RESUMO
In a total of 1,003 children (805 inpatients and 198 outpatients) with acute lower respiratory infections (ALRI), clinical, social, and environmental data were analyzed. The major clinical entities were bronchiolitis, pneumonia, bronchitis, and laryngitis. The first two of these predominated in inpatients; pneumonia and bronchitis were more common in older children, while bronchiolitis was observed in infants. Respiratory rates of > 50/min. were more common in younger children and in cases with bronchiolitis and bronchitis. Retractions showed markedly less age-dependent variations and were present in all severe cases with different clinical diagnoses. Retractions alone or associated with cyanosis were the best indicators for severity of ALRI. Among outpatients, fever and wheezing were more common; inpatients were younger, more frequently malnourished, and from a lower socioeconomic level; family history of chronic bronchitis, crowding, and parental smoking also prevailed in this group. Family asthma and exposure to domestic aerosols was more common among outpatients. Prematurity rate (17 and 15%) of all ALRI cases was twice that of the general pediatric population and a significant difference existed between in- and outpatients under 6 months of age when perinatal respiratory pathologies predominated among inpatients. It is suggested to consider the need for assessing personal, family, and environmental risk factors in addition to clinical signs and symptoms when severe cases of ALRI are evaluated.
Assuntos
Bronquiolite/epidemiologia , Bronquite/epidemiologia , Pacientes Internados , Laringite/epidemiologia , Pacientes Ambulatoriais , Pneumonia/epidemiologia , Doença Aguda , Fatores Etários , Argentina/epidemiologia , Bronquiolite/diagnóstico , Bronquite/diagnóstico , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Laringite/diagnóstico , Masculino , Anamnese , Pneumonia/diagnósticoRESUMO
Twenty-nine cases of pediatric acute lower respiratory disease associated with adenovirus genome type 7h were evaluated retrospectively. They constituted 2.4% of 1233 cases of acute respiratory infections treated in five hospitals in Buenos Aires, between September 1984 and September 1988. Pneumonia and bronchiolitis were the principal diagnoses. The mean age of patients was 8.8 months and 82.7% of the children were less than one year of age. None of the patients had previously been exposed to measles or was immunocompromised. A mixed infection, viral or bacterial, was demonstrated in 8 of the 29 patients. Sixteen children developed a severe pulmonary disease which required intensive care. Ten with a clinical diagnosis of multifocal pneumonia and necrotizing bronchiolitis died. Extrapulmonary manifestations were observed in the most severe cases. Observations suggest a possible high pathogenicity of adenovirus type 7h and emphasize the need for adequate control and case management programs.
Assuntos
Adenoviridae/isolamento & purificação , Infecções por Adenovirus Humanos/diagnóstico , Infecções Respiratórias/diagnóstico , Doença Aguda , Argentina , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , SorotipagemRESUMO
Forty-nine of 255 (19.2%) Argentinean children between the ages of 1 and 18 months without evidence of viral or bacterial infections, but with clinical and radiologic evidence of acute lower respiratory distress, had serologic evidence of recent Chlamydia trachomatis infection by the demonstration of specific IgM, seroconversion or 4-fold rise in titer or elevated titers by enzyme immunoassay and the microimmunofluorescence test. Recent C. trachomatis infection was detected in 28 of 166 (16.9%) of children with bronchiolitis and 18 of 89 (20.2%) with pneumonia. Three additional children with bronchiolitis had Chlamydia pneumoniae-specific antibody. There was a significantly higher prevalence of C. trachomatis infection in children living in La Plata city orphanage (26 of 74, 35.1%) than in those attending 2 pediatric hospitals in Buenos Aires (23 of 181, 12.7%) (P less than 0.001). C. trachomatis infection was detected in all age groups up to 18 months. Thirty of 49 infections were in children older than 3 months of age and 16 were in children older than 6 months. These results suggest that C. trachomatis infection may be associated with bronchiolitis and pneumonia in children between the ages of 1 and 18 months of age in Argentina and that a proportion may be horizontally transmitted.
Assuntos
Anticorpos Antibacterianos/sangue , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/imunologia , Infecções Respiratórias/microbiologia , Argentina , Chlamydia trachomatis/isolamento & purificação , Humanos , Lactente , Estudos Retrospectivos , Testes SorológicosRESUMO
The aim of this work was to evaluate the sensitivity of complement fixation for serological diagnosis of lower acute respiratory infections (ARI) in small children in comparison with direct methods such as indirect immunofluorescence (IIF) on nasopharyngeal aspirate and tissue culture isolation. Sera from children under 5 year of age with ARI were studied by complement fixation for 6 respiratory viruses (respiratory syncytial virus (RSV), adenovirus, influenza A and B and parainfluenza 1 and 3). In all, 264 pairs of serum samples from children with viral ARI diagnosis (n:135) or from doubtful cases (n:90) were studied. Thirty nine sera were anticomplementary. In samples from confirmed viral ARI patients, seroconversion was detected in 38%, whereas from those with a doubtful diagnosis it was only 14%. Seroconversion for RSV and adenovirus was 39% and 50%, respectively. On correlating seroconversion for the 6 viruses according to age group, 20% positivity was found in the 0-5 month-old group, 35% in the 6-10 month-old and 30% in those over 11 months of age. For RSV alone, 0-5 month-old patients presented 25% seroconversion, and in those over 6 months of age the percentage exceeded 60% (p less than 0.001). Complement fixation test sensitivity vs direct methods (IIF and/or culture) was 38.5%). Our findings confirm the low sensitivity of complement fixation to detect antibodies in ARI, particularly in children under 6 months of age and support the higher efficacy of direct diagnostic methods. However, complement fixation serology is useful for epidemiological studies in children over 6 months of age, since over 60% of RSV were readily detected.
Assuntos
Testes de Fixação de Complemento , Infecções Respiratórias/sangue , Viroses/sangue , Pré-Escolar , Imunofluorescência , Humanos , Lactente , Infecções Respiratórias/imunologia , Infecções Respiratórias/microbiologia , Cultura de Vírus , Vírus/isolamento & purificaçãoRESUMO
El objetivo de este estudio fue determinar la importancia de Chlamydia trachomatis como agente etiológico en infecciones respiratorias agudas (IRA) en lactantes. Se seleccionaron 161 aspirados nasofaríngeos (ANF) de niños menores de 6 meses de edad con diagnóstico clínico de neumonía, o bronquiolitis en los que se investigó la presencia de antígeno de Ch.trachomatis por enzimoinmunoensayo (Chlamydiazyme, Abbott). Se conformaron dos grupos de niños con diagnóstico de IRA, 77 con diagnóstico etiológico viral o bacteriano y 84 niños en los que no se pudo identificar el agente patógeno. Se detectó antígeno de Ch. trachomatis en 45 de los 161 ANF estudiados (27,9 por ciento). De los 77 niños con IRA viral o bacteriana, el 36,4 por ciento resultó positivo para Ch. trachomatis mientras que en los 84 niños sin diagnóstico etiológico, el 20,2 por ciento fue positivo para Ch. trachomatis. La mayor frecuencia de detección de antígeno de Ch. trachomatis en niños con infección viral o bacteriana fue estadísticamente significativa. Con respecto a los diagnósticos clínicos, se detectó Ch. trachomatis en el 32,6 por ciento de las bronquiolitis y en el 25,4 por ciento de las neumonías totales estudiadas. Considerando exclusivamente las bronquiolitis y neumonías con diagnóstico previo de IRA viral, se detectó Ch. trachomatis en el 45 por ciento y 26 por ciento, respectivamente. Esto indica una elevada frecuencia de infecciones mixtas por Chlamydia-virus, en especial el virus Sincicial Respiratorio. El 64 por ciento (29/45) de los ANF positivos para Chlamydia correspondió a niños menores de 3 meses de edad, aunque se detectaron casos positivos hasta los 5 meses. Los resultados obtenidos señalan la importancia de CH. trachomatis en bronquiolitis o neumonías en niños menores de 6 meses de edad ya sea como único agente o asociada a virus respiratorios, en especial al Sincicial Respiratorio (AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pneumonia/microbiologia , Bronquite/microbiologia , Bronquiolite/microbiologia , Infecções Respiratórias/diagnóstico , Antígenos de Bactérias/isolamento & purificação , Chlamydia trachomatis/patogenicidade , Infecções por Chlamydia/epidemiologia , Pneumonia/etiologia , Bronquite/etiologia , Bronquiolite/etiologia , Uretrite/etiologia , Uretrite/microbiologia , Antígenos de Bactérias/diagnóstico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/imunologia , Ensaio de Imunoadsorção Enzimática/métodosRESUMO
El objetivo de este estudio fue determinar la importancia de Chlamydia trachomatis como agente etiológico en infecciones respiratorias agudas (IRA) en lactantes. Se seleccionaron 161 aspirados nasofaríngeos (ANF) de niños menores de 6 meses de edad con diagnóstico clínico de neumonía, o bronquiolitis en los que se investigó la presencia de antígeno de Ch.trachomatis por enzimoinmunoensayo (Chlamydiazyme, Abbott). Se conformaron dos grupos de niños con diagnóstico de IRA, 77 con diagnóstico etiológico viral o bacteriano y 84 niños en los que no se pudo identificar el agente patógeno. Se detectó antígeno de Ch. trachomatis en 45 de los 161 ANF estudiados (27,9 por ciento). De los 77 niños con IRA viral o bacteriana, el 36,4 por ciento resultó positivo para Ch. trachomatis mientras que en los 84 niños sin diagnóstico etiológico, el 20,2 por ciento fue positivo para Ch. trachomatis. La mayor frecuencia de detección de antígeno de Ch. trachomatis en niños con infección viral o bacteriana fue estadísticamente significativa. Con respecto a los diagnósticos clínicos, se detectó Ch. trachomatis en el 32,6 por ciento de las bronquiolitis y en el 25,4 por ciento de las neumonías totales estudiadas. Considerando exclusivamente las bronquiolitis y neumonías con diagnóstico previo de IRA viral, se detectó Ch. trachomatis en el 45 por ciento y 26 por ciento, respectivamente. Esto indica una elevada frecuencia de infecciones mixtas por Chlamydia-virus, en especial el virus Sincicial Respiratorio. El 64 por ciento (29/45) de los ANF positivos para Chlamydia correspondió a niños menores de 3 meses de edad, aunque se detectaron casos positivos hasta los 5 meses. Los resultados obtenidos señalan la importancia de CH. trachomatis en bronquiolitis o neumonías en niños menores de 6 meses de edad ya sea como único agente o asociada a virus respiratorios, en especial al Sincicial Respiratorio
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Antígenos de Bactérias/isolamento & purificação , Bronquiolite/microbiologia , Bronquite/microbiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/patogenicidade , Pneumonia/microbiologia , Infecções Respiratórias/diagnóstico , Antígenos de Bactérias , Bronquiolite/etiologia , Bronquite/etiologia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/imunologia , Ensaio de Imunoadsorção Enzimática , Pneumonia/etiologia , Uretrite/etiologia , Uretrite/microbiologiaRESUMO
The aim of this work was to evaluate the sensitivity of complement fixation for serological diagnosis of lower acute respiratory infections (ARI) in small children in comparison with direct methods such as indirect immunofluorescence (IIF) on nasopharyngeal aspirate and tissue culture isolation. Sera from children under 5 year of age with ARI were studied by complement fixation for 6 respiratory viruses (respiratory syncytial virus (RSV), adenovirus, influenza A and B and parainfluenza 1 and 3). In all, 264 pairs of serum samples from children with viral ARI diagnosis (n:135) or from doubtful cases (n:90) were studied. Thirty nine sera were anticomplementary. In samples from confirmed viral ARI patients, seroconversion was detected in 38
, whereas from those with a doubtful diagnosis it was only 14
. Seroconversion for RSV and adenovirus was 39
and 50
, respectively. On correlating seroconversion for the 6 viruses according to age group, 20
positivity was found in the 0-5 month-old group, 35
in the 6-10 month-old and 30
in those over 11 months of age. For RSV alone, 0-5 month-old patients presented 25
seroconversion, and in those over 6 months of age the percentage exceeded 60
(p less than 0.001). Complement fixation test sensitivity vs direct methods (IIF and/or culture) was 38.5
). Our findings confirm the low sensitivity of complement fixation to detect antibodies in ARI, particularly in children under 6 months of age and support the higher efficacy of direct diagnostic methods. However, complement fixation serology is useful for epidemiological studies in children over 6 months of age, since over 60
of RSV were readily detected.