| Objective:Human Bocavirus(HBoV),a recently discovered parvovirus,constitutes a significant percentage of lower Respiratory Tract Infections(LRTI)in small children.However,its incidence,clinical outlook and role as a causative agent in respiratory tract illnesses in single and mix viral infection cases remains unclear.The objective of this study is to study and compare single and mix virus infections in hospitalized children with lower respiratory tract infection(LRTI).Methods:A total of 513 patients with HBoV infection during January 2013 and December 2016 at Pediatric Respiratory Department of the Children's Hospital of Soochow University were retrospectively reviewed for Bocavirus infections.The clinical data pertaining to single infections and mixed infections were examined and compared.Nasopharyngeal aspirates were examined by immunofluorescence assays or Polymerase chain reaction(PCR)for viruses.Results:In this study,patients with LRTI were screened for Bocavirus infections and later segregated into two groups on the basis of single virus and mix virus infection.1.From a total of 8213 with acute respiratory tract infections especially LRTI,HBoV was positive in 513(6.24%)patients.2.Out of the 513 patients with HBoV infection,329(64.13%)were males and 184(35.87%)were females.The male to female ratio was 1.78:1.3.The median age was 13 months(range from 1 month to 16 years).The highest number of cases were recorded in the age group ranging from less than or equal to 6-24 months.About 292 patients accounting for 56.9%of 513 patients observed were between the age range of 6-24 months while the lowest percentage was noted in the age group of greater than or equal to 60 months as 15,2.92%.4.A high percentage of cases were observed in the age groups of less than or equal to 12 months and 24 months,accounting for 140 cases,27.2%and 152,29.6%respectively.Lower percentages were observed in the age groups of 36 months with 67 cases accounting for 13.06%,60 months with 52 cases accounting for 10.13%with the lowest percentage noted in the age group of greater than or equal to 60 months as 15,2.92%.5.Infections with HBoV were found all around the year peaking in summer and autumn.Our study also reports a high incidence of 1BoV infections was recorded at Childrens Hospital of Soochow University indicating an epidemic of Bocavirus.6.From the 513 patients with HboV infection;66 cases,12.8%were seen during winter;115 cases,22.4%were seen during spring;150 cases,29.23%were seen during summer and 173 cases,33.72%were seen during autumn.While in the 303 patients with single HBoV infection,45 cases,14.09%were seen in winter;63 cases,20.8%were seen in spring;86 cases,28.7%were seen in summer and 109 cases,36.0%were seen in autumn.And in the 210 patients with mix virus infections,20 cases,9.5%were seen in winter;47 cases,22,4%were seen in spring;71 cases,33.8%was seen in summer and 72 cases,34.3%were seen in autumn.7.Age distribution in cases of coinfection was noted in 40.9%(210 of 513)of the patients.Co:infections were documented in 49.6%of patients<6 months old,45.4%of patients 6 months to<1 years old,35.3%of patients 1 to<2 years old,37.3%of patients 2 to<5 years old,and 31.9%of patients?5 years old.8.Coinfection was identified in 40.9%(210 of 513)of the patients.Of the 51 patients with coinfection,the most commonly detected pathogens were RSV(14.8%),HRV(26.87%),M.pneumoniae(24.63%),PIV(5.97.6%)and others(4.48%).9.The proportion of children presenting with fever,was significantly higher among patient group of mix virus infection.Their median age of children with single virus infections(13 months),was similar to that of children infected with mixed viruses(12 months).The duration of symptoms and usage of antibiotics preceding admission was similar among all groups of patients and no significant differences were observed.10.Blood sample comparison in the single virus infection patient group,the mean peripheral white blood cell count was 8.9x10^9/L,the mean percentage of granulocytes was 43.8%,lymphocytes was 42.85%,mean platelets level was 337.2,and Creatine Kinase Myocardial Band(CKMB)was 68.43 ng/mL.While in the mixed virus group,the mean peripheral white blood cell count was 11.97x10A9/L,the mean percentage of granulocytes was 44.8%,lymphocytes was 39.02,mean platelets level was 332.2,and Creatine Kinase Myocardial Band(CKMB)was 26.04 ng/mL11.Our study noted the statistical differences in the levels of IgA,IgG and IgM between the two groups.In instances of mixed virms infection,Immunoglobin G levels were found to be significantly higher(p<0.01)and while Immunoglobin A levels were found to be higher in the single virus group(p<0.01).However no significant differences were noted in the values of Immunoglobin M between the two groups.12.In liver function tests the mean alanine aminotransferase(ALT)level of patients with Single Virus infection was 34.79 U/L and the mean aspartate aminotransferase(AST)level was 19.18 U/L.Whereas the mean ALT level of patients with mixed virus infection was 26.52 U/L and the mean AST level was 37.65 U/L.There was a significant increase in AST levels in patients with mixed virus infection compared to patients with single virus infection.13.In our study there was no significant statistical difference found in CD3+,CD3+CD4+,CD3-CD8+,CD4/CD8,CD3-CD19+,CD3-CD(16+56)+ and CD19+CD23+.And no significant difference was found in CRP values because CRP is not so elevated in viral infectionsConclusion:Human Boca virus is frequently detected in co-infection with other respiratory viruses and the overall viral co-infections do not present greater severity but have mixed clinical features.No major significant differences in the admission diagnosis,laboratory parameters,patient demographics and clinical characteristics.No major significant difference in the manifestation of viral co-infection was observed in comparison with single viral infection.The high burden on hospitalized population underscores a need for the enhancement of sensitive,inexpensive,and rapid diagnostics to accurately identify lower respiratory tract pathogens. |
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