Viral and atypical bacterial aetiologies of infection inhospitalised patients admitted with clinical suspicion of influenza in Thailand, Vietnam and Indonesia.

Heiman Wertheim ,Khanh Huu Truong ,Tuan Manh Ha ,Chau Vinh Van Nguyen ,Kinh Van Nguyen ,Trung Vu Nguyen ,Agustiningsih Agustiningsih ,Suhud Malik ,Liem Thanh Nguyen ,Sinh Thi Tran ,Thuy Bich Thi Phung ,Menno D De Jong ,H Rogier Van Doorn ,Jeremy Farrar ,Marcel Wolbers ,Tran Tinh Hien ,Behzad Nadjm ,Diep N Nguyen ,Dung Viet Tien Vu ,Sherine Thomas ,Uyen Hanh Nguyen ,Kulkanya Chokephaibulkit ,Walter Taylor ,Pilaipan Puthavathana

doi:10.1111/irv.12326

Abstract

BackgroundInfluenza constitutes a leading cause of morbidity and mortality worldwide. There is limited information about the aetiology of infection presenting clinically as influenza in hospitalised adults and children in South-East Asia. Such data are important for future management of respiratory infections.ObjectivesTo describe the aetiology of infection presenting clinically as influenza in those hospitalised in South-East Asia.MethodsRespiratory specimens archived from July 2008 to June 2009 from patients hospitalised with suspected influenza from Indonesia, Thailand and Vietnam were tested for respiratory viruses and atypical bacteria by polymerase chain reaction.ResultsA total of 1222 patients’ samples were tested. Of 1222, 776 patients (63·5%) were under the age of 5. Viruses detected included rhinoviruses in 229 of 1222 patients (18·7%), bocaviruses in 200 (16·4%), respiratory syncytial viruses in 144 (11·8%), parainfluenza viruses in 140 (11·5%; PIV1: 32; PIV2: 12; PIV3: 71; PIV4: 25), adenovirus in 102 (8·4%), influenza viruses in 93 (7·6%; influenza A: 77; influenza B: 16) and coronaviruses in 23 (1·8%; OC43: 14; E229: 9). Bacterial pathogens were Mycoplasma pneumoniae (n = 33, 2·7%), Chlamydophila psittaci (n = 2), C. pneumoniae (n = 1), Bordetella pertussis (n = 1) and Legionella pneumophila (n = 2). Overall, in-hospital case fatality rate was 29 of 1222 (2·4%).ConclusionRespiratory viruses were the most commonly detected pathogens in patients hospitalised with a clinical suspicion of influenza. Rhinovirus was the most frequently detected virus, and M. pneumoniae, the most common atypical bacterium. The low number of detected influenza viruses demonstrates a low benefit for empirical oseltamivir therapy, unless during an influenza outbreak.

Highlights

Influenza is a common reason for primary care consultation and constitutes a leading cause of hospitalisation, morbidity and mortality worldwide.[1]
With clinically diagnosed influenza-like illnesses (ILIs) meeting the following criteria: age ≥1 year, signs of ILI according to treating physician, duration of ILI symptoms ≤10 days and respiratory specimens sent for influenza testing
Influenza testing capacity was created for a randomised clinical study comparing two dosages of oseltamivir for severe influenza by sites in the South East Asia Infectious Diseases Clinical Research Network, as described elsewhere.[13]

Summary

Introduction

Influenza is a common reason for primary care consultation and constitutes a leading cause of hospitalisation, morbidity and mortality worldwide.[1]. South-East Asia (SEA) are emerging, and this, in turn, is shedding more light on the epidemiology of other viral and bacterial aetiologies of influenza-like illnesses (ILIs) in hospitalised adults and children in this region.[2] The insight provided by this information is important for future prevention strategies, treatment and clinical management of respiratory infections, and to guide future studies in this region. Influenza constitutes a leading cause of morbidity and mortality worldwide. There is limited information about the aetiology of infection presenting clinically as influenza in hospitalised adults and children in South-East Asia. Such data are important for future management of respiratory infections

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