Virološke, kliničke i epidemiološke osobitosti adenovirusnih dišnih infekcija u djece u Zagrebu i okolici [Virological, clinical and epidemiological features of adenovirus respiratory infections in children in Zagreb region]

Tabain, Irena (2011) Virološke, kliničke i epidemiološke osobitosti adenovirusnih dišnih infekcija u djece u Zagrebu i okolici [Virological, clinical and epidemiological features of adenovirus respiratory infections in children in Zagreb region]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Adenoviruses are common pathogens all over the world. Adenovirus respiratory infections in children caused by types 1, 2, 3 and 5 are the most common. The aims of this study were: identification of adenovirus types and/or species which cause acute respiratory infections in children less than 10 years of age, their frequency and distribution according to gender and age, their incidence through the year, seasonal variations, clinical characteristics and values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and white blood cell count (WBC) according to the adenovirus types and species, respectively. This retrospective study (January, 1st 2006 - November, 30th 2008) included a total of 290 children with adenovirus infection. In taken nasopharyngeal aspirates adenovirus was detected by direct immunofluorescence and confirmed by viral culture. Demographics, clinical presentations and laboratory findings of the inpatients and demographics for outpatients were evaluated. Methods used to detect adenovirus were antigen detection, isolation and adenovirus typing. Out of 290 children there were 201 (69%) boys and 89 (31%) girls. Male to female ratio was 2.25:1. The median age was 20 months (range, 1-120 months). Most cases were younger than 2 years of age (185/290, 64%). Adenovirus type was determined in 256 patients. There were 34/290 (11%) cases with inconclusive typing result in neutralization test. We found 162 cases of adenovirus type 2 (63%), followed by 49 cases of type 1 (15%), 40 cases of type 3 (16%), 3 cases of type 6 (1.2%), one case of type 5 (0.5%) and one case of type 7 (0.5%). The major species found was species C (229/270; 84.8%) followed by species B (41/270; 15.2%). During study period cases occur year-around with slightly lower incidence during the summer. In this study period adenovirus type 2 appeared endemic and less frequently during summer season. There was tendency of yearly occurrence of adenovirus type 1 and seasonal occurrence of type 3. The most common features presented were fever (98%), cough (89%) and rhinorrhea (71%). The most common diagnosis was infection of upper respiratory tract (91%). Exudative tonsillitis was found in 25% of adenopositive patients and otitis media acuta in 28%. Lower respiratory tract infection was found in 9% of patients. CRP was ≥40 mg/L for 56% of patients, 68% had SE was ≥30mm/L and 77% of patients had WBC count ≥15,000/L. In conclusion, cases occur year-around and predominant type in the study period was adenovirus type 2. Respiratory adenovirus infections in children were associated with high fever, leukocytosis and substantially elevated CRP levels, mimicking bacterial infections.

Abstract in Croatian

Adenovirusi su česti uzročnici infekcija posvuda u svijetu. Adenovirusne infekcije dišnog sustava u djece najčešće uzrokuju tipovi 1, 2, 3 i 5 adenovirusa. Ciljevi istraživanja bili su: odrediti tipove, odnosno vrste adenovirusa koji uzrokuju akutne infekcije dišnog sustava u djece do 10 godina starosti, njihovu učestalost, raspodjelu po dobi i spolu djece, pojavnost tijekom godine, odnosno njihove sezonske varijacije, opisati kliničke osobitosti i vrijednosti sedimentacije eritrocita (SE), C-reaktivnog proteina (CRP-a) i leukocita ovisno o tipu, odnosno vrsti adenovirusa. U ovu retrospektivnu studiju (1. 1. 2006 - 30. 11. 2008.) uključeno je ukupno 290 djece s adenovirusnom infekcijom. Od svakog djeteta uzet je nazofaringealni sekret u kojem je adenovirus dokazan izravnom imunofluorescencijom i potvrđen izolacijom u staničnoj kulturi. Za hospitalizirane ispitanike analizirani su demografski, klinički i laboratorijski podaci, a za ambulantno obrađene samo demografski podaci. U istraživanju su korištene metode izravne virološke dijagnostike za dokaz antigena, izolacija virusa u staničnoj kulturi i određivanje tipa, odnosno vrste virusa. Od ukupno 290 bolesnika bilo je 201 (69%) dijete muškog spola i 89 (31%) ženskog spola. Odnos muško naprama žensko dijete bio je 2,25:1. Medijan dobi bio je 20 mjeseci, a raspon 1-120 mjeseci. Većina djece s adenovirusnom infekcijom dišnog sustava bila je mlađa od 2 godine (185/290, 64%). Tip adenovirusa određen u 256 bolesnika. Bilo je 34/290 (11%) izolata s neodređenim rezultatom tipizacije u neutralizacijskom testu. Tip 2 adenovirusa izoliran je u 162 (63%) bolesnika, zatim tip 1 u 49 (19%), tip 3 u 40 (16%), tip 6 u 3 (1%) bolesnika te po jedan bolesnika s tipom 5 (0,5%), odnosno tipom 7 (0,5%) adenovirusa. Najčešće je dokazana vrsta C (229/270; 84,8%), a zatim vrsta B (41/270; 15,2%) adenovirusa. Adenovirusi su se u istraživanom razdoblju javljali tijekom cijele godine, s nešto manjom učestalošću u ljetnim mjesecima. Endemski karakter pojavljivanja tipa 2 adenovirusa jasno je zabilježen u istraživanom razdoblju, uz nešto manju učestalošću tijekom ljetnih mjeseci, dok je srodni tip 1 pokazivao tendenciju fluktuacije na godišnjoj razini. Za tip 3 adenovirusa uočena je tendencija fluktuacije na sezonskoj razini s učestalijim pojavljivanjem od kolovoza do studenog. Najčešći simptomi bili su povišena tjelesna temperatura (98%), sekrecija iz nosa (89%) i kašalj (71%). Najčešća dijagnoza bila je neki oblik infekcije gornjeg dišnog sustava (91%). Eksudativni tonzilitis imalo je 25% adenopozitivnih bolesnika, a 28% akutnu upalu srednjeg uha. Infekcije donjeg dišnog sustava zabilježene su u 9% bolesnika. U 56% bolesnika koncentracije CRP-a bile su ≥40 mg/l, ubrzanu SE (≥30 mm/h) imalo je 68% bolesnika te u 77% bolesnika broj leukocita bio je ≥15 x 10 na 9/l. U zaključku, adenovirusne infekcije javljaju se tijekom cijele godine, a tijekom istraživanog razdoblja prevladavao je tip 2 adenovirusa. Adenovirusne infekcije dišnog sustava bile su povezane s vrućicom (>39,0°C), leukocitozom i značajno povišenim koncentracijama CRP-a, oponašajući time bakterijsku infekciju.

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