Clinical and epidemiological aspects related to the detection
          of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower
          respiratory tract infection

Ferone, Eduardo A.; Berezin, Eitan N.; Durigon, Giuliana S.; Finelli, Cristiane; Felício, Maria C.C.; Storni, Juliana G.; Durigon, Edison L.; Oliveira, Danielle B. L. de

doi:10.1016/j.jped.2013.05.005

Brasil

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Original articles • J. Pediatr. (Rio J.) 90 (01) • jan-feb 2014 • https://doi.org/10.1016/j.jped.2013.05.005 linkcopy

Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: To characterize and compare clinical, epidemiological, and laboratory aspects ofinfants with acute lower respiratory infection (ALRI) associated with the detection of adenovirus(ADV) or respiratory syncytial virus (RSV).

METHODS: A preliminary respiratory infection surveillance study collected samples of nasopharyngeal aspirate (NPA) for viral research, linked to the completion of a standard protocol, from children younger than two years admitted to a university hospital with ALRI, between March of 2008 and August of 2011. Polymerase chain reaction (PCR) was used for eight viruses: ADV, RSV, metapneumovirus, Parainfluenza 1, 2, and 3, and Influenza A and B. Cases with NPA collectedduring the first 24 hours of admission, negative results of blood culture, and exclusive detection of ADV (Gadv group) or RSV (Grsv group) were selected for comparisons.

RESULTS: The preliminary study included collection of 1,121 samples of NPA, 813 collected in thefirst 24 hours of admission, of which 50.3% were positive for at least one virus; RSV was identifiedin 27.3% of cases surveyed, and ADV was identified in 15.8%. Among the aspects analyzed inthe Gadv (n = 58) and Grsv (n = 134) groups, the following are noteworthy: the higher meanage, more frequent prescription of antibiotics, and the highest median of total white blood cellcount and C-reactive protein values in Gadv.

CONCLUSIONS: PCR can detect persistent/latent forms of ADV, an aspect to be considered wheninterpreting results. Additional studies with quantitative diagnostic techniques could elucidatethe importance of the high frequency observed.

Respiratory tract infections; Adenoviruses human; Child hospitalized

	Gadv Present/Analyzed	%	Grsv Present/Analyzed	%	p
Demographic data
Male gender	32/58	55.2	86/134	64.2	0.239^a
Mean age±SD	9.4±5.4		7.1±5.5		0.009^b
Prodrome
Coryza	34/52	65.4	116/128	90.6	< 0.001^a
Signs of conjunctivitis	7/54	13	15/129	11.6	0.800^a
Diarrhea	5/53	9.4	16/130	12.3	0.580^a
Signs and symptoms
Coughing	52/55	94.5	131/133	98.5	0.150^c
Tachypnea	49/54	90.7	131/132	99.2	0.008^c
Other signs of respiratory distress	49/54	90.7	130/133	97.7	0.046^c
Wheezing	42/54	77.8	121/131	92.4	0.005^a
Fever	36/54	66.7	92/131	70.2	0.633^a
Fever = 39^? C	16/42	38.1	27/117	23.1	0.060^a
Most common diagnostic terms
Bronchiolitis	22/58	37.9	90/134	67.2	< 0.001^a
Bronchospasm	21/58	36.2	33/134	24.6	0.101^a
Pneumonia	21/58	36.2	32/134	23.9	0.079^a
Antecedents
Patient with comorbidity	23/53	43.4	49/128	38.3	0.522^a
Prematurity < 37 weeks	9/55	16.4	24/129	18.6	0.717^a
Congenital heart disease	5/54	9.3	6/131	4.6	0.303^c
Bronchopulmonary dysplasia	2/54	3.7	6/128	4.7	> 0.999^c
Family history of atopy	28/47	59.6	73/118	61.9	0.785^a
Family member with a cough	28/48	58.3	81/120	67.5	0.261^a
Agglomeration = 5 persons per domicile	27/52	51.9	68/123	55.3	0.683^a
Passive smoking	13/48	27.1	54/124	43.5	0.047^a
Day care attendance	12/51	23.5	14/126	11.1	0.035^a
Severity and clinical evolution
Pulse oximetry < 90% at admission	17/48	35.4	37/112	33	0.770^a
Cyanosis	7/53	13.2	20/129	15.5	0.692^a
ICU admission	6/46	13	16/117	13.7	0.915^a
Need for mechanical ventilation	6/46	13	16/117	13.7	0.915^a
Antibiotic prescription	30/50	60	44/124	35.5	0.003^a
Median of hospital length of stay	5 days		5 days		0.902^d

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[TFN01t01] ^Gadv
, group associated with the exclusive detection of adenovirus among analyzed viruses

[TFN02t01] ^Grsv
, group associated with exclusive detection of respiratory syncytial virus among analyzed viruses

[TFN03t01] ^ICU
, intensive care unit

[TFN04t01] ^m
, months

[TFN05t01] ^SD
, standard deviation.

[TFN06t01] ^a
Chi-squared test.

[TFN07t01] ^b
Student's t-test.

[TFN08t01] ^c
Fisher's exact test.

[TFN09t01] ^d
Mann-Whitney test.