Human metapneumovirus in Jordan: prevalence and clinical symptoms in hospitalized pediatric patients and molecular virus characterization.

Respiratory viral infections account for significant morbidity and mortality especially in young children worldwide. Human metapneumovirus (hMPV) causes illnesses ranging from mild respiratory problems to bronchiolitis and severe pneumonia. From January to December 2007, 220 nasopharyngeal aspirates were collected from children younger ≤ 13 years old hospitalized with lower respiratory tract infection to detect hMPV by revese transcription-polymerase chain reaction and to clone and sequence the hMPV-positive samples. Human metapneumovirus was detected in 28 (12.7%) specimens with a median age of 7 months (range 1.3 to 24 months). Human metapneumovirus type A and type B were detected in 26 (93%) and 8 (28.6%) of specimens, respectively. Coinfection with hMPV type A and type B was detected in 6 (21.4%) specimens positive for hMPV. The major clinical diagnosis of hMPV-positive patients was bronchiolitis (75%). Human metapneumovirus and hMPV type B were found to be significantly associated with bronchiolitis (P = 0.03 and 0.01, respectively). Human metapneumovirus and hMPV type A were found to be significantly associated with pneumonia (P = 0.004 and 0.002, respectively). The main symptoms in patients infected with hMPV were cough (92.9%), fever (82.1%), and wheezing (78.6%), with a significant association of hMPV type A with fever (P = 0.018). Human metapneumovirus was seasonally distributed; most infections with hMPV were reported in the late winter and early spring. The peak of hMPV incidence was in February (10/28; 35.7%). Sequencing of purified plasmid DNA was performed in forward and reverse direction to confirm the results of hMPV-positive samples which scored 97% identity to hMPV type A genome isolate NL/17/00 and showing C-T variation that had no effect on the amino acid sequence F(Phe)-F(Phe).

Rapid detection and clinical features of infants and young children with acute lower respiratory tract infection due to respiratory syncytial virus.

During December to the end of February of 2003 and 2004, a total of 282 nasopharyngeal aspirates were obtained from infants and young children admitted to the Buraidah Maternity and Pediatric Hospital, Al-Qassim, Saudi Arabia, and clinically diagnosed as suffering from acute lower respiratory tract infections. The aspirates were tested for the presence of respiratory syncytial virus using direct fluorescein-labeled monoclonal antibody assay. Of the 282 specimens, 128 (45.4%) were found to be positive for respiratory syncytial virus. The most positive specimens came from patients less than one year old (51.3%), and were associated with bronchopneumonia (56.7%) or bronchiolits (55.4%). Coughing (100%) and tachpnea (98%) were significantly more frequent in infants with respiratory syncytial virus infection, followed by wheezing, crepitation and retraction, each representing 66%. Three deaths were reported. The availability of a rapid viral diagnostic assay will be an important tool for physicians to make more accurate treatment decisions and therefore reduce unnecessary antibiotic usage and hospital stay for the patients.

Rapid detection and clinical features of influenza and parainfluenza in infants and young children hospitalized with acute lower respiratory illnesses.

During the winter seasons of 2003 and 2004, a total of 282 nasopharyngeal aspirates (NPAs) were obtained from infants and young children admitted to the Buraidah Maternity and Pediatric Hospital, Al-Qassim, Saudi Arabia, and clinically diagnosed as suffering from acute lower respiratory tract infections. NPAs were screened for the presence of respiratory viruses and further confirmed for the presence of influenza, parainfluenza, and adenovirus using direct fluorescein-labeled monoclonal antibody assay. Of all the 282 specimens, 44 (15.6 per cent) were found positive for influenza, parainfluenza, and adenovirus. Influenza A and B were identified in 22 (7.8 per cent), 4 (1.4 per cent), respectively, parainfluenza 1, 2, and 3 in 9 (3.2 per cent), 4 (1.4 per cent), and 1 (0.4 per cent), respectively, and adenovirus in 4 (1.4 per cent). Influenza and parainfluenza viruses were noted more in patients below the age of 1 year; 11.3 per cent and 6.2 per cent, respectively. Bronchiolitis, coughing, and tachpnea were significantly more frequent in infants with influenza infection: 13.1 per cent, 55 per cent, and 50 per cent, respectively. The availability of rapid viral diagnostic assay is an important tool for physicians to make more accurate treatment decisions and therefore reduces unnecessary antibiotic usage and hospital stay for patients.

Enteroviral meningitis in Northern Jordan: prevalence and association with clinical findings.

During the summer-autumn of 1999, 390 specimens of cerebrospinal fluid were taken from infants and children younger than 15 years of age. They were suspected of having meningitis and were admitted to Princess Rahma Hospital, Northern Jordan. They were investigated for the presence of enteroviruses using shell vial culture and indirect immunofluorescence assays. Most cases (46.9%) occurred in children younger than 1 year of age in which males represented 71.9%. The common symptoms were fever, vomiting, and headache. Enteroviruses were isolated from 32 (8.2%) cases, coxsackievirus B types 2, 4, and 5 from 15 (46.9%) cases, and echovirus 9 (31.3%) was the most common identified serotype. The virus isolation rate was directly proportional to the number of leukocytes in the cerebrospinal fluid. However, enteroviral isolation was demonstrated in 4 (12.5%) of 32 cerebrospinal fluid specimens without pleocytosis. Leukocyte differential count revealed a predominance of polymorphonuclear cells in 71.4% of the cases. Hospitalization ranged from 1 day to 25 days with a mean of 7 days. The majority of enterovirus-infected patients (88.9%) were treated with at least one type of antibiotic. These results emphasize the importance of shell vial culture assay for diagnosing enteroviruses, especially in laboratories that do not have access to advanced techniques such as polymerase chain reaction.