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      Viruses and atypical bacteria associated with asthma exacerbations in hospitalized children†

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          Abstract

          Objectives and Working Hypothesis

          To evaluate the prevalence of respiratory viruses Mycoplasma pneumoniae and Chlamydophila pneumoniae and gain insight into their seasonal circulation pattern in children with acute asthma exacerbations in a temperate southern hemisphere region.

          Study Design

          Patients hospitalized between 3 months and 16 years of age were included in a 1‐year prospective, observational, cross‐sectional study. Respiratory secretions were collected and the presence of different viruses and atypical bacteria analyzed by immunofluorescence and polymerase chain reaction.

          Results

          Two hundred nine patients (118 females) aged (mean ± SD) 4.4 ± 4 years were included. A potential causative agent was detected in 78% of the patients. The most frequently detected viruses were respiratory syncytial virus (HRSV) (n = 85; 40%) and rhinovirus (HRV) (n = 52; 24.5%); M. pneumoniae and C. pneumoniae were detected in 4.5% and 2% of the cases, respectively. Patients with HRSV (vs. HRV) were hospitalized for a longer time (6.7 vs. 5.2 days, P = 0.012), required more days of oxygen supply (5.1 vs. 3.4, P = 0.005), had a longer duration of the exacerbation before hospitalization (3.6 vs. 1.9 days, P = 0.001) and were younger (3.7 vs. 5.1 years, P = 0.012). Three peaks of admissions were observed. A first peak (early autumn) caused by HRV, a second peak (winter) caused mainly by HRSV and a third one (spring), caused by HRSV, an increase in HMPV together with a second outbreak of HRV.

          Conclusions

          Children with an acute asthma exacerbation presented a high prevalence of respiratory viruses. Most hospitalizations corresponded to seasonal increases in prevalence of HRV and HRSV. Pediatr Pulmonol. 2010; 45:619–625. © 2010 Wiley‐Liss, Inc.

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          Most cited references25

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          Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

          S Johnston, P Pattemore, G. Sanderson … (1995)
          To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. 108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. Southampton and surrounding community. Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. Viruses were detected in 80% of reported episodes of reduced peak expiratory flow, 80% of reported episodes of wheeze, and in 85% of reported episodes of upper respiratory symptoms, cough, wheeze, and a fall in peak expiratory flow. The median duration of reported falls in peak expiratory flow was 14 days, and the median maximum fall in peak expiratory flow was 81 l/min. The most commonly identified virus type was rhinovirus. This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.
          Article 0 comments Cited 427 times – based on 0 reviews     Review now
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            Human Bocavirus and Acute Wheezing in Children

            Tobias Allander, Tuomas Jartti, Shawon Gupta … (2007)
            Abstract Background . Human bocavirus is a newly discovered parvovirus. It has been detected primarily in children with acute lower respiratory tract infection, but its occurrence, clinical profile, and role as a causative agent of respiratory tract disease are not clear. Methods . We investigated the presence of human bocavirus by quantitative polymerase chain reaction of nasopharyngeal aspirate specimens and selected serum samples obtained from 259 children (median age, 1.6 years) who had been hospitalized for acute expiratory wheezing. The samples were analyzed for 16 respiratory viruses by polymerase chain reaction, virus culture, antigen detection, and serological assays. Results . At least 1 potential etiologic agent was detected in 95% of children, and >1 agent was detected in 34% of children. Human bocavirus was detected in 49 children (19%). A large proportion of the cases were mixed infections with other viruses, but human bocavirus was the only virus detected in 12 children (5%). High viral loads of human bocavirus were noted mainly in the absence of other viral agents, suggesting a causative role for acute wheezing. In addition, infections that had uncertain clinical relevance and low viral loads were prevalent. Human bocavirus DNA was frequently detected in serum specimens obtained from patients with acute wheezing, suggesting systemic infection. Conclusions . Human bocavirus is prevalent among children with acute wheezing and can cause systemic infection. Results suggest a model for bocavirus infection in which high viral loads are potentially associated with respiratory symptoms and low viral loads indicate asymptomatic shedding. Therefore, quantitative polymerase chain reaction analysis may be important for additional studies of human bocavirus.
            Article 0 comments Cited 233 times – based on 0 reviews     Review now
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              Comparison of real-time PCR assays with fluorescent-antibody assays for diagnosis of respiratory virus infections in children.

              Susan N Wright, Lawrence Corey, Jane Kuypers … (2006)
              Conventional fluorescent-antibody (FA) methods were compared to real-time PCR assays for detection of respiratory syncytial virus (RSV), influenza virus type A (FluA), parainfluenza virus types 1, 2, and 3 (PIV1, PIV2, and PIV3), human metapneumovirus (MPV), and adenovirus (AdV) in 1,138 specimens from children with respiratory illnesses collected over a 1-year period. At least one virus was detected in 436 (38.3%) specimens by FA and in 608 (53.4%) specimens by PCR (P<0.001). Specimen quality was inadequate for FA in 52 (4.6%) specimens; 13 of these (25%) were positive by PCR. In contrast, 18 (1.6%) specimens could not be analyzed by PCR; 1 of these was positive by FA. The number of specimens positive only by PCR among specimens positive by PCR and/or FA was 18 (7.0%) of 257 for RSV, 18 (13.4%) of 134 for FluA, 25 (64.1%) of 39 for PIV1, 8 (88.9%) of 9 for PIV2, 17 (30.1%) of 55 for PIV3, and 101 (76.5%) of 132 for AdV. MPV was detected in 6.6% of all specimens and in 9.5% of the 702 specimens negative by FA. The mean number of virus copies per milliliter in specimens positive by both PCR and FA was significantly higher, at 6.7x10(7), than that in specimens positive only by PCR, at 4.1x10(4) (P<0.001). The PCR assays were significantly more sensitive than FA assays for detecting respiratory viruses, especially parainfluenza virus and adenovirus. Use of real-time PCR to identify viral respiratory pathogens in children will lead to improved diagnosis of respiratory illness.
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                Author and article information

                Contributors
                Alberto F. Maffey: amaffey@gmail.com
                Journal
                Journal ID (nlm-ta): Pediatr Pulmonol
                Journal ID (iso-abbrev): Pediatr. Pulmonol
                Journal ID (doi): 10.1002/(ISSN)1099-0496
                Journal ID (publisher-id): PPUL
                Title: Pediatric Pulmonology
                Publisher: Wiley Subscription Services, Inc., A Wiley Company (Hoboken )
                ISSN (Print): 8755-6863
                ISSN (Electronic): 1099-0496
                Publication date (Electronic): 06 May 2010
                Publication date (Print): June 2010
                Volume: 45
                Issue: 6 ( doiID: 10.1002/ppul.v45:6 )
                Pages: 619-625
                Affiliations
                [ 1 ]Centro Respiratorio, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
                [ 2 ]Laboratorio de Virología, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
                [ 3 ]Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
                [ 4 ]Inmunología Clínica, Cátedra de Análisis Clínicos I, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas “José de San Martín,” Universidad de Buenos Aires, Buenos Aires, Argentina
                [ 5 ]Comisión de Investigaciones Científicas de la Provincia de Buenos Aires (CIC), Buenos Aires, Argentina
                Author notes
                [*] [* ]Peña 2757, 1 “C”, (1425), Buenos Aires, Argentina.
                Article
                Publisher ID: PPUL21236
                DOI: 10.1002/ppul.21236
                PMC ID: 7167758
                PubMed ID: 20503289
                SO-VID: adc115bd-b281-4ed6-87e9-2c61273376a9
                Copyright © Copyright © 2010 Wiley‐Liss, Inc.
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 12 June 2009
                Date revision received : 18 November 2009
                Date accepted : 24 January 2010
                Page count
                Figures: 2, Tables: 2, References: 31, Pages: 7, Words: 1197
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date June 2010
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

                ScienceOpen disciplines: Pediatrics
                Keywords: rhinovirus,respiratory syncytial virus,wheezing illness
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: rhinovirus, respiratory syncytial virus, wheezing illness

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