Acute Respiratory Infections In Children Research Articles

Pitfalls in interpretation of CT-values of RT-PCR in children with acute respiratory tract infections

BackgroundThe relation between viral load and disease severity in childhood acute respiratory tract infections (ARI) is not fully understood. ObjectivesTo assess the clinical relevance of the relation between viral load, determined by cycle threshold (CT) value of real-time reverse transcription-polymerase chain reaction assays and disease severity in children with single- and multiple viral ARI. Study design582 children with ARI were prospectively followed and tested for 15 viruses. Correlations were calculated between CT values and clinical parameters. ResultsIn single viral ARI, statistically significant correlations were found between viral loads of Respiratory Syncytial Virus (RSV) and hospitalization and between viral loads of Human Coronavirus (HCoV) and a disease severity score. In multiple-viral ARI, statistically significant correlations between viral load and clinical parameters were found. In RSV-Rhinovirus (RV) multiple infections, a low viral load of RV was correlated with a high length of hospital stay and a high duration of extra oxygen use. The mean CT value for RV, HCoV and Parainfluenza virus was significantly lower in single- versus multiple infections. ConclusionAlthough correlations between CT values and clinical parameters in patients with single and multiple viral infection were found, the clinical importance of these findings is limited because individual differences in host-, viral and laboratory factors complicate the interpretation of statistically significant findings. In multiple infections, viral load cannot be used to differentiate between disease causing virus and innocent bystanders.

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh.

AbstractUnderstanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly selected population clusters we sampled 17 households with at least one child < 5 years of age. Childhood diarrhea incidence was 3,451 and ARI incidence was 5,849/1,000 child-years. For diarrhea and ARI outpatient care per 1,000 child-years, parents spent more on unqualified ($2,361 and $4,822) than qualified health-care practitioners ($113 and $947). For outpatient care, visits to unqualified health-care practitioners were at least five times more common than visits to qualified practitioners. Costs for outpatient care treatment by unqualified health-care practitioners per episode of illness were similar to those for qualified health-care practitioners. Homecare costs were similar for diarrhea and ARI ($0.16 and $0.24) as were similar hospitalization costs per episode of diarrhea and ARI ($35.40 and $37.76). On average, rural Bangladeshi households with children < 5 years of age spent 1.3% ($12 of $915) of their annual income managing diarrhea and ARI for those children. The majority of childhood illness management cost comprised visits to unqualified health-care practitioners. Policy makers should consider strategies to increase the skills of unqualified health-care practitioners, use community health workers to provide referral, and promote homecare for diarrhea and ARI. Incentives to motivate existing qualified physicians who are interested to work in rural Bangladesh could also be considered.

Viral aetiology of wheezing in children under five.

Background & objectives:Wheezing is a common problem in children under five with acute respiratory infections (ARIs). Viruses are known to be responsible for a considerable proportion of ARIs in children. This study was undertaken to know the viral aetiology of wheezing among the children less than five years of age, admitted to a tertiary care hospital in eastern India.Methods:Seventy five children, under the age of five years admitted with wheezing, were included in the study. Throat and nasal swabs were collected, and real-time multiplex polymerase chain reaction (PCR) assay was used to screen for influenza 1 and 2, respiratory syncytial virus (RSV), parainfluenza virus (PIV) 1, 2, 3 and 4, rhinovirus, human meta-pneumovirus, bocavirus (HBoV), Coronavirus, adenovirus, Enterovirus and Parechovirus.Results:The total viral detection rate was 28.57 per cent. Viral RNA markers were detected from children diagnosed to be having pneumonia (3 cases), bronchiolitis (9 cases), episodic wheeze (2 cases) and multitrigger wheeze (6 cases). RSV was the most common virus (35%) followed by PIV1, 2 and 3 (20%), HBoV (10%) and rhinovirus (5%). However, mixed infection was observed in 30 per cent of cases.Interpretation & conclusions:The study reported the presence of respiratory viral agents in 28.57 per cent of children with wheezing; RSV and PIV were most common, accounting to 55 per cent of the total cases. Mixed infection was reported in 30 per cent of cases. Seasonal variation in the occurrence of these viruses was also noted. Further studies need to be done with a large sample and longer follow up period to verify these findings.

Viral Infections in Egyptian Hospitalized Children with Acute Respiratory Tract Infections

Acute respiratory tract infections (ARTIs) are associated with significant morbidity and mortality worldwide, especially in developing countries. Children under the age of 5 years old are mostly affected. Both viral and bacterial causes are implicated, but viral etiologies are more difficult to diagnose. Viral infections can occur either single or mixed, but the significance and association of polyviral agents with the severity of cases are poorly understood. More studies are critical for understanding this role, improving diagnosis and treatment. Objective: To identify the rule of five chosen viral pathogens in ARTIs in children below 5 years old and the association of polyviral etiology with the severity of the disease. Methods: Nasopharyngeal swabs were taken from 120 children who had symptoms and signs of ARTIs, attending the outpatient clinic and admitted in pediatric department or pediatric intensive care unit, Banha university hospital. All children were subjected to full history taking, analysis by multiplex PCR for five viruses (Rhinovirus, Respiratory syncytial virus, Human metapneumovirus, Adenovirus, and Human boca virus). Results: 54 viruses were identified by multiplex PCR from 41 children (34.2%), 75.6% of them had a single viral infection, (17% and 7.4%) were co-infected with two and three viruses respectively. Positive cases were mostly of children admitted in pediatric ward and the majority were infants. URTIs was the most common presentation followed by bronchiolitis then bronchopneumonia. HRV was the most frequently detected as a single and mixed infection (35.2%) followed by RSV (22.2%). Non-significant correlation was found between mixed infection and the severity of infection. Conclusion: HRV is the most frequently recognized viral pathogen either as single or mixed in children below 5 years old in our patient group. Mixed infection has no correlation with disease severity. And using Multiplex PCR is an ideal tool for investigating mixed infection.

Антибактериальная терапия при острых респираторных инфекциях у детей

Антибактериальная терапия при острых респираторных инфекциях у детей

Effects of Almaty city ecological factors on students blood indices at Al-Farabi Kazakh National University

Environment pollution is a wide-researching problem and it is likely to influence the health of human populations is great. And environmental health is that aspects of public health that is concerned with those forms of life substances, forces and conditions in the surroundings of man that may exert an influenceon man’s health and well-being. A number of natural and anthropogenic activities and may cause adverse effects on human health and the environment. Increased combustion of fossil fuels in the last century is responsible for the progressive change in the atmospheric composition. Air pollution has both acuteand chronic effects on human health, affecting a number of different systems and organs. It ranges from minor upper respiratory irritation to chronic effects on human disease, lung cancer, and acute respiratory infections in children and chronic bronchitis in adults. The effects of environmental factors on student’shealth and its mechanisms are briefly discussed.The climatic – geographic conditions of the environmental living habitat is one of the most influential reasons that has always affected and produced physiological changes in our body. Because of this, it gives a chance to determine the change in organisms in time, and give us enough time to organize the appropriate prophylactic events in advance.In our work, the data which had been measured during laboratory research was statistical analyzed the methods were used in our study, and assessment of the value of the measured data, we paid much more attention to assess correctly the changes because of various climatic – geographical reasons effects tostudents body. In order to determine the functional status of the students’ organisms, we used special pilot tested, and got the effective positive comment on its using. In this study we put significant effort to determine the physiological variations (disorders) to the students’ which from the different regions ofthe republic of Kazakhstan and their adaptation process in immune system because of various climatic – geographical changes in their life.

The Incidence of Acute Respiratory Infections in Children who Have Undergone Critical Conditions in the Neonatal Period, Depending on the Severity оf Organ Dysfunction. Retrospective Cohort Study

Background: It is assumed that the severity of the multiple organ dysfunctions syndrome (MODS) in children who have experienced critical conditions in the neonatal period is a risk factor for the development of acute respiratory infections (ARI). Objective. The Aim was to study the relationship between the severities of organ dysfunctions in children who had undergone critical conditions in the neonatal period, with an ARI frequency at preschool age. Methods : The study included children with MODS, the severity of which was assessed on the NEOMOD scale (moderate dysfunction 4 points, severe 5 points). An infectious index (II) was calculated since the discharge from the hospital till the age of 7: the ratio of the number of cases ARI during the past year to the age of the child that year, and the proportion of often ill children (OIC) — the number of ARI 4, 6 and 5 cases per year at the age of 1, 1–3 and 4– 5 years respectively. Data on cases of ARI are obtained from the history of child development (form № 112/y). Results: The study included 198 children, 100 of them with severe manifestations of MODS and 98 with moderate manifestations of MODS. The groups were comparable by sex, age, social factors (age and level of education of parents), place of residence (city / village). II (median and 95% confidence interval) in children with severe and moderate manifestations of MODS under 1 year were 2 (2; 3) and 1.5 (1; 2) respectively (p=0.006); 1–2 years — 1.5 (1–2) and 1 (1– 1.5) (p=0.008); 2–3 years — 1 (0.7–1.2) and 0.7 (0.5–1) (p=0.006); 3–4 years old — 1,1 (0,8–1,3) and 0,8 (0,6–0,8) (р=0.003); 4–5 years — 0,6 (0.6–0,7) and 0,4 (0.4–0,5) (р=0.001); 5–6 years — 0.5 (0.3–0.5) and 0.3 (0.2–0.3) (p=0.001); 6–7 years — 0.3 (0.3–0.3) and 0.1 (0.1–0.3) (p=0.025). The OIC in the groups for the entire follow-up period was 60 (60%) and 42 (43%) respectively (p=0.011). Сonclusion : Severe manifestations of MODS in the neonatal period are associated with a higher susceptibility of children to ARI.

THE EFFECTIVENESS OF A NATURAL PREPARATION IN THE TREATMENT AND PREVENTION OF INFLUENZA AND OTHER ACUTE RESPIRATORY DISEASES IN CHILDREN

The results of application of the drug of natural origin (Aflubin) with immunomodulating, anti-inflammatory, detoxifying effect in complex treatment of influenza and acute respiratory infections in children are presented. The inclusion of Aflubin in the complex treatment of diseases contributed to reducing the severity and duration of intoxication, reducing the duration of catarrhal phenomena, preventing the development of secondary bacterial complications. Relative simplicity of the drug (drops) at affordable cost, therapeutic and preventive efficacy in all age groups ensure its high compliance.

Antibiotic prescribing and dispensing for acute respiratory infections in children: effectiveness of a multi-faceted intervention for health-care providers in Vietnam

ABSTRACT Background: Appropriate antibiotic use is vital to effectively contain antibiotic resistance and improve global health. Acute respiratory infections (ARIs) remain the leading cause of disease and death in children under five in low-income countries. Objective: To evaluate a multi-faceted intervention targeting health-care-providers’ (HCPs) knowledge, practical competences and practices regarding antibiotic use for ARIs. Methods: A multi-faceted educational intervention with a two-armed randomised controlled design targeting HCPs treating ARIs in children was conducted in Bavi district, a rural district in Northern Vietnam in 2010–2011. Thirty-two communes of the district were randomized into two arms, with 144 HCPs in the intervention arm and 160 in the control arm. The intervention, conducted over seven months, comprised: (i) education regarding appropriate-antibiotic use, (ii) case scenario discussion and (iii) poster distribution. Questionnaires to assess knowledge and dispensing/prescribing forms to assess practice were completed before-and after interventions. The main outcome measures were differences in improvement in knowledge and practice in the intervention and control group, respectively. Results: Knowledge improved in the intervention group for ARI aetiology by 28% (ΔDecrement control arm 10%), antibiotic use for mild ARIs by 15% (ΔDecrement control arm 13%) and for severe ARIs by 14% (ΔImprovement control arm 29%). Practical competence for a mild ARI case scenario improved in the intervention and control groups by 20% and 11%, respectively. Total knowledge score increased statistically in the intervention group (Δmean improvement 1.17); less so in the control group (Δmean improvement 0.48). Practice regarding antibiotics for mild ARIs improved by 28% in the intervention group (ΔDecrement control arm 3%). Conclusions: The intervention significantly improved HCPs’ knowledge of ARIs and practice of antibiotic use in treatment of ARIs. We suggest mixed method assessment and long-term follow-up of these interventions to enable better appreciation of the effects and effect sizes of our interventions.

Prevention of bacterial respiratory tract infections in children

The analytical review is devoted to modern methods of immunotherapy of respiratory infections in childhood. The article provides literature data and the authors' findings related to the evaluation of clinical effectiveness of the bacterial extract Broncho-Vaxom in the prevention and treatment of acute respiratory infections in children.

Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children.

Acute respiratory tract infections (ARTIs) are common in children and can involve both upper and lower airways. Many children experience frequent ARTI episodes or recurrent respiratory tract infections (RRTIs) in early life, which creates challenges for paediatricians, primary care physicians, parents and carers of children.In China, Astragalus (Huang qi), alone or in combination with other herbs, is used by Traditional Chinese Medicine (TCM) practitioners in the form of a water extract, to reduce the risk of ARTIs; it is believed to stimulate the immune system. Better understanding of the therapeutic mechanisms of Astragalus may provide insights into ARTI prevention, and consequently reduced antibiotic use. To assess the effectiveness and safety of oral Astragalus for preventing frequent episodes of acute respiratory tract infections (ARTIs) in children in community settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2015), MEDLINE (Ovid) (1946 to 31 December 2015), Embase (Elsevier) (1974 to 31 December 2015), AMED (Ovid) (1985 to 31 December 2015), Chinese National Knowledge Infrastructure (CNKI) (1979 to 31 December 2015) and Chinese Scientific Journals full text database (CQVIP) (1989 to 31 December 2015), China Biology Medicine disc (CBM 1976 to 31 December 2015) and Wanfang Data Knowledge Service Platform (WanFang) (1998 to 31 December 2015). We included randomised controlled trials (RCTs) comparing oral Astragalus as a sole Chinese herbal preparation with placebo to prevent frequent episodes of ARTIs in children. We used standard Cochrane methodological procedures for this review. We assessed search results to identify relevant studies. We planned to extract data using standardised forms. Disagreements were to be resolved through discussion. Risk of bias was to be assessed using the Cochrane 'Risk of bias' tool. We planned to use mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) or odds ratio (OR) to analyse dichotomous data, both with 95% confidence intervals (CIs). We identified 6080 records: 3352 from English language databases, 2724 from Chinese databases, and four from other sources. Following initial screening and deduplication, we obtained 120 full-text papers for assessment. Of these, 21 were not RCTs; 55 did not meet the inclusion criteria because: participants were aged over 14 years; definition was not included for recurrent or frequent episodes;Astragalus preparation was not an intervention; Astragalus preparation was in the formula but was not the sole agent; the Astragalus preparation was not administered orally; or Astragalus was used for treatment rather than prevention of ARTI. A further 44 studies were excluded because they were not placebo-controlled, although other inclusion criteria were fulfilled.No RCTs met our inclusion criteria. We found insufficient evidence to enable assessment of the effectiveness and safety of oral Astragalus as a sole intervention to prevent frequent ARTIs in children aged up to 14 years.

Internal living environment and respiratory disease in children: findings from the Growing Up in New Zealand longitudinal child cohort study.

BackgroundThe incidence of early childhood acute respiratory infections (ARIs) has been associated with aspects of the indoor environment. In recent years, public awareness about some of these environmental issues has increased, including new laws and subsequent changes in occupant behaviours. This New Zealand study investigated current exposures to specific risk factors in the home during the first five years of life and provided updated evidence on the links between the home environment and childhood ARI hospitalisation.MethodsPregnant women (n = 6822) were recruited in 2009 and 2010, and their 6853 children created a child cohort that was representative of New Zealand births from 2007-10. Longitudinal data were collected through face-to-face interviews and linkage to routinely collected national datasets. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed.ResultsLiving in a rented dwelling (48%), household crowding (22%) or dampness (20%); and, in the child’s room, heavy condensation (20%) or mould or mildew on walls or ceilings (13%) were prevalent. In 14% of the households, the mother smoked cigarettes and in 30%, other household members smoked. Electric heaters were commonly used, followed by wood, flued gas and unflued portable gas heaters. The incidence of ARI hospitalisation before age five years was 33/1000 person-years. The risk of ARI hospitalisation was higher for children living in households where there was a gas heater in the child’s bedroom: hazard ratio for flued gas heater 1.69 (95% CI: 1.21-2.36); and for unflued gas heater 1.68 (95% CI: 1.12-2.53); and where a gas heater was the sole type of household heating (hazard ratio: 1.64 (95% CI: 1.29-2.09)). The risk was reduced in households that used electric heaters (Hazard ratio: 0.74 (95% CI: 0.61-0.89)) or wood burners (hazard ratio: 0.79 (95% CI: 0.66-0.93)) as a form of household heating. The associations with other risk factors were not significant.ConclusionsThe risk of early childhood ARI hospitalisation is increased by gas heater usage, specifically in the child’s bedroom. Use of non-gas forms of heating may reduce the risk of early childhood ARI hospitalisation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0207-z) contains supplementary material, which is available to authorized users.

Considering spatial heterogeneity in the distributed lag non-linear model when analyzing spatiotemporal data.

The distributed lag non-linear (DLNM) model has been frequently used in time series environmental health research. However, its functionality for assessing spatial heterogeneity is still restricted, especially in analyzing spatiotemporal data. This study proposed a solution to take a spatial function into account in the DLNM, and compared the influence with and without considering spatial heterogeneity in a case study. This research applied the DLNM to investigate non-linear lag effect up to 7 days in a case study about the spatiotemporal impact of fine particulate matter (PM2.5) on preschool children's acute respiratory infection in 41 districts of northern Taiwan during 2005 to 2007. We applied two spatiotemporal methods to impute missing air pollutant data, and included the Markov random fields to analyze district boundary data in the DLNM. When analyzing the original data without a spatial function, the overall PM2.5 effect accumulated from all lag-specific effects had a slight variation at smaller PM2.5 measurements, but eventually decreased to relative risk significantly <1 when PM2.5 increased. While analyzing spatiotemporal imputed data without a spatial function, the overall PM2.5 effect did not decrease but increased in monotone as PM2.5 increased over 20 μg/m3. After adding a spatial function in the DLNM, spatiotemporal imputed data conducted similar results compared with the overall effect from the original data. Moreover, the spatial function showed a clear and uneven pattern in Taipei, revealing that preschool children living in 31 districts of Taipei were vulnerable to acute respiratory infection. Our findings suggest the necessity of including a spatial function in the DLNM to make a spatiotemporal analysis available and to conduct more reliable and explainable research. This study also revealed the analytical impact if spatial heterogeneity is ignored.

Acute respiratory infection in children from developing nations: A multi-level study

Acute respiratory infection in children from developing nations: A multi-level study

Clinical and epidemiological characteristics of severe acute respiratory infection due to respiratory syncytial virus in children under 5 years

Objective: To compare the clinical and epidemiological characteristics of severe acute respiratory infection in children under 5 years old with and without infection due to respiratory syncytial virus. Material and methods: Retrospective study in a sample of 65 cases and 65 controls in children under 5 years old with acute respiratory infection (SARI) treated at the Pediatric Emergency Hospital during 2014. The diagnosis of RSV test was performed using direct inmufluorescencia (IFD) in nasal and throat samples (D3 Ultra DFA Respiratory Virus 8 ™ Screening &amp; ID Kit). The results were expressed in absolute and relative terms; the analysis was performed by measures of central tendency, chi-square, “t” Student and Mann Whitney tests. Results: Significant differences were found between cases and controls in the average age in the month of infection, the average respiratory rate, use of mechanical ventilation in antibiotic treatment and diagnosis of bronchiolitis at medical discharge. Conclusions: The results show that there are clinical and epidemiological differences between the cases and controls.

Комплексная терапия острых респираторных инфекций у детей

Комплексная терапия острых респираторных инфекций у детей

Community vulnerability and symptoms of acute respiratory infection among preschool age children in the Democratic Republic of Congo, Malawi and Nigeria: evidence from Demographic and Health Surveys

BackgroundAs a consequence of the global spread of HIV infection in sub-Saharan Africa, the impact of the AIDS pandemic has contributed to more than 40 million orphaned and vulnerable children...

Obesity as a risk factor for complications during acute respiratory infections in children

Obesity has a high prevalence among children. On the other hand, acute respiratory infections especially of viral origin, are an important cause of morbidity and mortality in this age group. During the recent pandemic of influenza A (H1N1) virus, obesity was identified as a novel independent risk factor for severity multiple markers of the disease. We reviewed the evidence associating obesity with a worse course of respiratory diseases in children. Nine out of 40 retrieved articles, were chosen to be reviewed. We concluded that there is evidence suggesting that immunomodulatory effects of obesity could be considered as a novel risk factor. Thus, bearing in mind the drastic rise in obesity prevalence around the world and in Chile, and the latent possibility of new respiratory pandemics caused by viruses, studying the possible effect of obesity aggravating viral respiratory infections will become important.

RSV N-nanorings fused to palivizumab-targeted neutralizing epitope as a nanoparticle RSV vaccine

Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infections in children, yet no vaccine is available. The sole licensed preventive treatment against RSV is composed of a monoclonal neutralizing antibody (palivizumab), which targets a conformational epitope located on the fusion protein (F). Palivizumab reduces the burden of bronchiolitis but does not prevent infection. Thus, the development of RSV vaccines remains a priority. We previously evaluated nanorings formed by RSV nucleoprotein (N) as an RSV vaccine, as well as an immunostimulatory carrier for heterologous antigens. Here, we linked the palivizumab-targeted epitope (called FsII) to N, to generate N-FsII-nanorings. Intranasal N-FsII immunization elicited anti-F antibodies in mice that were non-neutralizing in vitro. Nevertheless, RSV-challenged animals were better protected against virus replication than mice immunized with N-nanorings, especially in the upper airways. In conclusion, an N-FsII–focused vaccine is an attractive candidate combining N-specific cellular immunity and F-specific antibodies for protection.

Contribution of influenza viruses to medically attended acute respiratory illnesses in children in high-income countries: ameta-analysis.

Aim:The burden of disease in children attributable to influenza viruses is difficult to quantify given the similarity of symptoms caused by infection due to influenza and other viruses. This uncertainty impacts clinical decision‐making and estimates of burden. We aimed to systematically review the literature to determine the proportion of healthy children presenting for health care with an acute respiratory illness (ARI) who have laboratory‐confirmed seasonal influenza (PROSPERO ID#CRD42014013896).Method:We searched Ovid MEDLINE, EMBASE, Scopus, and references of included articles. We included studies that used polymerase chain reaction methods to test for influenza in healthy children aged ≤5 years who presented for health care in high‐income countries with an influenza‐like or ARI. A standardized form was used to collect data on positivity and other relevant study elements.ResultsSeventeen studies covering 12 different influenza seasons were included. The proportion of influenza positivity ranged from 11% to 56%. Subgroup analyses were performed by influenza season, continent, healthcare setting, age group, and vaccination status. Higher influenza positivity was reported among children aged 3–5 years compared with children aged ≤2 years, and for unvaccinated children.ConclusionThe minority of healthy patients aged ≤5 years with medically attended influenza‐like or acute respiratory symptoms have laboratory‐confirmed influenza virus infection, although this varied by influenza season. Prevention efforts should be targeted accordingly.StatementMost influenza‐like illnesses are not laboratory‐confirmed and have similar clinical presentations. Consequently, the true contribution of influenza to acute respiratory infections in children remains uncertain. Our systematic review estimates that this proportion ranges from 11% to 56%. This finding can help both clinicians and public health professionals target prevention.