The viral etiologies of UTRIs and LTRIs in children in Jinan city were investigated between July 2009 and June 2010. Nasal and throat swabs were collected from 397 children with URTIs and bronchoalveolar lavage fluid specimens were collected from 323 children with LRTIs. RT-PCR/PCR was used to examine all samples for IFV, PIV, RSV, RV, hMPV, HBoV, CoV, ADV, RSV, and EV. Viral pathogens were detected in 47.10% of URTI samples and 66.57% samples, and the incidence of viral coinfection was 5.29% and 21.05%, respectively. IFV was the most common virus in URTIs, with a detection rate of 19.40%, followed by PIV (10.83%), RV (10.58%), and EV (6.30%). For LRTIs, PIV and RV were both detected in 27% of samples, followed by RSV (9.91%), HBoV (8.36%), IFV (5.57%), and hMPV (5.57%). RSV and HBoV were more prevalent in the youngest children of no more than six months. Meanwhile, RV, PIV, and RSV were the most frequent viruses combined with bacterial pathogens in LRTIs. In conclusion, the spectrum of respiratory virus infections in URTIs and LRTIs differed in terms of the most common pathogens, seasonal distribution, and coinfection rate. 1. Introduction Acute respiratory tract infection (ARTI) is a persistent and pervasive public health issue and a great burden to both families and the wider society. Acute low respiratory tract infection is a particular problem, being the principal cause of morbidity and mortality in young people worldwide [1–3]. The most common viral causes of ARTI worldwide include respiratory syncytial virus (RSV), parainfluenza viruses (PIVs), influenza viruses (IFVs), enteroviruses (EVs), adenoviruses (ADVs), human rhinoviruses (HRVs), human metapneumovirus (hMPV), and human coronaviruses (HCoVs) 229E, OC43, NL63, and HKU1. There are an increasing number of cases with severe acute respiratory syndrome caused by coronaviruses, including NL63, HKU1 [4–6], and human bocavirus [7], and the WU and KI polyomaviruses have been discovered to cause acute respiratory tract infections [8, 9]. The pattern of respiratory tract infections is variable and is related to factors that include region, season, and year [10, 11]. The virologic epidemiology of ARTIs in children has been investigated in various regions [12–14]. In this study, we aimed to characterize the viral spectrum and pattern of upper and lower ARTIs in children in Shandong province, China. 2. Materials and Methods 2.1. Ethics Statement The study followed the Declaration of Helsinki on medical protocol and ethics. The Ethics Committees of both Shandong Medicinal Biotechnology Centre and Qilu
References
[1]
A.-M. Demers, P. Morency, F. Mberyo-Yaah et al., “Risk factors for mortality among children hospitalized because of acute respiratory infections in Bangui, Central African Republic,” Pediatric Infectious Disease Journal, vol. 19, no. 5, pp. 424–432, 2000.
[2]
J. Garbino, M. W. Gerbase, W. Wunderli et al., “Respiratory viruses and severe lower respiratory tract complications in hospitalized patients,” Chest, vol. 125, no. 3, pp. 1033–1039, 2004.
[3]
J. P. Mizgerd, “Lung infection—a public health priority,” PLoS Medicine, vol. 3, no. 2, pp. 0155–0158, 2006.
[4]
J. S. M. Peiris, S. T. Lai, L. L. M. Poon et al., “Coronavirus as a possible cause of severe acute respiratory syndrome,” The Lancet, vol. 361, no. 9366, pp. 1319–1325, 2003.
[5]
L. van der Hoek, K. Pyrc, M. F. Jebbink et al., “Identification of a new human coronavirus,” Nature Medicine, vol. 10, no. 4, pp. 368–373, 2004.
[6]
P. C. Y. Woo, S. K. P. Lau, C.-M. Chu et al., “Characterization and complete genome sequence of a novel coronavirus, coronavirus HKU1, from patients with pneumonia,” Journal of Virology, vol. 79, no. 2, pp. 884–895, 2005.
[7]
T. Allander, M. T. Tammi, M. Eriksson, A. Bjerkner, A. Tiveljung-Lindell, and B. Andersson, “Cloning of a human parvovirus by molecular screening of respiratory tract samples,” Proceedings of the National Academy of Sciences of the United States of America, vol. 102, no. 36, pp. 12891–12896, 2005.
[8]
M. Debiaggi, F. Canducci, R. Brerra et al., “Molecular epidemiology of KI and WU polyomaviruses in infants with acute respiratory disease and in adult hematopoietic stem cell transplant recipients,” Journal of Medical Virology, vol. 82, no. 1, pp. 153–156, 2010.
[9]
L. Ren, R. Gonzalez, Z. Xie et al., “WU and KI polyomavirus present in the respiratory tract of children, but not in immunocompetent adults,” Journal of Clinical Virology, vol. 43, no. 3, pp. 330–333, 2008.
[10]
C. Larcher, V. Jeller, H. Fischer, and H. P. Huemer, “Prevalence of respiratory viruses, including newly identified viruses, in hospitalised children in Austria,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 25, no. 11, pp. 681–686, 2006.
[11]
F. E. A. Moura, A. C. B. Perdig？o, and M. M. Siqueira, “Seasonality of influenza in the tropics: a distinct pattern in northeastern Brazil,” American Journal of Tropical Medicine and Hygiene, vol. 81, no. 1, pp. 180–183, 2009.
[12]
J. Shen, Q. R. Zhu, M. Zeng, H. Yu, and X. H. Wang, “Molecular epidemiology of human metapneumovirus in children with acute lower respiratory tract infections in Shanghai,” Zhonghua Liu Xing Bing Xue Za Zhi, vol. 31, no. 4, pp. 447–450, 2010.
[13]
S. Sonoda, Y. Gotoh, F. Bann, and T. Nakayama, “Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo,” Pediatrics International, vol. 41, no. 5, pp. 519–524, 1999.
[14]
S. Zamberi, I. Zulkifli, and I. Ilina, “Respiratory viruses detected in hospitalised paediatric patients with respiratory infections,” Medical Journal of Malaysia, vol. 58, no. 5, pp. 681–687, 2003.
[15]
Y. Lu, J. Tong, F. Pei et al., “Viral aetiology in adults with acute upper respiratory tract infection in jinan, northern china,” Clinical and Developmental Immunology, vol. 2013, Article ID 869521, 7 pages, 2013.
[16]
M. T. Coiras, J. C. Aguilar, M. L. García, I. Casas, and P. Pérez-Bre？a, “Simultaneous detection of fourteen respiratory viruses in clinical specimens by two multiplex reverse transcription nested-PCR assays,” Journal of Medical Virology, vol. 72, no. 3, pp. 484–495, 2004.
[17]
M. T. Coiras, P. Pérez-Bre？a, M. L. García, and I. Casas, “Simultaneous detection of influenza A, B, and C viruses, respiratory syncytial virus, and adenoviruses in clinical samples by multiplex reverse transcription nested-PCR assay,” Journal of Medical Virology, vol. 69, no. 1, pp. 132–144, 2003.
[18]
J. S. M. Peiris, W.-H. Tang, K.-H. Chan et al., “Children with respiratory disease associated with metapneumovirus in Hong Kong,” Emerging Infectious Diseases, vol. 9, no. 6, pp. 628–633, 2003.
[19]
A. Allard, R. Girones, P. Juto, and G. Wadell, “Polymerase chain reaction for detection of adenoviruses in stool samples,” Journal of Clinical Microbiology, vol. 28, no. 12, pp. 2659–2667, 1990.
[20]
A. Kapoor, P. Simmonds, E. Slikas et al., “Human bocaviruses are highly diverse, dispersed, recombination prone, and prevalent in enteric infections,” Journal of Infectious Diseases, vol. 201, no. 11, pp. 1633–1643, 2010.
[21]
S. Lambert, D. M. Whiley, N. T.o'Neill et al., “Comparing nose-throat swabs and nasopharyngeal aspirates collected from children with symptoms for respiratory virus identification using real-time polymerase chain reaction,” Pediatrics, vol. 122, no. 3, pp. e615–e620, 2008.
[22]
L. Ren, R. Gonzalez, Z. Wang et al., “Prevalence of human respiratory viruses in adults with acute respiratory tract infections in Beijing, 2005—2007,” Clinical Microbiology and Infection, vol. 15, no. 12, pp. 1146–1153, 2009.
[23]
H. Yu, S. Cauchemez, C. A. Donnelly et al., “Transmission dynamics, border entry screening, and school holidays during the 2009 influenza A (H1N1) pandemic, China,” Emerging Infectious Diseases, vol. 18, no. 5, pp. 758–766, 2012.
[24]
C. Manoha, S. Espinosa, S.-L. Aho, F. Huet, and P. Pothier, “Epidemiological and clinical features of hMPV, RSV and RVs infections in young children,” Journal of Clinical Virology, vol. 38, no. 3, pp. 221–226, 2007.
[25]
C.-C. Sung, H. Chi, N.-C. Chiu et al., “Viral etiology of acute lower respiratory tract infections in hospitalized young children in Northern Taiwan,” Journal of Microbiology, Immunology and Infection, vol. 44, no. 3, pp. 184–190, 2011.
[26]
J. Teeratakulpisarn, T. Ekalaksananan, C. Pientong, and C. Limwattananon, “Human metapneumovirus and respiratory syncytial virus detection in young children with acute bronchiolitis,” Asian Pacific Journal of Allergy and Immunology, vol. 25, no. 2-3, pp. 139–145, 2007.
[27]
L. Zhang, L. Tang, Z. Xie et al., “Viral etiology and clinical characteristics in children with acute lower repiratory tract infection,” Journal of Applied Clinical Pediatrics, vol. 23, no. 22, pp. 1743–1744, 2008.
[28]
C. Liu, Z. Xie, R. Gonzalez, et al., “Study of viral etiology of acute lower respiratory tract infection in children,” Chinese Journal of Practical Pediatrics, vol. 24, no. 4, pp. 270–273, 2009.
[29]
Z. D. Xie, Y. Xiao, C. Y. Liu et al., “Three years surveillance of viral etiology of acute lower respiratory tract infection in children from 2007 to 2010,” Zhonghua Er Ke Za Zhi, vol. 49, no. 10, pp. 745–749.
[30]
N.-G. Xiao, B. Zhang, Z.-J. Duan et al., “Viral etiology of 1165 hospitalized children with acute lower respiratory tract infection,” Chinese Journal of Contemporary Pediatrics, vol. 14, no. 1, pp. 28–32, 2012.
[31]
X.-W. Qu, Z.-J. Duan, Z.-Y. Qi et al., “Human bocavirus infection, People's Republic of China,” Emerging Infectious Diseases, vol. 13, no. 1, pp. 165–168, 2007.
[32]
T. Chieochansin, C. Thongmee, L. Vimolket, A. Theamboonlers, and Y. Poovorawan, “Human bocavirus infection in children with acute gastroenteritis and healthy controls,” Japanese Journal of Infectious Diseases, vol. 61, no. 6, pp. 479–481, 2008.
[33]
S. Bicer, T. Giray, D. Col et al., “Virological and clinical characterizations of respiratory infections in hospitalized children,” Italian Journal of Pediatrics, vol. 39, p. 22, 2013.
[34]
C. F. Shafik, E. W. Mohareb, A. S. Yassin et al., “Viral etiologies of lower respiratory tract infections among Egyptian children under five years of age,” BMC Infectious Diseases, vol. 12, p. 350, 2012.
[35]
N. Richard, F. Komurian-Pradel, E. Javouhey et al., “The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis,” Pediatric Infectious Disease Journal, vol. 27, no. 3, pp. 213–217, 2008.
[36]
J. Greensill, P. S. McNamara, W. Dove, B. Flanagan, R. L. Smyth, and C. A. Hart, “Human metapneumovirus in severe respiratory syncytial virus bronchiolitis,” Emerging Infectious Diseases, vol. 9, no. 3, pp. 372–375, 2003.
[37]
V. Foulongne, G. Guyon, M. Rodière, and M. Segondy, “Human metapneumovirus infection in young children hospitalized with respiratory tract disease,” Pediatric Infectious Disease Journal, vol. 25, no. 4, pp. 354–359, 2006.
[38]
M. G. Semple, A. Cowell, W. Dove et al., “Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis,” Journal of Infectious Diseases, vol. 191, no. 3, pp. 382–386, 2005.
[39]
A. Wilkesmann, O. Schildgen, A. M. Eis-Hübinger et al., “Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections,” European Journal of Pediatrics, vol. 165, no. 7, pp. 467–475, 2006.
[40]
A. Capelastegui, P. P. Espana, A. Bilbao et al., “Etiology of community-acquired pneumonia in a population-based study: link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes,” BMC Infectious Diseases, vol. 12, p. 134, 2012.
[41]
S. Mermond, A. Berlioz-Arthaud, M. Estivals, F. Baumann, H. Levenes, and P. M. V. Martin, “Aetiology of community-acquired pneumonia in hospitalized adult patients in New Caledonia,” Tropical Medicine and International Health, vol. 15, no. 12, pp. 1517–1524, 2010.
[42]
M. M. Pettigrew, J. F. Gent, R. B. Pyles, A. L. Miller, J. Nokso-Koivisto, and T. Chonmaitree, “Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection,” Journal of Clinical Microbiology, vol. 49, no. 11, pp. 3750–3755, 2011.
