MP) (15.31%(2 866/18 716)), followed by respiratory syncytial virus (RSV) (10.40%(1 946/18 716)) and parainfluenza virus Ⅲ (PIV-Ⅲ) (4.65%(871/18 716)). The detection rate of pathogens in female was significantly higher than that in male (38.48%(2 936/7 630) vs 35.92%(3 982/11 086), χ2=12.72, P<0.001). RSV and influenza virus A (Flu-A) infections peaked in winter. The detection rates of influenza virus B (Flu-B) and human metapneumovirus (MPV) were higher in winter and spring. PIV-Ⅲ infection peaked in spring and summer. The peak of PIV-Ⅱ infection occurred in summer and autumn. The infections of adenovirus (ADV), MP, Chlamydia trachomatis (CT) and PIV-Ⅰ were prevalent throughout the year without significant seasonality. The detection rate of RSV declined with age, while the detection rate of MP increased with age. The co-infection rate was 1.65%(309/18 716), and the predominant co-infection type was MP and RSV (0.37%(70/18 716)). Conclusions:A variety of pathogens lead to children′s LRTI in Shanghai from 2015 to 2019, with the common infection of MP, RSV and PIV-Ⅲ. Different pathogens showed different epidemiological characteristics in age and season distributions.
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The lower respiratory tract of healthy children exists microbiota, not sterile.The microbiota is symbiotic with children and plays a role in nutrition absorption, vitamin synthesis, metabolism of foreign substances and immune regulation, to maintain the health of children′s lower respiratory tract.The disturbance of lower respiratory tract microbiota would lead to some lower respiratory tract diseases or aggravate the occurrence and development of diseases.This paper reviews the research progress in the sources and detection methods of lower respiratory tract microbiota, the characteristics of lower respiratory tract microbiota in healthy children, and the relationship between lower respiratory tract microbiota and lower respiratory tract diseases in children, to provide help for more accurate diagnosis and treatment of lower respiratory diseases in children.
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Objective: To examine the effects of human bocavirus type 1 (HBoV1) on the course of lower respiratory tract infections in cases of monoinfection and coinfection, and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections. Methods: Children under six years of age, who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study. Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction (PCR). Results: Fifty-four (16.4%) children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study. There were 28 (51.9%) males and 26 (48.1%) females with a median age 23.4 months [interquartile range (IQR): 13.2, 30.0 months] (min-max:1 month-68 months). HBoV1 was detected as a monoinfecton in 26 (48.1%) children, and as a coinfection with other respiratory agents in 28 children (51.9%). In multiple regression analysis, coinfection (P=0.032) was associated with the length of hospitalization (P<0.001; R 2 =0.166). There was a negative correlation (r= 0.281, P=0.040) between cough and cycle threshold. Fever was found to be positively correlated with C-reactive protein (r=0.568, P<0.001) and procalcitonin (r=0.472; P=0.001). Conclusions: Although we found a higher HBoV1 viral load in children with more cough symptoms in our study, it had no effect on the severity of the disease, such as length of hospital stay and need for intensive care. Coinfection was found to affect the length of hospitalization.
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Objective:To investigate the epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (ALRTI), and to analyzed the risk factors for severe infection.Methods:The epidemiological and clinical data of hospitalized children with ALRTI and positive RSV test from Children′s Hospital of Fudan University from January 2013 to December 2018 were retrospectively analyzed.The hospitalized children from October 2016 to November 2017 were selected by random singular sequence and divided into severe infection group and non-severe infection group. The clinical data of the two groups were compared. Multivariate logistic regression analysis was used to analyze the risk factors of severe RSV-associated ALRTI.Results:A total of 34 192 hospitalized children were diagnosed with ALRTI, and 8 113(23.73%) children were positive for respiratory tract viruses, including 4 028(11.78%) children with RSV infection, which was higher than other common respiratory tract viruses. Among the 4 028 RSV-positive children, 2 550(63.31%) were under six months of age, 3 623(89.95%) were under two years of age. The detection rates of RSV in spring, summer, autumn and winter were 6.47%(553/8 551), 2.46%(176/7 161), 12.85%(1 042/8 111) and 21.77%(2 257/10 369), respectively. In 347 hospitalized children with RSV-associated ALRTI, 54 cases were severe cases. Multivariate logistic regression analysis showed that RSV-positive patients complicated with respiratory diseases ( Z=3.43), cardiovascular diseases ( Z=4.96), non-exclusive breast-feeding ( Z=-1.97) and premature birth ( Z=-1.98) were independent risk factors for severe RSV-associated ALRTI (all P<0.050). Conclusions:RSV is the most important and common viral pathogen in hospitalized children with ALRTI in Shanghai, and infants under six months of age are the most susceptible to RSV. RSV patients complicated with respiratory diseases, cardiovascular diseases, non-exclusive breast-feeding and premature birth are more likely to develope severe RSV-associated ALRTI.
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Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.
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INTRODUCTION@#Chest physiotherapy (CPT) may benefit children aged below five years who suffer from lower respiratory tract infection (LRTI). However, its effects depend on the technique used. This study aimed to determine whether mechanical CPT using the LEGA-Kid® mechanical percussion device is superior to manual CPT in children with LRTI.@*METHODS@#Children aged five months to five years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid. Outcomes measured before intervention and two hours after intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.@*RESULTS@#All 30 enrolled patients showed significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.@*CONCLUSION@#Children receiving both manual and mechanical CPT showed improvements in respiratory distress symptoms, with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements in moderately severe respiratory distress. The LEGA-Kid mechanical CPT method is superior to manual CPT in reducing the RR.
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Child , Humans , Percussion/methods , Physical Therapy Modalities , Respiratory Distress Syndrome, Newborn , Respiratory Therapy/methods , Respiratory Tract Infections , Single-Blind MethodABSTRACT
Abstract Objective: To investigate the impact of recombinant human interferon α1b (rhIFNα1b) treatment in infants hospitalized with lower respiratory tract infections on subsequent wheezing. Methods: The clinical data of infants (n = 540) with viral pneumonia, wheezy bronchitis, or bronchiolitis hospitalized in 19 Chinese hospitals from June 2009 to June 2015 were retrospectively analyzed. The parameters relevant to wheezing episodes within the last year were collected by telephone and questionnaires. The rhIFNα1b treatment group (n = 253) and control group (n = 287) were compared in terms of wheezing episodes within the last year. Moreover, the wheezing group (95 cases) and non-wheezing group (445 cases) were compared. Results: Out of 540 cases, 95 (17.6%) experienced wheezing episodes, 13.8% (35/253) cases treated with rhIFNα1b, and 20.9% (60/287) cases without rhIFNα1b experienced wheezing episodes within the last year. The rhIFNα1b treatment significantly improved wheezing episodes within the last year, compared with the control peers (p = 0.031). Single-factor regression showed statistically significant differences between the wheezing and non-wheezing groups in terms of age, rhIFNα1b use, childhood and family history of allergy, housing situation, and feeding history (p < 0.05). Binary logistic regression showed a childhood history of allergy (OR = 2.14, p = 0.004), no rhIFNα1b use (OR = 1.70, p = 0.028), and living in a crowded house (OR = 1.92, p = 0.012) might be risk factors of subsequent wheezing. Accordingly, breastfeeding (OR = 0.44, p = 0.008) and hospitalization age of 1-year-old (OR = 0.58, p = 0.024) were protective factors. Conclusions: Early use of rhIFNα1b in infants hospitalized with lower respiratory tract infections and breastfeeding could prevent subsequent wheezing. Living in a crowded house could promote subsequent wheezing.
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Humans , Female , Infant , Respiratory Tract Infections/drug therapy , Bronchiolitis , Respiratory Sounds , Retrospective Studies , Risk Factors , InterferonsABSTRACT
RESUMEN Introducción: A la luz de los conocimientos más recientes, es trascendente enfatizar el potencial papel que desarrolla la microbiota intestinal, a través del eje intestino-pulmón, con la microbiota pulmonar. Objetivo: Actualizar criterios acerca de la microbiota pulmonar en sujetos sanos y su relación con el eje intestino-pulmón. Métodos: Se revisaron publicaciones en español e inglés en PubMed, Google Scholar, ScIELO, desde enero 2010-mayo 2020, se usaron los términos: microbiota pulmonar, microbiota vías respiratorias inferiores, eje intestino-pulmón, microbiota pulmonar e inmunidad y probióticos de nueva generación. Análisis e integración de la información: Se exponen argumentos relacionados con la presencia de microbiota comensal residente en el pulmón formada por bacterias, hongos y virus como integrantes de la comunidad microbiana. Papel del eje intestino-pulmón y su participación en modulación inmune. Se describen rasgos de la microbiota pulmonar, su biomasa, diversidad, y filos integrantes. Se resumen investigaciones en animales. Se destaca valor de la nueva tecnología de secuenciación gen 16S del ARNr para estudio e identificación. Consideraciones finales: El pulmón era considerado órgano estéril. Aquí se documenta la presencia de microbiota comensal residente en el pulmón, de gran diversidad, se postulan los mecanismos del eje intestino-pulmón y su papel en la modulación de la inmunidad pulmonar y valor diagnóstico en enfermedades del tracto respiratorio inferior. Se enfatiza el uso futuro de probióticos de nueva generación como moduladores de la microbiota pulmonar.
ABSTRACT Introduction: In the light of the most recent knowledge, it is important to emphasize the potential role played by the gut microbiota, through the gut-lung axis, with the lung microbiota. Objective: Update the criteria about the lung microbiota in healthy subjects and its relationship with the gut-lung axis. Methods: Publications in Spanish and English were reviewed in PubMed, Google Scholar, ScIELO, from January 2010 to May 2020; the following terms were used: lung microbiota, lower respiratory tract microbiota, gut-lung axis, lung microbiota and immunity and next- generation probiotics. Analysis and integration of information: Arguments related to the presence of commensal microbiota resident in the lung formed by bacteria, fungi and viruses as members of the microbial community are presented. Role of the gut-lung axis and its participation in immune modulation. Features of the lung microbiota, its biomass, diversity, and component phylums are described. Researches in animals are summarized. The value of the new 16S gene sequencing technology of rRNA for study and identification is highlighted. Final considerations: The lung was considered a sterile organ. Here the presence of resident commensal microbiota of great diversity in the lung is documented; the mechanisms of the gut-lung axis and its role in the modulation of lung immunity and diagnostic value in diseases of the lower respiratory tract are stated. The future use of next-generation probiotics as modulators of the lung microbiota is emphasized.
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Background: AmpC or class C or group 1 beta lactamases are class C cephalosporinases that hydrolyse a wide variety of beta-lactam antibiotics including alpha methoxy beta-lactams (cefoxitin), narrow and broad spectrum cephalosporins. This study was conducted to characterize plasmid-mediated AmpC producing enteric Gram- negative bacteria from patients with lower respiratory tract infections in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile Ife, Osun State, Nigeria Methodology: A total of 149 patients with clinical features of lower respiratory tract infections (LRTI) were selected by simple random sampling for the study. All Gram-negative isolates recovered from standard microbiological cultures of respiratory specimens of these patients were tested against cefoxitin, third generation cephalosporins (3GCs), and other antibiotics using the disc diffusion AST method, and also screened for production of AmpC beta-lactamases phenotypically by the CLSI method. Plasmid DNA extraction was carried out on twenty-nine cefoxitin-resistant selected isolates using the Kado and Lin method, while genotypic detection of plasmid-mediated AmpC gene was carried out by the polymerase chain reaction (PCR) assay. Results: The results showed that 204 (43.3%) of 471 isolates recovered from the 149 selected patients were resistant to 3GC in the AST assay, among which 121 (59.3%) were resistant to cefoxitin, and 189 of the 471 isolates (40.1%) were AmpC producers. The AmpC producers concurrently showed multiple resistance pattern to other antibiotics tested in this study. Ninety six percent of the 29 selected isolates for plasmid analysis contained plasmids, 45% of which amplified positive on PCR for CMY, 38% for FOX, and 31% for ACC types of AmpC genes. Conclusion: This study showed a high degree of antibiotic resistance among enteric Gram-negative bacteria recovered from patients with LRTIs, as well as high degree of plasmid-encoded AmpC genes responsible for this high antibiotic resistance among the isolates. Proper antibiotic policy and regulation are required to limit the spread of plasmid mediated AmpC ß-lactamase
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Humans , Plasmids , Respiratory Tract Infections , Polymerase Chain Reaction , Tertiary Care Centers , NigeriaABSTRACT
Objective:To investigate the clinical characteristics of acute lower respiratory tract infection (ALRTI) in neonates caused by respiratory syncytial virus (RSV), and to analyze the factors associated with the severe infection.Methods:Clinical data of 399 ALRTI neonates with positive nucleic acids or antigen of RSV admitted to Shenzhen Children′s Hospital from January 2014 to December 2020 were retrospectively analyzed for their clinical cha-racteristics.They were divided into mild-to-moderate group and severe group according to the severity index (SI), and the clinical data of the 2 groups were compared.Relevant factors of severe ALRTI of RSV in neonates were analyzed by multivariate Logistic regression. Results:(1) A total of 399 ALRTI neonates with RSV infection were included, involving 239 males (59.9%) and 160 females (40.1%) with a male-to-female ratio of 1.49∶1.00.There were 349 cases (87.5%) and 50 cases (12.5%) in the mild-to-moderate group and severe group, respectively.The disease mainly occurred from March to October.(2) There were significant differences in the preterm delivery [15 cases (4.3%) vs.9 cases (18.0%)], low birth weight [11 cases (3.2%) vs.6 cases (12.0%)], previous hospitalization history [12 cases (3.4%) vs.5 cases (10.0%)], and breastfeeding [167 cases (47.9%) vs.16 cases (32.0%)] between the mild-to-moderate group and severe group ( χ2=14.524, 8.394, 4.616 and 4.426, respectively, all P<0.05). (3) There were significant differences in fever [78 cases (22.4%) vs.18 cases (36.0%)], shortness of breath [156 cases (44.7%) vs.36 cases (72.0%)], poor appetite [48 cases (13.8%) vs.15 cases (30.0%)], wheezing [20 cases (5.7%) vs.10 cases (20.0%)], cyanosis [30 cases (8.0%) vs.16 cases (32.0%)] and mental status (irritability/malaise) [20 cases (5.7%) vs.8 cases (16.0%)], and duration of cough[(8.1±2.6) days vs.(9.4±2.9) days ] between the mild-to-moderate group and severe group ( χ2=4.460, 13.057, 8.682, 12.806, 23.486 and 7.068, t=-3.054, all P<0.05). Moist rales in the lungs [29 cases (58.0%) vs.114 cases (32.7%)] and three concave signs [14 cases (28.0%) vs.20 cases (5.7%)] were commonly found in the severe group, while pulmonary phlegm sounds [168 cases (48.1%) vs.14 cases (28.0%)]was commonly found in the mild-to-moderate group, and the differences were statistically significant ( χ2=12.208, 27.823 and 7.149, respectively, all P<0.05). (4) Multifactorial analysis showed that premature delivery was an independent risk factor for the development of severe ALRTI caused by RSV in neonates ( OR=3.717, 95% CI: 1.257-10.987), and shortness of breath ( OR=2.216, 95% CI: 1.061-4.629), cyanosis ( OR=3.621, 95% CI: 1.638-8.004) and three concave signs ( OR=2.688, 95% CI: 1.077-6.711) may be early warning factors for the severe condition. Conclusions:Preterm infants with RSV infection are prone to develop into severe disease, and neonates with RSV infection with shortness of breath, cyanosis and three concave signs as symptoms of severe infection should be well concerned for a close monitoring.
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Lower respiratory tract infections (LRTIs) caused by Pseudomonas aeruginosa are the most common infection among hospitalized patients, associated with increased levels of morbidity, mortality and attributable health care costs. Increased resistant Pseudomonas worldwide has been quite meaningful to patients, especially in intensive care unit (ICUs). Different species of Pseudomonas exhibit different genetic profile and varied drug resistance. The present study determines the molecular epidemiology through DNA fingerprinting method and drug resistance of P. aeruginosa isolated from patients with LTRIs admitted in ICU. A total of 79 P. aeruginosa isolated from patients with LRTIs admitted in ICU were characterized by Restriction Fragment Length Polymorphism (RFLP), Random Amplified Polymorphic DNA (RAPD) and Repetitive Extrapalindromic PCR (REP-PCR). Antibiotic resistance was determined by minimum inhibitory concentration (MIC) assay while MDR genes, viz, blaTEM, blaOXA, blaVIM, blaCTX-M-15 were detected by polymerase chain reaction (PCR). Of the 137 Pseudomonas sp isolated from ICU patients, 57.7% of the isolates were reported to be P. aeruginosa. The overall prevalence of P. aeruginosa among the all included patients was 34.5%. The RAPD analysis yielded 45 different patterns with 72 clusters with 57% to 100% similarity level. The RFLP analysis yielded 8 different patterns with 14 clusters with 76% to 100% similarity level. The REP PCR analysis yielded 37 different patterns with 65 clusters with 56% to 100% similarity level. There was no correlation among the different DNA patterns observed between the three different methods. Predominant of the isolates (46.8%) were resistant to amikacin. Of the 79 isolates, 60.8% were positive for blaTEM gene and 39.2% were positive for blaOXA gene. P. aeruginosa was predominantly isolated from patients with LRTIs admitted in ICU. The difference in the similarity level observed between the three DNA fingerprinting methods indicates that there is high inter-strain variability. The high genetic variability and resistance patterns indicates that we should continuously monitor the trend in the prevalence and antibiotic resistance of P. aeruginosa especially in patients with LRTIs admitted in ICU.
Infecções do trato respiratório inferior (ITRIs) são as infecções mais comuns entre pacientes internados em unidade de terapia intensiva (UTI). Pseudomonas aeruginosa é a causa mais comum de ITRIs e está associada ao aumento da mortalidade. Diferentes espécies de Pseudomonas exibem diferentes perfis genéticos e resistência variada as drogas. O presente estudo determina a epidemiologia molecular através do método de fingerprinting de DNA e resistência as drogas de P. aeruginosa isoladas de pacientes com LTRIs internados em UTI. Um total de 79 P. aeruginosa isoladas de pacientes com ITRIs internados em UTI foram caracterizados por Polimorfismo de Comprimento de Fragmentos de Restrição (RFLP), DNA Polimórfico Amplificado ao Acaso (RAPD) e PCR Extrapalindrômico Repetitivo (REP-PCR). A resistência aos antibióticos foram determinadas pelos ensaios de concentrações inibitória mínima (MIC), enquanto os genes MDR, blaTEM, blaOXA, blaVIM, blaCTX-M-15 foram detectados pela reação em cadeia da polimerase (PCR). Das 137 Pseudomonas sp isoladas de pacientes de UTI, 57,7% dos isolados foram relatados como P. aeruginosa. A prevalência geral de P. aeruginosa entre os pacientes incluídos foram de 34,5%. A análise RAPD renderam 45 padrões diferentes com 72 clusters com nível de similaridade de 57% a 100%. A análise RFLP renderam 8 padrões diferentes com 14 clusters com 76% a 100% de similaridade. A análise de PCR do REP produziram 37 padrões diferentes com 65 clusters com nível de similaridade de 56% a 100%. Não houveram correlações entre os diferentes padrões de DNA observados entre os três diferentes métodos. Predominantes dos isolados (46,8%) eram resistentes à amicacina. Dos 79 isolados, 60,8% foram positivos para o gene blaTEM e 39,2% foram positivos para o gene blaOXA. P. aeruginosa foi predominantemente isolado de pacientes com ITRIs internados em UTI. A diferença no nível de similaridade observado entre os três métodos de fingerprinting do DNA indica que há alta variabilidade inter-strain. A alta variabilidade genética e os padrões de resistência indicam que devemos monitorar continuamente a tendência na prevalência e resistência a antibióticos de P. aeruginosa, especialmente em pacientes com ITRIs internados em UTI.
Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/epidemiology , Respiratory System/microbiology , Microbial Sensitivity Tests , Molecular Epidemiology , Random Amplified Polymorphic DNA Technique , Intensive Care UnitsABSTRACT
Next-generation sequencing (NGS), also known as high-throughput sequencing, is more efficient compared with Sanger sequencing that has become the standard method of clinical DNA sequencing, and can obtain a large amount of information in a relatively short time at a lower cost.NGS has broad prospects in such aspects as diagnosing the pathogen of lower respiratory tract infection in children, identifying the pathogen of cross-infection in hospital, drug resistance research and vaccine development.It is still worth conducting further studies on the approach to improve the specificity and sensitivity of diagnosis and to optimize NGS.
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Background: Frequency of nutritional rickets, its clinicobiochemical profile and its relationship to the lower respiratory tract infections in indoor patients from 2 to 60 months of age.Methods: Children aged 2 to 60 months admitted for the first time were included in the study and divided into two groups i.e. with and without clinical signs of rickets. Disease profile was studied in both groups. Incidence of lower respiratory tract infection was compared between two groups. Children with clinicoradiological signs of rickets were also investigated for biochemical abnormalities.Results: During the one year study period a total of 393 children were admitted, 65 were found to have rickets constituted as study group and 328 were without rickets were included the controls. Rickets incidence was 16.5% of which majority (74.6%) were males and most rachitic children (64.6%) were below six months of age. Acute lower respiratory tract infection (64.6%) was commonest in study group and acute gastroenteritis (24.4%) in the controls. The rate of ALRTI was nearly three times in study group. Frontal bossing (67.7%) was most common sign of rickets and increased alkaline phosphatase (93.8%) was the commonest biochemical abnormality.Conclusions: Nutritional rickets, a multifactorial disease, is easily preventable. The present study has revealed the high incidence of rickets i. e., 16.5% and also show the strong statistically significant association of nutritional rickets with acute lower respiratory tract infections.
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The diagnosis of several diseases in chelonians is a challenge in the veterinary clinic, because a detailed physical examination with auscultation and palpation is difficult due the presence of carapace and plastron. Imaging analysis such as radiography and computed tomography (CT) have been shown to be beneficial for diagnosis, prognosis and treatment in numerous animal species. Thus, this study aimed to identify and describe the structures of the lower respiratory tract in red-foot tortoises, by computed tomography, radiography and gross anatomy in twelve red-foot tortoises (Chelonoidis carbonaria), adults and of both sexes. The lower respiratory tract in these animals comprised the larynx, trachea, bronchi and the lungs. The presence of epiglottic cartilage was not observed in the animals studied. CT allowed the observation of the intrapulmonary part of the bronchi, which was accompanied by large intrapulmonary blood vessels. The lungs presented a reticulated parenchyma, without lobulations. Each lung had a small chamber located near the cranial and caudal poles. These structures were identified in CT and 3D CT reconstructions and these could suggest that these chambers could be non-respiratory structures, and could be comparable to the air sacs of birds. This study establishes normal CT anatomy of the lower respiratory tract of the red-foot tortoise; and may be used as a reference in the assessment of respiratory disorders in this tortoise.(AU)
O diagnóstico de diversas afecções em quelônios é um desafio para a clínica veterinária, já que um exame físico detalhado com auscultação e palpação é difícil devido à presença da carapaça e do plastrão. A radiografia e a tomografia computadorizada (TC) tem se mostrado benéficas para o diagnóstico, prognóstico e tratamento em muitas espécies animais. Assim, este estudo teve por objetivo identificar e descrever as estruturas do trato respiratório inferior no jabuti-piranga por meio da tomografia computadorizada, radiografia e anatomia em 12 jabutis-piranga (Chelonoidis carbonara), adultos e de ambos os sexos. Nos animais estudados, o trato respiratório inferior consistiu da laringe, traqueia, brônquios e os pulmões. A cartilagem epiglote não foi observada. A TC permitiu a observação da parte intrapulmonar dos brônquios, a qual estava acompanhada dos vasos sanguíneos intrapulmonares. Os pulmões possuíam um parênquima reticulado, sem lobações. Cada pulmão tinha uma pequena câmara localizada junto aos pólos cranial e caudal. Estas estruturas foram identificadas na TC e na reconstrução 3D a partir da TC e poderiam ser estruturas não-respiratórias, podendo ser comparadas aos sacos aéreos das aves. Este estudo identificou a anatomia normal por meio da TC do trato respiratório inferior do jabuti-piranga, o que pode ser usado como referência para diagnóstico de desordens respiratórias nesta espécie.(AU)
Subject(s)
Animals , Trachea/diagnostic imaging , Turtles/anatomy & histology , Bronchi/diagnostic imaging , Larynx/diagnostic imaging , Lung/diagnostic imaging , Respiratory System/anatomy & histology , Radiography/veterinary , Tomography, X-Ray Computed/veterinaryABSTRACT
Background: Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Poverty and malnutrition underlie both the high incidence and deaths of young children from pneumonia in SEAR countries.Methods: A hospital based prospective observational study was conducted in a tertiary care hospital. A total of 200 children admitted with signs of ALRI were included in the study. A portable oximeter was used to measure oxygen saturation with an appropriately sized sensor on the finger or the toe. Weight was recorded on a standardized digital weighing scale and plotted on standard WHO weight for age chart. Chi-square test was used to test the significance.Results: Out of 200 children studied hypoxemia was present in 90 children with a percentage of 45% and absent in 110 children with a percentage of 55%. Out of 90 children who had hypoxemia, 40 children had weight less than 3rd centile. Out 110 children who had did not have hypoxemia, only 24 children had weight less than 3rd centile. It was observed that children with Weight for age less than 3rd centile according to standard WHO charts had higher incidence of hypoxemia. This correlation was statistically significant at p value of 0.001.Conclusions: Based on the results of this study hypoxemia is widely prevalent in children aged between six months to five years presenting with acute lower respiratory tract infection. There was significant correlation with weight and hypoxemia in children aged between six months to five years with acute lower respiratory tract infection.
ABSTRACT
Background: Vitamin D plays important role in immunity and its deficiency might be associated with increased risk of lower respiratory tract infection. This study aimed to determine whether vitamin D deficiency is commoner in infants with acute lower respiratory tract infection as compared to normal infants and to correlate the severity of vitamin D deficiency with severity of ALRTI.Methods: A hospital based prospective case-control study was conducted in a tertiary care hospital. A total of 208 infants (109 cases and 99 controls) older than 7 days to 12 months of age, were enrolled. Cases were selected according to the definition of ALRTI given by WHO (2). Controls were chosen from children attending paediatric outpatients department for immunization or minor short duration aliments. Primary outcome measured as serum 25-hydroxy vitamin D3 (25OHD3) levels and severity of ALRTI was independent variable.Results: Among 109 cases suffering from ALRTI, vitamin D deficiency was present in 65.11%, 92.3%, 88.9% children of ‘pneumonia, severe pneumonia and very severe pneumonia group respectively. It was found that vitamin D deficiency was commoner in cases as compared to controls (80.70 % vs 25.50% ) with OR of 12.40 (95 % CI was 6.13 - 25.38). There was inverse relationship between the severity of ALRTI and Vitamin D levels (p value <0.001 and Pearson correlation coefficient -0.32).Conclusions: Vitamin D levels were significantly lower in ALRI cases as compared to controls and had negative correlation between vitamin D levels and severity of pneumonia.
ABSTRACT
Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.