Viral etiology of pneumonia among severely malnourished under-five children in an urban hospital, Bangladesh.
- 作者列表："Chowdhury F","Shahid ASMSB","Ghosh PK","Rahman M","Hassan MZ","Akhtar Z","Muneer SM","Shahrin L","Ahmed T","Chisti MJ
BACKGROUND:In Bangladesh, pneumonia has a higher mortality among malnourished children aged <5 years. Evaluating pneumonia etiology among malnourished children may help improve empiric treatment guidelines. METHODS:During April 2015-December 2017, we conducted a case-control study among severe acute malnourished (SAM) children aged <5 years admitted to the Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). We enrolled hospital admitted SAM children with clinical or radiological pneumonia as cases (during April 2015 to March 2017) and hospital admitted SAM children without any respiratory symptom in the past 10 days before admission as controls (during February 2016 to December 2017). We tested nasopharyngeal wash from both case and control for respiratory syncytial virus (RSV), human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV), rhinovirus and adenovirus by singleplex real-time reverse transcriptase polymerase chain reaction. To identify the independent association of pneumonia with viral pathogens during February 2016 to March 2017, we used multivariable logistic regression for calculating adjusted odds ratios. RESULTS:We enrolled 360 cases and 334 controls. For case and control the median age was 8 months (IQR: 5-13) and 11 months (IQR: 6-18) (p = 0.001) respectively. Weight/age Z-score was -4.3 (SD ±0.7) for cases and -4.1 (SD ±1.1) for controls (p = 0.01). Among cases 68% had both clinical and radiological pneumonia, 1% had clinical pneumonia and 31% had only radiological pneumonia. Respiratory virus detection was high in cases compared to controls [69.9% (251) vs. 44.8% (148), p = 0.0001]. The most frequently detected viruses among cases were rhinoviruses (79, 22.0%) followed by RSV (32, 8.9%), adenovirus (23, 6.4%), HPIV (22, 6.1%), influenza virus (16, 4.5%), and HMPV (16, 4.5%). Among the controls, rhinoviruses (82, 24.8%) were most commonly detected one followed by adenovirus (26,7.9%), HMPV (5, 1.5%), HPIV (4, 1.2%), RSV (3, 0.9%), and influenza virus (2, 0.6%). RSV (OR 13.1; 95% CI: 1.6, 106.1), influenza virus (OR 8.7; 95% CI: 1.0, 78.9), HPIV (3.8; 95% CI: 1.0, 14.8), and HMPV (2.7; 95% CI: 1.3, 5.5) were independently associated with pneumonia while compared between 178 cases and 174 controls. CONCLUSION:Viral etiology of pneumonia in SAM children were mainly attributable to RSV, influenza, HPIV and HMPV. Our study findings may help in planning further studies targeting vaccines or drugs against common respiratory viruses responsible for pneumonia among SAM children.
背景: 在孟加拉国，肺炎在 5 岁以下营养不良儿童中死亡率较高。评估营养不良儿童的肺炎病因可能有助于改进经验性治疗指南。 方法: 在 2015 年 4 月至 2017 年 12 月期间，我们在严重急性营养不良 (SAM) 中进行了一项病例对照研究。孟加拉国国际腹泻病研究中心达卡医院收治的 5 岁以下儿童 (icddr，b)。选取医院收治的SAM患儿临床及放射性肺炎的情况下 (在 2015-2017) 和医院入院前 10 天内无任何呼吸道症状的SAM患儿作为对照 (2016 年 2 月至 2017 年 12 月期间)。我们检测了病例和对照的鼻咽洗液的呼吸道合胞病毒 (RSV) 、人偏肺病毒 (HMPV) 、流感病毒、人副流感病毒 (HPIV) 、鼻病毒和腺病毒单倍体实时逆转录聚合酶链反应。为了确定 2016 年 2 月至 2017 年 3 月期间肺炎与病毒性病原体的独立关联，我们使用多变量逻辑回归计算调整后的比值比。 结果: 我们纳入了 360 例病例和 334 例对照。对于病例和对照，中位年龄分别为 8 个月 (IQR: 5-13) 和 11 个月 (IQR: 6-18) (p = 0.001)。病例的体重/年龄Z评分为-4.3 (SD ± 0.7)，对照为-4.1 (SD ± 1.1) (p = 0.01)。在病例中，68% 同时患有临床和放射性肺炎，1% 患有肺炎，31% 仅患有放射肺炎。与对照组相比，病例中的呼吸道病毒检测较高 [69.9% (251) 对 44.8% (148)，p = 0.0001]。病例中最常见的病毒es是犀牛病毒es (79，22.0%)，其次是RSV (32，8.9%)，腺病毒病毒 (23，6.4%)，HPIV (22，6.1%) 、流感病毒 (4.5%) 和HMPV (4.5%)。在对照组中，最常检测到的是犀牛病毒es (82，24.8%)，其次是腺病毒病毒 (26，7.9%)，HMPV (5，1.5%)，HPIV (4，1.2%) 、RSV (0.9%) 和流感病毒 (0.6%)。RSV (OR 13.1; 95% CI: 1.6，106.1)，流感病毒 (OR 8.7; 95% CI: 1.0，78.9)，HPIV (3.8; 95% CI: 1.0，14.8)，和HMPV (2.7; 95% CI: 1.3，5.5)与肺炎独立相关，同时在 178 例病例和 174 例对照之间进行比较。 结论: SAM患儿肺炎的病毒病原学主要由RSV、流感、HPIV和HMPV引起。我们的研究结果可能有助于规划针对SAM儿童肺炎的常见呼吸道病毒的疫苗或药物的进一步研究。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.