Çocukluk Çağı Alt Solunum Yolu Enfeksiyonlarında Yeni Etkenler

Çocukluk çağının en sık enfeksiyon grubunu oluşturan alt solunum yolu enfeksiyonlarından (ASYE) sıklıkla viral etkenler sorumlu tutulur. Bunlar arasında Influenza, Parainfluenza, Adenovirüsler ve Respiratuar sinsityel virüs (RSV) yer alır. Son yıllarda, ASYE bulguları olanlarda metapnömovirüs, avian influenza A, H5N1, SARS coronavirüs gibi yeni etkenler saptanmıştır. Paramiksovirüs ailesinden bir RNA virüs olan metapnömovirus, özellikle tropikal ülkelerde ilkbahar ve yaz aylarında sık saptanır. Hem üst hem de alt solunum yolunu ilgilendiren bulgular ile ortaya çıkabilir. RNA virüsü olan Coronavirüsler, sıklıkla ASYE, daha nadiren ise ÜSYE bulguları ile ortaya çıkabilir. SARS (Severe acute respiratory syndrome-ağır akut solunum yetmezliği sendromu), corona virüs ailesine aittir. Küçük DNA virüslerden olan polyomavirüsler ise, asemptomatik gidişten ağrı ASYE bulguları olan klinik tabloya kadar geniş bir yelpazeye neden olurlar. Bocavirusler ise parvovirüs ailesinden olan alt solunum yolu enfeksiyon etkenleridir. İnfluenza ise, H1N1 ve H5N1 gibi farklı serotipleri nedeni ile epidemi ve pandemi nedeni olabilen solunum yolu enfeksiyon etkenidir.Sonuç olarak, ASYE’larının klinik bulguları ve prognozu çoğunlukla nonspesifik olmakla birlikte, etiyolojik etken ile ilişkilidir. Bu nedenle, etken olan ajanlarla ilgili prevalans ve insidansın daha net olarak ortaya çıkarılması için çalışmalara gereksinim vardır.

Anahtar Kelimeler:

solunum yolu enfeksiyonu, influenza, metapnömovirus, coronavirüsler, bocavirüs, polyomavirüs

NEW ETIOLOGICAL AGENTS OF CHILDHOOD LOWER RESPIRATORY TRACT INFECTIONS

Viral etiological agents are commonly encountered in lower respiratory tract infections (LRTI) that comprise the most common infectious disease group of childhood. These agents include Influenza, Parainfluenza, Adenoviruses and Respiratory syncitial viruses (RSV). Recently, new etiological agents such as metapneumovirus, avian influenza A, H5N1 and SARS coronaviruses have been detected in children with LRTI findings. Metapneumovirus, which is an RNA virus member of the Paramyxovirus family, is commonly encountered in tropical countries during spring and summer. It might present with symptoms involving both upper and lower respiratory tract. Coronaviruses that are RNA viruses present commonly with LRTIs but rarely may cause upper respiratory tract findings. SARS (Severe acute respiratory syndrome) belongs to the corona virus family. Polyomaviruses that are small DNA viruses cause a wide spectrum of clinical findings that range from aseymtpomatic infection to severe LRTI findings. Bocaviruses from Parvovirus family are other LRTI etiologic agents. Influenza viruses are LRTI agents that may lead to epidemics and pandemics due to their different serotypes like H1N1 and H5N1. In conclusion, clinical findings and prognosis of LRTIs, though usually nonspecific, depend on the etiological agent. Therefore, further research is required to identify prevalence and incidence of these etiological agents

Keywords:

Lower respiratory tract infection, influenza, metapneumovirus, coronavirus, bocavirus, polyomavirus,

PDF

___

Alto WA. Human metapneumovirus: a newly described respiratory tract pathogen. J Am Board Fam Pract 2004; 17: 466-469.
Farshad N, Saffar MJ, Khalilian AR, Saffar H. Respiratory viruses in hospitalized children with acute lower respiratory tract infections Mazandaran Province, Iran. Indian Pediatr 2008; 45: 590-592.
Yüksel H, Yilmaz O, Akçali S, Söğüt A, Yilmaz Ciftdoğan D, Urk V, Ertan P, Sanlidağ T. [Common viral etiologies of community acquired lower respiratory tract infections in young children and their relationship with long term complications] Mikrobiyol Bul 2008; 42: 429-435.
Iwane MK, Edwards KM, Szilagyi PG, Walker FJ, Griffin MR, Weinberg GA, Coulen C, Poehling KA, Shone LP, Balter S, Hall CB, Erdman DD, Wooten K, Schwartz B; New Vaccine Surveillance Network. Population- based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics 2004;113:1758-1764.
Kelly JT, Busse WW. Host immune responses to rhinovirus: mechanisms in asthma. JAllergy Clin Immunol 2008; 122: 671-682.
Matthew J, Pinto Pereira LM, Pappas TE, Swenson CA, Grindle KA, Roberg KA, Lemanske RF Jr, Lee WM, Gern JE. Distribution and seasonality of rhinovirus and other respiratory viruses in a cross-section of asthmatic children in Trinidad, West Indies. Ital J Pediatr 2009;35:16.
Sym D, Patel PN, El-Chaar GM. Seasonal, avian, and novel H1N1 influenza: prevention and treatment modalities. Ann Pharmacother. 2009;43:2001- 2011.
Dogan N, Ozkan B, Boga I, Kizilkaya M, Altindağ H. A succesful treatment of avian influenza infection in Turkey. J Trop Pediatr 2009;55:268-271.
Brodzinski H, Ruddy RM. Review of new and newly discovered respiratory tract viruses in children. Pediatr Emerg Care 2009; 25: 352-360.
Ozbay B, Sertoğullarindan B, Tekin M, Altinoz O. Influenza-associated pneumonia in a Turkish area with endemic avian influenza. Respirology 2008;13:444–446.
Altiok E, Taylan F, Yenen OS, Demirkeser G, Bozaci M, Onel D, Akcadag B, Iyisan AS, Ciblak M, Bozkaya E, Yuksel S, Badur S. Mutations in Influenza A virus (H5N1) and possible limited spread, Turkey,2006. Emerg Infect Dis 2008;14:491-492.
Garcia-Garcia L, Valdespino-Gómez JL, Lazcano-Ponce E, Jimenez-Corona A, Higuera-Iglesias A, Cruz-Hervert P, Cano-Arellano B, Garcia-Anaya A, Ferreira-Guerrero E, Baez-Saldaña R, Ferreyra-Reyes L, Ponce-de- León-Rosales S, Alpuche-Aranda C, Rodriguez-López MH, Perez-Padilla R, Hernandez-Avila M. Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009: case-control study in Mexico City. BMJ 2009;339:3928.
Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, Stelfox T, Bagshaw S, Choong K, Lamontagne F, Turgeon AF, Lapinsky S, Ahern SP, Smith O, Siddiqui F, Jouvet P, Khwaja K, McIntyre L, Menon K, Hutchison J, Hornstein D, Joffe A, Lauzier F, Singh J, Karachi T, Wiebe K, Olafson K, Ramsey C, Sharma S, Dodek P, Meade M, Hall R, Fowler RA; Canadian Critical Care Trials Group H1N1 Collaborative. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009;302;1872-1879.
O’Riordan S, Barton M, Yau Y, Read SE, Allen U, Tran D. Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza. CMA 2009 (Epub ahead of print).
Blyth CC, Iredell JR, Dwyer DE. Rapid-Test Sensitivity for Novel Swine- Origin Influenza A (H1N1) Virus in Humans. N Engl J Med 2009 (Epub ahead of print).
Uyeki T. Antiviral treatment for patients hospitalized with 2009 pandemic influenza A (H1N1). N Engl J Med 2009;361:110.
Quispe-Laime AM, Bracco JD, Barberio PA, Campagne CG, Rolfo VE, Umberger R, Meduri GU. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med 2009 (Epub ahead of print).
Esposito S, Bosis S, Niesters HG, Tremolati E, Sabatini C, Porta A, Fossali E, Osterhaus AD, Principi N. Impact of human bocavirus on children and their families. J Clin Microbiol 2008; 46: 1337-1342.
Van de pol AC, Wolfs TF, Jansen NJ, Kimpen JL, Van Loon AM, Rossen JW. Human bocavirus and KI/WU polymaviruses in pediatric intensive care patients. Emerg Infect Dis 2009; 15: 454-457.
Yaman G. Human Bocavirus. Van Tıp Dergisi 2006;13:109-112.
Schildgen O, Müller A, Allander T, Mackay IM, Völz S, Kupfer B, Simon A. Human bocavirus:passenger or pathogen in acute respiratory tract infections? Clin Microbiol Rev 2008;21:291-304.
Broor S, Bharaj P, Chahar HS. Human metapneumovirus: a new respiratory pathogen. J Biosci 2008;33:483-493.
Cseke G, Maginnis MS, Cox RG, Tollefson SJ, Podsiad AB, Wright DW, Dermody TS, Williams JV. Integrin alphabeta1 promotes infection by human metapneumovirus. Proc Natl Acad Sci U S A 2009;106:1566-1571.
de Graaf M, Schrauwen EJ, Herfst S, van Amerongen G, Osterhaus AD, Fouchier RA.Fusion protein is the main determinant of metapneumovirus host tropism. J Gen Virol 2009; 90: 1408-1416.
Tsai MH, Lin TY, Chiu CH, Lin PY, Huang YC, Tsao KC, Huang CG, Hsu KH, Lin MC, Hwang KP, Yang KD. Seroprevalence of SARS Coronavirus Among Residents Near a Hospital with a Nosocomial Outbreak. J Formos Med Assoc 2008; 107: 885-891.
Kuypers J, Martin ET, Heugel J, Wright N, Morrow R, Englund JA. Clinical disease in children associated with newly described coronavirus subtypes. Pediatrics 2007;119: 70-76.
Bialasiewicz S, Lambert SB, Whiley DM, Nissen MD, Sloots TP. Merkel Cell polyomavirus DNA in respiratory specimens from children and adults. Emerg Infect Dis 2009;15:492-494.
Kean JM, Rao S, Wang M, Garcea RL. Seroepidemiology of human polyomaviruses. PLoS Pathog 2009;5:1000363.
Weiskittel PD. Polyoma virus in renal transplant recipients. Nephrol Nurs J 2002;29: 247-250.
Le BM, Demertzis LM, Wu G, Tibbets RJ, Buller R, Arens MQ, Gaynor AM, Storch GA, Wang D. Clinical and epidemiologic characterization of WU polyomavirus infection, St. Louis, Missouri. Emerg In fect Dis 2007;13:1936-1938.
Mueller A, Simon A, Gillen J, Schildgen V, Tillmann RL, Reiter K, Schildgen O. Polyomaviruses KI and WU in children with respiratory tract infections. Arch Virol 2009 (Epub ahead of print).