Abstract
BackgroundIn Madagascar, very little is known about the etiology and prevalence of acute respiratory infections (ARIs) in a rural tropical area. Recent data are needed to determine the viral and atypical bacterial etiologies in children with defined clinical manifestations of ARIs.MethodsDuring one year, we conducted a prospective study on ARIs in children between 2 to 59 months in the community hospital of Ampasimanjeva, located in the south-east of Madagascar. Respiratory samples were analyzed by multiplex real-time RT-PCR, including 18 viruses and 2 atypical bacteria. The various episodes of ARI were grouped into four clinical manifestations with well-documented diagnosis: “Community Acquired Pneumonia”(CAP, group I), “Other acute lower respiratory infections (Other ALRIs, group II)”, “Upper respiratory tract infections with cough (URTIs with cough, group III)”and “Upper respiratory tract infections without cough (URTIs without cough, group IV)”.Results295 children were included in the study between February 2010 and February 2011. Viruses and/or atypical bacteria respiratory pathogens were detected in 74.6% of samples, the rate of co-infection was 27.3%. Human rhinovirus (HRV; 20.5%), metapneumovirus (HMPV A/B, 13.8%), coronaviruses (HCoV, 12.5%), parainfluenza virus (HPIV, 11.8%) and respiratory syncytial virus A and B (RSV A/B, 11.8%) were the most detected. HRV was predominantly single detected (23.8%) in all the clinical groups while HMPV A/B (23.9%) was mainly related to CAP (group I), HPIV (17.3%) to the “Other ALRIs” (group II), RSV A/B (19.5%) predominated in the group “URTIs with cough” (group III) and Adenovirus (HAdV, 17.8%) was mainly detected in the “without cough” (group IV).InterpretationThis study describes for the first time the etiology of respiratory infections in febrile children under 5 years in a malaria rural area of Madagascar and highlights the role of respiratory viruses in a well clinically defined population of ARIs.
Highlights
Acute respiratory infections (ARIs) are a major public health problem causing approximately 1.9 million child deaths in 2000 [1]
Since 2001, several new respiratory viruses have been described such as metapneumovirus (HMPV) [6], human coronavirus (HCoV), NL63 [7] and HKU1 [8] and human bocavirus (HBoV) [9]
Considering clinical records provided by physicians, children were classified into 4 groups: 83 (28%) in group I (‘‘Community acquired pneumonia (CAP)’’), 95 (32%) in group II (‘‘other acute lower respiratory infections (ALRIs)’’), 66 (22%) in group III (‘‘Upper respiratory tract infections (URTIs) with’’) and 51 (18%) in group IV (‘‘URTIs without’’)
Summary
Acute respiratory infections (ARIs) are a major public health problem causing approximately 1.9 million child deaths in 2000 [1]. A recent study shows that respiratory viruses play an important role in children under 5 years old consulting in public and private clinics in Antananarivo with Influenza-Like Illnesses (ILIs) symptoms [12]. In Ampasimanjeva, a small village located in a rural area endemic for malaria, a recent study showed that 68% of acute fever illnesses among children are not explained by malaria (Ratsimbasoa, personal communication). The objective of this study is to determine the prevalence and seasonal distribution of a large panel of respiratory pathogens including viruses and atypical bacteria among a well clinically defined cohort of acute febrile children between 2 to 59 months of age presenting clinical ARIs symptoms in Ampasimanjeva. In Madagascar, very little is known about the etiology and prevalence of acute respiratory infections (ARIs) in a rural tropical area.
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