Hışıltılı çocuklarda respiratuar sinsisyal virüs, parainfluenza virüs, influenza virüs ve insan metapnömovirüs sıklığının araştırılması

Amaç: Bu çalışma 0-5 yaş arası hışıltılı çocuklarda respiratuar sinsisyal virüs (RSV), influenza virüs, insan metapnömovirüs (hMPV) ve parainfluenza virüs (PIV) sıklığı ve bu viral etkenlerin klinik özelliklerinin değerlendirilmesi amacıyla yapıldı. Yöntemler: Çalışmaya Ocak-Haziran 2007 tarihleri arasında Mersin Üniversitesi Çocuk Sağlığı ve Hastalıkları polikliniklerine başvuran 0-5 yaş arası, hışıltısı olan çocuklar alındı. Başvuru anında alınan nazofarengeal yıkama örneklerinden virüs izolasyonu HEXAPLEX® PLUS Multipleks polimeraz zincir reaksiyonu ile yapıldı. Hastaların demografik, klinik ve laboratuvar özellikleri, konulan klinik tanı, uygulanan tedaviler, varsa hastanede yatış süresi ile viral etkenler arasındaki ilişki değerlendirildi. Bulgular: Hastaların %73’ünde en az bir viral etken saptandı. hMPV’nin %59.7 ile en sık izole edilen ajan olduğu ve en sık 6-11 ay arası çocuklarda akut hışıltıya neden olduğu saptandı. hMPV’nin influenza’dan daha çok bronkopnömoniye yol açtığı, hMPV ile PIV’ün klinik özelliklerinin benzer olduğu görüldü. Hastaların %53’ünde koenfeksiyon olduğu saptandı. Koenfeksiyonlarda hMPV varlığının hastalığın kliniğinin daha ağır seyretmesine neden olduğu görüldü. Sonuç: Bu yaş grubunda akut hışıltının en önemli nedeninin solunum yolu virüsleri olduğu ve hMPV’nin en çok izole edilen etken olduğu görüldü. Hastalara gereksiz antibiyotik tedavisi uygulamasının önlenmesi ve seçilmiş vakalarda uygun antiviral tedavinin uygulanması için solunum yolu sekresyonları ile virolojik tanı koyulması, hMPV’den korunmak için özgül olmayan yöntemlere önem verilmesi ve özgül yöntemlerin geliştirilmesi gereklidir.

Prevalence of respiratory syncytial virus, parainfluenza virus, influenza virus, and human metapneumovirus in children with wheezin

Objective: The purpose of this study is to investigate the clinical manifestations and prevalence of respiratory syncytial virus (RSV), parainfluenza virus (PIV) , influenza virus, and human metapneumovirus (hMPV) in 0-5 year old children with wheezing. Methods: Between January and June 2007, 0-5 year old children with wheezing attending the Pediatric Clinics, University of Mersin were prospectively enrolled. Nasopharyngeal wash specimens obtained at enrollment were tested for viral detection by HEXAPLEX® PLUS multiplex polimerase chain reaction. Relationships between viral pathogen and patients’ demographic, clinical, and laboratory features and treatment modalities were assessed. Results: At least one viral agent was detected in 73% of all patients. hMPV was found in 59.7%of the cases and it was the most commonly isolated agent. It caused wheezing in 6-11 month old children mostly. Bronchopneumonia was more frequent among hMPV positive patients than those infected by influenza. Clinical manifestations of hMPV and PIV were similar. Coinfection was detected in 53%of all patients. Patients with hMPV coinfections showed a relatively more severe clinical course than patients with non-hMPV coinfections. Conclusion: Respiratory viruses are the most important cause of wheezing in this age group and hMPV was the most commonly isolated pathogen. Hence, to prevent unnecessary antibacterial treatment and to apply suitable antiviral treatment to selected patients, virologic diagnosis from respiratory secretions is mandatory. Nonspecific methods of protection from hMPV should be given importance and specific methods should be developed.

Kaynakça

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