Advertisement

Respiratory Pathogens in Infants Diagnosed with Acute Lower Respiratory Tract Infection in a Tertiary Care Hospital of Western India Using Multiplex Real Time PCR

  • Anuja A. SonawaneEmail author
  • Jayanthi Shastri
  • Sandeep B. Bavdekar
Original Article
  • 28 Downloads

Abstract

Objective

To determine the frequency of respiratory pathogens in infants diagnosed with acute lower respiratory tract infections.

Methods

A prospective cross-sectional observational study was conducted in infants hospitalized with a diagnosis of acute lower respiratory tract infection (ALRTI), in a tertiary care hospital in a metropolitan city of Western India. Nasopharyngeal swabs were analyzed by multiplex real time polymerase chain reaction, for 18 viruses and 3 bacteria (H. influenzae type b, C. pneumoniae and M. pneumoniae). The entire data was entered in Microsoft excel sheet and frequencies were determined.

Results

One hundred eligible infants were enrolled. Pathogens were detected in 82 samples, which included Respiratory syncytial viruses (RSV) A / B (35.4%), Human rhinovirus (25.6%), Adenovirus (22%), Human Parainfluenza viruses (11%), Human bocavirus (9.8), Human metapneumovirus A / B (8.5%), Influenza A (H1N1) pdm 09 (6.1%), Parechovirus (3.7%), Human coronaviruses (3.66%), Haemophilus influenzae type b (6.1%), Chlamydia pneumoniae (2.4%) and Mycoplasma pneumoniae (2.4%). Influenza A (other than H1N1), Influenza B, Human Coronavirus 229E and Enterovirus were not detected. The rate of coinfection was 34% and rhinovirus was the most common of the multiple pathogens.

Conclusions

Spectrum of viral etiologies of ALRTI is highlighted. Etiological diagnosis of ALRTI would enable specific antiviral therapy, restrict antibiotic use and help in knowing burden of disease.

Keywords

Multiplex real time PCR Acute lower respiratory tract infection Infants Respiratory viruses RSV Co-infection 

Notes

Acknowledgements

The authors’ thank Puritan Medical Products, USA, for providing them flocked swabs with universal transport media (UT – 317).

Authors' Contributions

AAS: Assistance in conceptualization of the research project and developing protocol, conduct of research, data collection, interpretation of results, intellectual inputs in drafting the manuscript and approval of the final draft; JS: Conceptualized the research idea, supervised the conduct of the research, intellectual inputs in drafting the manuscript and approval of the final draft; SSB: Assistance in conceptualization of the research project and developing protocol, interpretation of results, intellectual inputs for improving the research paper and approval of the final draft.

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

Intramural research funds.

References

  1. 1.
    Martins Júnior R, Carney S, Goldemberg D, et al. Detection of respiratory viruses by real-time polymerase chain reaction in outpatients with acute respiratory infection. Mem Inst Oswaldo Cruz. 2014;109:716–21.CrossRefGoogle Scholar
  2. 2.
    Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2095–128.CrossRefGoogle Scholar
  3. 3.
    Liu L, Johnson H, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–61.CrossRefGoogle Scholar
  4. 4.
    Yeolekar L, Damle R, Kamat A, Khude M, Simha V, Pandit A. Respiratory viruses in acute respiratory tract infections in Western India. Indian J Pediatr. 2008;75:341–5.CrossRefGoogle Scholar
  5. 5.
    Kabra S, Lodha R, Broor S, Chaudhary R, Ghosh M, Maitreyi R. Etiology of acute lower respiratory tract infection. Indian J Pediatr. 2003;70:33–6.CrossRefGoogle Scholar
  6. 6.
    Singh AK, Jain A, Jain B, et al. Viral aetiology of acute lower respiratory tract illness in hospitalized paediatric patients of a tertiary hospital: one-year prospective study. Indian J Med Microbiol. 2014;32:13–8.CrossRefGoogle Scholar
  7. 7.
    Mathew JL, Singhi S, Ray P, et al. Etiology of community acquired pneumonia among children in India: prospective, cohort study. J Glob Health. 2015;5:050418.CrossRefGoogle Scholar
  8. 8.
    Bharaj P, Sullender WM, Kabra SK, et al. Respiratory viral infections detected by multiplex PCR among pediatric patients with lower respiratory tract infections seen at an urban hospital in Delhi from 2005 to 2007. Virol J. 2009;6:89.CrossRefGoogle Scholar
  9. 9.
    Broor S, Parveen S, Bharaj P, et al. A prospective three-year cohort study of the epidemiology and virology of acute respiratory infections of children in rural India. PLoS One. 2007;2:e491.Google Scholar
  10. 10.
    Wright P, Cutt F. Generic protocol to examine the incidence of lower respiratory infection due to respiratory syncytial virus in children less than five years of age [Internet]. Geneva, Switzerland: World Health Organization, Department of Vaccines and Biologicals;2000. Available at:http://apps.who.int/iris/bitstream/handle/10665/66276/WHO_V_and_B_00.08_eng.pdf?sequence=1. Accessed 23 Aug 2018.
  11. 11.
    Centre for Disease Control & Prevention, World Food Programme. A Manual: Measuring and Interpreting Malnutrition and Mortality. Rome: CDS & World Food Programme: C; 2005: 17–20.Google Scholar
  12. 12.
    World Health Organization. WHO Child Growth Standards. Weight-for-age; girls birth to 2 years (z-scores) [Internet]. WHO; Available at: http://www.who.int/childgrowth/standards/cht_wfa_girls_z_0_2.pdf?ua=1. Accessed 5 Oct 2015.
  13. 13.
    World Health Organization. WHO Child Growth Standards. Weight for age; boys birth to 2 years (z scores). Available at: http://www.who.int/childgrowth/standards/cht_wfa_boys_z_0_2.pdf?ua=1. Accessed 5 Oct 2015.
  14. 14.
    Frayha H, Castriciano S, Mahony J, Chernesky M. Nasopharyngeal swabs and nasopharyngeal aspirates equally effective for the diagnosis of viral respiratory disease in hospitalized children. J Clin Microbiol. 1989;27:1387–9.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Hoffmann J, Rabezanahary H, Randriamarotia M, et al. Viral and atypical bacterial etiology of acute respiratory infections in children under 5 years old living in a rural tropical area of Madagascar. PLoS One. 2012;7:e43666.CrossRefGoogle Scholar
  16. 16.
    Feng L, Li Z, Zhao S, et al. Viral etiologies of hospitalized acute lower respiratory infection patients in China, 2009-2013. PLoS One. 2014;9:e99419.CrossRefGoogle Scholar
  17. 17.
    Espínola E, Russomando G, Aquino C, Basualdo W. Phylogeny-based classification of human rhinoviruses detected in hospitalized children with acute lower respiratory infection in Paraguay, 2010-2011. J Med Virol. 2013;85:1645–51.CrossRefGoogle Scholar
  18. 18.
    Pretorius MA, Madhi SA, Cohen C, et al. Respiratory viral coinfections identified by a 10-plex real-time reverse-transcription polymerase chain reaction assay in patients hospitalized with severe acute respiratory illness--South Africa, 2009-2010. J Infect Dis. 2012;206:S159–65.CrossRefGoogle Scholar
  19. 19.
    Longtin J, Bastien M, Gilca R, et al. Human bocavirus infections in hospitalized children and adults. Emerg Infect Dis. 2008;14:217–21.CrossRefGoogle Scholar
  20. 20.
    Child Health Programme [Internet]. Minister of Health & Family Welfare; 2015 Available at: https://mohfw.gov.in/sites/default/files/54789632475632147555.pdf. Accessed 4 Oct 2015.
  21. 21.
    Meerhoff T, Houben M, Coenjaerts F, et al. Detection of multiple respiratory pathogens during primary respiratory infection: nasal swab versus nasopharyngeal aspirate using real-time polymerase chain reaction. Eur J Clin Microbiol Infect Dis. 2010;29:365–71.CrossRefGoogle Scholar
  22. 22.
    Proenca-Modena JL, Pereira Valera FC, Jacob M, et al. High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease. PLoS One. 2012;7:e42136.Google Scholar
  23. 23.
    Nunes MC, Kuschner ZC, Rabede Z, et al. Clinical epidemiology of bocavirus, rhinovirus, two polyomaviruses and four coronaviruses in HIV-infected and HIV-uninfected South African children. PLoS One. 2014;9:e86448.CrossRefGoogle Scholar
  24. 24.
    Martin E, Fairchok M, Stednick Z, Kuyperss J, Englund J. Epidemiology of multiple respiratory viruses in childcare attendees. J Infect Dis. 2013;207:982–9.CrossRefGoogle Scholar
  25. 25.
    da Silva ER, Pitrez MCP, Arruda E, et al. Severe lower respiratory tract infection in infants and toddlers from a non-affluent population: viral etiology and co-detection as risk factors. BMC Infect Dis. 2013;13:41.CrossRefGoogle Scholar
  26. 26.
    Robert S, Lhommet C, Brun C, et al. Diagnostic performance of multiplex PCR on pulmonary samples versus nasopharyngeal aspirates in community-acquired severe lower respiratory tract infections. J Clin Virol. 2018;108:1–5.CrossRefGoogle Scholar
  27. 27.
    Zhang X, Lu A, Shi P, Wang L, Qian L. Diagnostic value of nasopharyngeal aspirates in children with lower respiratory tract infections. Chiness Med J. 2017;130:647–51.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Department of MicrobiologyT.N. Medical College & B.Y.L. Nair HospitalMumbaiIndia
  2. 2.Department of PediatricsT.N. Medical College & B.Y.L. Nair HospitalMumbaiIndia

Personalised recommendations