Clinical Epidemiology And Follow-up Research Of Childhood Lower Respiratory Tract Infection Due To Seven Viruses In Suzhou

Objective:To compare the clinical epidemiological characteristics of children with lower respiratory tract respiratory syncytial virus（RSV）、human rhinovirus（HRV）、human boka virus（HBoV）、parainfluenza（PinF）、influenza virus（Flu）、adenovirus（ADV）and human met pneumonia（hMPV）infection.To follow up the incidence of recurrent wheezing after RSV and HRV infection and analyze the risk factors associated with wheezing.Methods:The clinical data of 4369 patients with acute lower respiratory tract infection（ALRTI）who were hospitalized in our hospital from January 2013 to October2016 were retrospectively analyzed.The clinical epidemiological characteristics of seven lower respiratory tract infections were compared.The follow-up of recurrent wheezing after RSV and HRV infection was followed by Logistic multiple regression analysis of respite-related risk factors.Result:First.Clinical epidemiology of seven lower respiratory tract virus infections⑴Virus detection situation:From the 4369 cases of nasopharyngeal secretions specimens,1543 cases were detected at least one virus,the total detection rate was 35.32%,a variety of virus detection positive rate from high to low followed by RSV12.45%,HRV12.22%,HBoV6.13%,PinF5.15%,Flu1.12%,ADV0.85%and hMPV0.46%.There are 118 cases of virus and other virus mixed infection,626 cases of virus and bacterial infection,235 cases of virus and MP mixed infection,which HRV and HBoV mixed with other pathogens accounted for the majority,HRV mixed with other viruses accounted for65.25%,mixed with bacterial infection accounted for 40.82%,mixed with MP infection accounted for 18.91%,HBoV mixed with other viruses accounted for 53.38%,mixed with bacterial infection accounted for 32.09%,mixed with MP infection accounted for 20.52%.⑵Age distribution:The detection rate of RSV was the highest among infants≤1 year old,including 21.92%for 29 days to 6 months and 12.16%for 6 months to 1 year（P<0.05）.The detection rate of HRV was the highest among children aged>1 years,including 11.08%for 1 year olds and 9.68%for 3 years old and 8.79%for 5 years old,there was no significant difference in the detection rate of HRV among all ages（P>0.05）.The detection rate of HBoV in children aged 1 to 3 was the highest,which was about 8.36%（P<0.05）.The detection rate of PinF was the highest in infants>6 months to 1 year old,which was about 6.99%（P<0.05）.⑶Seasonal distribution:The detection rate of RSV was the highest in winter（29.99%,P<0.05）.The detection rate of HRV was the highest in autumn,15.95%,followed by 12.41%in spring and 12.00%in summer（P<0.05）.The detection rate of HBoV in summer and autumn was higher than that in winter and spring（8.11%,8.54%vs 4.67%,5.09%,P<0.05）.The detection rate of PinF in spring and summer was higher than that in autumn and winter（7.32%,8.65%vs 2.14%,0.42%,P<0.05）.Flu highest detection rates in winter,is 3.54%（P<0.05）.⑷Clinical features:（1）The detection rate of RSV,HRV and HBoV in the wheezing group was higher than that in the no wheezing group（18.08%,13.06%and 5.53%vs 6.57%,8.56%and 3.98%,P<0.05）.（2）The detection rate of RSV and HRV in fever group was higher than that in fever group（16.92%,13.47%vs 6.60%,7.88%,P<0.05）.The detection rate of HBo V,Flu and ADV in fever group was higher than that in fever group%,1.28%and 1.07%vs 3.34%,0.26%and0.26%,P<0.05).（3）The detection rate of RSV and HBoV in the group of dyspnea was higher than that in group without dyspnea（18.25%,6.49%vs 10.13%,4.32%,P<0.05）,The detection rate of PinF in dyspnea group was lower than that in group without dyspnea（2.81%vs 4.79%,P<0.05）.⑸Disease:The detection rate of RSV in bronchiolitis group was the highest,reaching 27.23%;The highest detection rate of HRV in acute asthma group was 21.08%;The highest detection rate of HBo V in severe pneumonia group was8.46%;There was no significant difference in the detection rate of PinF,Flu,ADV and hMPV in different disease groups（P>0.05）.The highest detection rate of HRV was 9.32%in normal pneumonia group and 27.36%in severe pneumonia group.⑹Laboratory tests:（1）The detection rate of RSV in WBC>10×10⁹ group was lower than that in≤10×10⁹group（7.84%vs 10.03%,P<0.05）.The detection rate of HRV in WBC>10×10⁹ group was higher than that in≤10×10⁹group（13.54%vs 7.82%,P<0.05）.（2）The detection rate of RSV in Gra>75%group was lower than that in≤75%group（1.96%vs 9.83%,P<0.05）.The detection rate of Flow in the 75%group was higher than that in the≤75%group（2.52%vs0.60%,P<0.05）.（3）The detection rate of RSV and PinF in sCRP>8mg/L group was lower than that in sCRP≤8mg/L group（4.66%,2.45%vs 11.17%,5.36%,P<0.05）.The detection rate of HRV,Flu and ADV in sCRP>8mg/L group was higher than that in sCRP≤8mg/L group（11.68%,1.23%and 1.39%vs 9.57%,0.57%and 0.30%,P<0.05）.（4）The detection rate of RSV in CKMB>3.7ng/ml group was higher than that in CKMB≤3.7ng/ml group（10.22%vs 6.18%,P<0.05）.（5）The detection rate of RSV in ALT>40U/L group was higher than that in ALT≤40U/L group（12.92%vs 8.53%,P<0.05）.There was no significant difference between the two groups in the other indexes（P>0.05）.⑺Appropriate physical fitness:The detection rate of HRV in children with atopic fitness was higher than that in children without atopic fitness（16.23%vs 10.11%,P<0.05）.There was no statistically significant difference between the two groups（P>0.05）.Second.The risk factors analysis and follow-up study⑴Age<2 years（OR=3.816,95%CI:2.044⁷.124）and atopic（OR=2.166,95%CI:1.456³.218）are independent risk factors for children with RSV-related wheezing.⑵Male（OR=1.694,95%CI:1.127².547）,atopic（OR=1.560,95%CI:1.031².359）,recurrent respiratory tract infection（OR=2.062,95%CI:1.299³.274）,artificial feeding（OR=1.947,95%CI:1.303².911）and living in urban（OR=1.905,95%CI:1.249².905）are independent risk factors for HRV-related wheezing in children.⑶A year after follow-up of children with RSV and HRV infection,it was found that there was no significant difference in the incidence of recurrent wheezing between the RSV infection group and the HRV infection group（P>0.05）.⑷Analysis of influential factors of repeated wheezing in two virus infections:Atopic[RSV group（OR=5.804,95%CI:1.118³0.144）,HRV group（OR=16.986,95%CI:2.710¹06.478）and post-discharge recurrent respiratory infections[RSV group（OR=12.829,95%CI:1.379¹19.350）,HRV group（OR=13.264,95%CI:2.520⁶9.799）are independent risk factors for subsequent recurrent wheezing in children with RSV infection and HRV infection.Conclusion:⑴RSV is susceptible to infants less than 1 years old,especially less than6 months old,with a peak in autumn and winter,RSV infection can cause wheezing,shortness of breath and difficulty in breathing and other clinical manifestations,leading to bronchiolitis and severe pneumonia and other diseases,Laboratory tests suggest that myocardial damage,abnormal liver function,but the inflammation is often normal.Age less than 2 years old,atopy,recurrent respiratory tract infections are risk factors for recurrent wheezing after RSV infection.⑵HRV is susceptible to children older than 1 year old,with a peak in spring,summer and autumn,most likely to be detected in patients with acute asthma attacks.HRV infection can cause wheezing symptoms,due to easy mixed with bacterial infection,Laboratory tests often suggest that WBC,sCRP increased.Male,atopic,recurrent respiratory tract infection,artificial feeding and living in the city are risk factors for recurrent wheezing after HRV infection.⑶HBoV is most likely to be detected in children aged 1 to 3 years old,with a peak in summer and autumn,most likely to be detected in patients with severe pneumonia.HBoV is often mixed with other pathogens.HBoV infection can cause wheezing,fever,shortness of breath and other clinical manifestations,but the laboratory test results are not specific.⑷PinF is most likely to be detected in children from 6 months to 1 year old,with a peak in spring and summer.Both clinical manifestations caused by PinF infection and the laboratory test results are not specific.⑸The detection rate of Flu was higher in winter.Flu infection can cause fever symptoms.Due to easy mixed with bacterial infection,Laboratory tests often suggest that Gra,sCRP increased.In this study,because of the low detection rate of Flu,other clinical epidemiological characteristics were not statistically significant.⑹ADV infection can cause fever symptoms.Laboratory tests often suggest that sCRP abnormalities.In this study,because of the low detection rate of ADV,other clinical epidemiological characteristics were not statistically significant.⑺The detection rate of hMPV was the lowest among the 4369 children（0.46%）included in the study,so the results were prone to bias in this study.