Abstract
BackgroundPneumonia has a high incidence rate and is a major cause of mortality in children, mostly community-acquired pneumonia (CAP). Human bocavirus (HBoV), since it first identified in 2005, has been repeatedly associated with respiratory tract infections. Nevertheless, the role and related information of HBoV as a pathogen of CAP has not been fulfilled. Here our study is to assess the epidemiological and clinical features in HBoV-positive children with CAP.MethodsA total of 878 secretions of lower respiratory samples were obtained, multiplex PCR was used to detect HBoV and other respiratory viruses.ResultsOf all cases, HBoV was detected in 10.0%, with a peak incidence of infection among children < 2 year old, and predominantly noted in autumn and winter. Only 8 patients were HBoV single infection. Co-infection with other respiratory viruses was observed in 86.4%. Moreover, co-infection with bacteria occurred in 27.3% and with Mycoplasma pneumoniae (MP) in 33.0% of HBoV-positive patients. Among all HBoV-positive samples co-infected with bacteria, 87.5% are gram negative bacteria. Compared with HBoV-negative group, age (P = 0.048), wheezing (P = 0.015), tachypnea (P = 0.016), lactate dehydrogenase (P = 0.026) and severe pneumonia (P = 0.023) were statistically significant in HBoV-positive patients. Furthermore, HBoV-positive patients less than 1 year old were more likely to have co-infection with bacteria (P = 0.007).ConclusionsHBoV can be detected alone in respiratory samples of children with CAP, maybe it is one of the causes of CAP in infants. The high incidence of severe pneumonia was found in HBoV-positive patients compared with HBoV-negative cases may indicate a relationship between severe pneumonia and HBoV.
Highlights
Pneumonia has a high incidence rate and is a major cause of mortality in children, mostly communityacquired pneumonia (CAP)
Human bocavirus (HBoV) was detected in 88 samples (10.0%), and detection rate of other viruses were as follows (Fig. 2): human rhinovirus (HRV) (n = 333, 37.9%), respiratory syncytial virus (RSV) (n = 281, 32.0%), Parainfluenza viruses (PIV)-3 (n = 224, 25.5%), Human metapneumovirus (HMPV) (n = 140, 15.9%), PIV-1 (n = 72, 8.2%), AdV (n = 50, 5.7%), influenza virus (IFV)-A (n = 45, 5.1%), PIV-2 (n = 42, 4.8%), PIV-4 (n = 28, 3.2%) and human coronavirus (HCoV) (n = 28, 3.2%), EV (n = 26, 3.0%), IFV-B (n = 4, 0.5%)
Measurement data were expressed as median (IQR), and data were compared by rank sum test; Categorical variables were expressed as number and percentage, proportion were compared by chi-squared CRP, C-reactive protein; PCT, procalcitonin Reference levels: white blood cells count (WBC) (4.4–11.9)109/L, NEUT (40–75) %, lactate dehydrogenase (LDH) (120–250) U/L, Aspartate aminotransferase (AST) (13–35) U/L, ALT (7–40) U/L, CRP (0–10) mg/L, PCT (0–0.046) ng/mL *Age was statistically significant between the two groups (P < 0.05)
Summary
Pneumonia has a high incidence rate and is a major cause of mortality in children, mostly communityacquired pneumonia (CAP). HBoV is small non-enveloped single-stranded DNA viruses of the Parvoviridae family with four HBoV genotypes, HBoV-1 has been mainly identified in respiratory samples, whereas genotypes 2 to 4 of HBoV are principally detected in intestinal infection [9]. It has been reported with frequencies ranging from 1.9 to 24.6% in respiratory samples [10], mostly from children with acute respiratory tract infection, HBoV can be detected in asymptomatic people [8], Probably because HBoV-1 has been shown to stay in the nasopharynx for weeks and even months after acute infection, thereby posing a challenge to diagnosis of acute HBoV-1 infection [11]. We described the prevalence of HBoV in infants and children who presented at the hospital with CAP, the clinical features of the infected children, and a phylogenetic analysis of HBoV was carried out
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