Abstract
BackgroundChildhood asthma in the Caribbean is advancing in prevalence and morbidity. Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. We examined the distribution of respiratory viruses and their association with seasons in acute and stable asthmatic children in Trinidad.MethodsIn a cross-sectional study of 70 wheezing children attending the emergency department for nebulisation and 80 stable control subjects (2 to 16 yr of age) in the asthma clinic, nasal specimens were collected during the dry (n = 38, January to May) and rainy (n = 112, June to December) seasons. A multitarget, sensitive, specific high-throughput Respiratory MultiCode assay tested for respiratory-virus sequences for eight distinct groups: human rhinovirus, respiratory syncytial virus, parainfluenza virus, influenza virus, metapneumovirus, adenovirus, coronavirus, and enterovirus.ResultsWheezing children had a higher [χ2 = 5.561, p = 0.018] prevalence of respiratory viruses compared with stabilized asthmatics (34.3% (24) versus (vs.) 17.5% (14)). Acute asthmatics were thrice as likely to be infected with a respiratory virus (OR = 2.5, 95% CI = 1.2 – 5.3). The predominant pathogens detected in acute versus stable asthmatics were the rhinovirus (RV) (n = 18, 25.7% vs. n = 7, 8.8%; p = 0.005), respiratory syncytial virus B (RSV B) (n = 2, 2.9% vs. n = 4, 5.0%), and enterovirus (n = 1, 1.4% vs. n = 2, 2.5%). Strong odds for rhinoviral infection were observed among nebulised children compared with stable asthmatics (p = 0.005, OR = 3.6, 95% CI = 1.4 – 9.3,). RV was prevalent throughout the year (Dry, n = 6, 15.8%; Rainy, n = 19, 17.0%) and without seasonal association [χ2 = 0.028, p = 0.867]. However it was the most frequently detected virus [Dry = 6/10, (60.0%); Rainy = 19/28, (67.9%)] in both seasons.ConclusionEmergent wheezing illnesses during childhood can be linked to infection with rhinovirus in Trinidad's tropical environment. Viral-induced exacerbations of asthma are independent of seasons in this tropical climate. Further clinical and virology investigations are recommended on the role of infections with the rhinovirus in Caribbean childhood wheeze.
Highlights
Childhood asthma in the Caribbean is advancing in prevalence and morbidity
Rhinovirus (RV), respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus and influenza virus are the major pathogens that are responsible for early wheezing in infancy [1,2]
Being informed by epidemiological data from other geographical locations, we examined if RV was the major viral cause for asthma exacerbations in children in Trinidad, and whether the frequency rates of viral infection differed with seasonality
Summary
Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. Viral respiratory infections are associated with wheezing illnesses and asthma exacerbations in childhood. Viral respiratory tract infections have been the major cause of asthma exacerbations in children [6] with reported prevalence rates of 85% in exacerbations of childhood asthma [7]. Higher rates of respiratory tract infection are associated with a significant increase in asthma admissions observed every autumn (September – November) in the US, Canada, England and Wales [8]. In Canada and France, children who presented to hospitals with asthma exacerbations had a higher prevalence of viral respiratory infections than asymptomatic asthmatic children [9,10]
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