Clinical analysis of 82 cases of children with post-influenza acute lower respiratory tract infection / 中国小儿急救医学

ABSTRACT

Objective To explore the clinical characteristics of acute lower respiratory tract infection in children after influenza,and to provide evidence-based basis for timely diagnosis and accurate treatment of acute lower respiratory tract infection in children after influenza. Methods Eighty- two patients with acute lower respiratory tract infection admitted to Shanghai Children′ s Medical Center from October 2016 to November 2017 were enrolled in our study. The clinical data of these patients were analyzed and influenza A or influenza B were confirmed by Filmarray platform. The clinical characteristics of patients with influenza A and influenza B,severe pneumonia and non-severe pneumonia,mechanical ventilation and non-mechanical ventilation were compared. Results The age distribution of the children ranged from 0. 13 to 15 years old, with 73 cases (89. 0％ ) being younger than 5 years old. There were 47 cases of influenza A (57. 3％ ) and 35 cases of influenza B (42. 7％ ). The proportions of cases in spring,summer,autumn and winter were 35. 3％ ,15. 9％ ,15. 9％ and 32. 9％ ,respectively. Congenital heart disease was the most common underlying disease (28 cases,34. 1％ ). Twenty-five(30. 5％ ) patients were diagnosed as severe pneumonia. Oseltamivir was added on the first to eighth days of the course with median time ( IQR) 2. 0 (3. 0) days. Thirteen (15. 9％ ) patients needed ventilator-assisted ventilation. There were significant differences in the incidence of influenza A and influenza B in summer (12 / 47 vs. 1 / 35,χ2 = 7. 7,P < 0. 01). Compared to non-severe pneu-monia,severe pneumonia was positively correlated with underlying diseases(17 / 25 vs. 18 / 57,χ2 = 9. 4,P <0. 01),digestive tract symptoms(10 / 25 vs. 6 / 57,χ2 = 9. 6,P < 0. 01) and high PCT level(8 / 23 vs. 8 / 56,χ2 = 3. 1,P < 0. 01),but negatively correlated with oseltamivir application[M(IQR)] [5. 0(2. 5) d vs. 2. 0 (1. 5)d,Z = - 6. 1,P < 0. 01]. There was significant difference in the proportion of influenza A/ B between ventilator group and non-ventilator group (11 / 2 vs. 36 / 33,χ2 = 4. 7,P < 0. 01). Conclusion Filmarray re-spiratory tract detection system can detect influenza virus infection quickly and accurately,providing a good basis for early diagnosis and treatment. Children under 5 years old are susceptible to influenza. Influenza in children mainly occurs in winter and spring. Influenza A mainly occurs in summer. Patients with influenza A infection,underlying diseases,digestive tract symptoms during the course of illness and elevated PCT are more likely to progress to severe illness or even use ventilator treatment. Early use of oseltamivir can improve the prognosis of the disease.