百日咳鲍特菌合并呼吸道病毒感染患儿的实验室指标及临床特征
|
摘要
目的探讨百日咳鲍特菌和呼吸道病毒共感染患儿与百日咳鲍特菌单纯感染患儿实验室相关指标临床特征的差异。方法采集首都医科大学附属北京地坛医院2016年11月至2017年5月临床确诊为百日咳患儿的咽拭子标本共42份,利用自动巢式多重PCR系统对42份标本定性检测百日咳鲍特菌及其他17种呼吸道病毒,回顾性分析患儿的检测结果和病例资料,按照病原体检出结果分为百日咳鲍特菌单检出组(简称单检出组)和百日咳鲍特菌合并其他呼吸道病毒共检出组(简称共检出组)。结果 42份标本中百日咳鲍特菌单检出16份(38.10%,16/42),百日咳鲍特菌伴1种及以上呼吸道病毒共检出26例(61.90%,26/42);呼吸道病毒共计检出32例次,其中以人鼻病毒检出为主,共16例次(50%,16/32),呼吸道合胞病毒6例次(18.75%,6/32),副流感病毒和腺病毒各检出4例次(12.50%,4/32),甲型流感病毒检出2例次(6.25%,6/32)。共检出组患儿白细胞计数较单检出组差异无统计学意义(t=-0.445,P=0.661),而共检出组患儿淋巴细胞比例增高(t=-2.913,P=0.019);与单检出组患儿影像学改变相比,共检出患儿影像学改变以肺炎为主(15/26、57.69%vs. 2/16、12.50%,P=0.010)。共检出组患儿最高体温更高(t=-3.348、P=0.030)、咳嗽持续时间(t=-3.141,P=0.005)和咳嗽加重期更长(t=-4.748、P <0.001),同单检出组患儿比较差异均具有统计学意义。共检出组患儿住院时间(t=-4.123、P <0.001)与抗菌疗程(t=-4.292、P <0.001)均长于单检出组患儿,差异具有统计学意义。结论相较于百日咳鲍特菌单检出的患儿,伴有其他呼吸道病毒检出的患儿临床症状更严重,恢复时间更长。在百日咳尤其是症状较重的百日咳患儿救治过程中需注意同时合并其他呼吸道病毒感染的可能。
Objective To investigate the difference of laboratory indexes and clinical characteristics between children with Bordetella pertussis and respiratory virus coinfection and those with Bordetella pertussis infection alone. Methods From November 2016 to May 2017, a total of 42 throat swabs of children with pertussis were collected from Beijing Ditan Hospital, Capital Medical University. Total of 42 samples were qualitatively detected for Bordetella pertussis and other 17 kinds of respiratory virus by automatic nested multiplex PCR system. The detection results and clinical data of the children were analyzed, retrospectively. According to the pathogen detection results, patients were divided into children with Bordetella pertussis single detection(single detection group) and children with Bordetella pertussis and other respiratory virus codetection(codetection group). Results Among the 42 specimens, 16 specimens(38.10%, 16/42) were isolated with Bordetella pertussis infection, 26 cases(61.90%,26/42) with Bordetella pertussis and one or more respiratory viral pathogens. Total of 32 cases were detected with respiratory, among whom, 16 case(50%, 16/32) with human rhinovirus infection, while 6 case(18.75%,6/32) with respiratory syncytial virus infection, 4 cases(12.50%, 4/32) with Parainfluenza virus and adenovirus and 2 cases(6.25%, 6/32) with influenza A virus infection. Laboratory examination results showed that there was no significant difference of white blood cell count between the two groups(t =-0.445, P = 0.661), but the proportion of lymphocytes in the codetection group increased(t =-2.913, P = 0.019). Compared with single detected group, the imaging changes of codetection group were mainly pneumonia(15/26, 57.69% vs. 2/16,12.50%; P = 0.010). The highest body temperature was higher(t =-3.348, P = 0.030), the duration of cough(t =-3.141, P = 0.005) and the exacerbation period of cough(t =-4.748, P < 0.001) were longer than those of the control group, and the duration of cough was longer(t =-3.141, P = 0.005) than that of the control group. The length of hospitalization(t =-4.123, P = 0.001) and the course of antimicrobial treatment(t =-4.292, P < 0.001)codetection group were longer than those of single detection group, with significant differences. Conclusions The clinical symptoms of children with other respiratory viruses infection were more severe and the recovery time was longer than those with single Bordetella pertussis infection. In the treatment of pertussis, especially children with severe symptoms, attention should be paid to the possibility of coinfection with other respiratory viruses.
Objective To investigate the difference of laboratory indexes and clinical characteristics between children with Bordetella pertussis and respiratory virus coinfection and those with Bordetella pertussis infection alone. Methods From November 2016 to May 2017, a total of 42 throat swabs of children with pertussis were collected from Beijing Ditan Hospital, Capital Medical University. Total of 42 samples were qualitatively detected for Bordetella pertussis and other 17 kinds of respiratory virus by automatic nested multiplex PCR system. The detection results and clinical data of the children were analyzed, retrospectively. According to the pathogen detection results, patients were divided into children with Bordetella pertussis single detection(single detection group) and children with Bordetella pertussis and other respiratory virus codetection(codetection group). Results Among the 42 specimens, 16 specimens(38.10%, 16/42) were isolated with Bordetella pertussis infection, 26 cases(61.90%,26/42) with Bordetella pertussis and one or more respiratory viral pathogens. Total of 32 cases were detected with respiratory, among whom, 16 case(50%, 16/32) with human rhinovirus infection, while 6 case(18.75%,6/32) with respiratory syncytial virus infection, 4 cases(12.50%, 4/32) with Parainfluenza virus and adenovirus and 2 cases(6.25%, 6/32) with influenza A virus infection. Laboratory examination results showed that there was no significant difference of white blood cell count between the two groups(t =-0.445, P = 0.661), but the proportion of lymphocytes in the codetection group increased(t =-2.913, P = 0.019). Compared with single detected group, the imaging changes of codetection group were mainly pneumonia(15/26, 57.69% vs. 2/16,12.50%; P = 0.010). The highest body temperature was higher(t =-3.348, P = 0.030), the duration of cough(t =-3.141, P = 0.005) and the exacerbation period of cough(t =-4.748, P < 0.001) were longer than those of the control group, and the duration of cough was longer(t =-3.141, P = 0.005) than that of the control group. The length of hospitalization(t =-4.123, P = 0.001) and the course of antimicrobial treatment(t =-4.292, P < 0.001)codetection group were longer than those of single detection group, with significant differences. Conclusions The clinical symptoms of children with other respiratory viruses infection were more severe and the recovery time was longer than those with single Bordetella pertussis infection. In the treatment of pertussis, especially children with severe symptoms, attention should be paid to the possibility of coinfection with other respiratory viruses.
引文
[1]National Vaccine Advisory Committee.Enhancing the work of the Department of Health and Human Services national vaccine program in global immunization:recommendations of the National Vaccine Advisory Committee[J].Public Health Rep,2014,129(Suppl 3):12-85.
[2]Hartzell JD,Blaylock JM.Whooping cough in 2014 and beyond:an update and review[J].Chest,2014,146(1):205-214.
[3]Jiménez-Truque N,Edwards KM.Maternal pertussis immunization:can it help infants?[J].JAMA,2014,311(17):1736-1737.
[4]Cherry JD.Epidemic pertussis in 2012--the resurgence of a vaccinepreventable disease[J].N Engl J Med,2012,367(9):785-787.
[5]徐颖华,张柳,王丽婵,等.中国百日咳鲍特菌血清型及其相关基因分析[J].中华微生物学和免疫学杂志,2010,30(1):6-10.
[6]Cimolai N,Trombley C,O’Neill D.Diagnosis of whooping cough:a new era with rapid molecular diagnostics[J].Pediatr Emerg Care,1996,12(2):91-93.
[7]Vemula SV,Zhao J,Liu J,et al.Current approaches for diagnosis of influenza virus infections in humans[J].Viruses,2016,8(4):96.
[8]Mertens PL,Stals FS,Steyerberg EW,et al.Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults:an evaluation for outbreak management in public health practice[J].BMC Infect Dis,2007,7:53.
[9]Wu LT,Thomas I,Curran MD,et al.Duplex molecular assay intended for point-of-care diagnosis of influenza A/B virus infection[J].J Clin Microbiol,2013,51(9):3031-3038.
[10]Hatchette TF,Bastien N,Berry J,et al.The limitations of point of care testing for pandemic influenza:what clinicians and public health professionals need to know[J].Can J Public Health,2009,100(3):204-207.
[11]Poritz MA,Blaschke AJ,Byington CL,et al.FilmArray,an automated nested multiplex PCR system for multi-pathogen detection:development and application to respiratory tract infection[J].PLoSOne,2011,6(10):e26047.
[12]Pierce VM,Elkan M,Leet M,et al.Comparison of the Idaho Technology FilmArray system to real-time PCR for detection of respiratory pathogens in children[J].J Clin Microbiol,2012,50(2):364-371.
[13]窦聪,刘奉琴,郭春艳,等.2012年至2014年百日咳流行特征及住院患者临床特点分析[J].中华实用儿科临床杂志,2016,31(20):1559-1562.
[14]Frassanito A,Nenna R,Nicolai A,et al.Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections[J].BMC Infect Dis,2017,17(1):492.
[15]Centers for Disease Control and Prevention.Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A(H1N1)--United States,May-August 2009[J].MMWR Morb Mortal Wkly Rep,2009,58(38):1071-1074.
[16]Ebell MH,Marchello C,Callahan M.Clinical diagnosis of bordetella pertussis infection:A systematic review[J].J Am Board Fam Med,2017,30(3):308.
[17]Srinivasan A,Gu Z,Smith T,et al.Prospective detection of respiratory pathogens in symptomatic children with cancer[J].Pediatr Infect Dis J,2013,32(3):e99-e104.
[18]Miron D,Srugo I,Kra-Oz Z,et al.Sole pathogen in acute bronchiolitis:is there a role for other organisms apart from respiratory syncytial virus?[J].Pediatr Infect Dis J,2010,29(1):e7-e10.
[19]刘莹,姚开虎.百日咳再现的研究进展[J].中华儿科杂志,2018,56(4):313-316.
[20]Kuchar E,Karlikowska-Skwarnik M,Han S,et al.Pertussis:History of the disease and current prevention failure[J].Adv Exp Med Biol,2016,934:77.
[2]Hartzell JD,Blaylock JM.Whooping cough in 2014 and beyond:an update and review[J].Chest,2014,146(1):205-214.
[3]Jiménez-Truque N,Edwards KM.Maternal pertussis immunization:can it help infants?[J].JAMA,2014,311(17):1736-1737.
[4]Cherry JD.Epidemic pertussis in 2012--the resurgence of a vaccinepreventable disease[J].N Engl J Med,2012,367(9):785-787.
[5]徐颖华,张柳,王丽婵,等.中国百日咳鲍特菌血清型及其相关基因分析[J].中华微生物学和免疫学杂志,2010,30(1):6-10.
[6]Cimolai N,Trombley C,O’Neill D.Diagnosis of whooping cough:a new era with rapid molecular diagnostics[J].Pediatr Emerg Care,1996,12(2):91-93.
[7]Vemula SV,Zhao J,Liu J,et al.Current approaches for diagnosis of influenza virus infections in humans[J].Viruses,2016,8(4):96.
[8]Mertens PL,Stals FS,Steyerberg EW,et al.Sensitivity and specificity of single IgA and IgG antibody concentrations for early diagnosis of pertussis in adults:an evaluation for outbreak management in public health practice[J].BMC Infect Dis,2007,7:53.
[9]Wu LT,Thomas I,Curran MD,et al.Duplex molecular assay intended for point-of-care diagnosis of influenza A/B virus infection[J].J Clin Microbiol,2013,51(9):3031-3038.
[10]Hatchette TF,Bastien N,Berry J,et al.The limitations of point of care testing for pandemic influenza:what clinicians and public health professionals need to know[J].Can J Public Health,2009,100(3):204-207.
[11]Poritz MA,Blaschke AJ,Byington CL,et al.FilmArray,an automated nested multiplex PCR system for multi-pathogen detection:development and application to respiratory tract infection[J].PLoSOne,2011,6(10):e26047.
[12]Pierce VM,Elkan M,Leet M,et al.Comparison of the Idaho Technology FilmArray system to real-time PCR for detection of respiratory pathogens in children[J].J Clin Microbiol,2012,50(2):364-371.
[13]窦聪,刘奉琴,郭春艳,等.2012年至2014年百日咳流行特征及住院患者临床特点分析[J].中华实用儿科临床杂志,2016,31(20):1559-1562.
[14]Frassanito A,Nenna R,Nicolai A,et al.Infants hospitalized for Bordetella pertussis infection commonly have respiratory viral coinfections[J].BMC Infect Dis,2017,17(1):492.
[15]Centers for Disease Control and Prevention.Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A(H1N1)--United States,May-August 2009[J].MMWR Morb Mortal Wkly Rep,2009,58(38):1071-1074.
[16]Ebell MH,Marchello C,Callahan M.Clinical diagnosis of bordetella pertussis infection:A systematic review[J].J Am Board Fam Med,2017,30(3):308.
[17]Srinivasan A,Gu Z,Smith T,et al.Prospective detection of respiratory pathogens in symptomatic children with cancer[J].Pediatr Infect Dis J,2013,32(3):e99-e104.
[18]Miron D,Srugo I,Kra-Oz Z,et al.Sole pathogen in acute bronchiolitis:is there a role for other organisms apart from respiratory syncytial virus?[J].Pediatr Infect Dis J,2010,29(1):e7-e10.
[19]刘莹,姚开虎.百日咳再现的研究进展[J].中华儿科杂志,2018,56(4):313-316.
[20]Kuchar E,Karlikowska-Skwarnik M,Han S,et al.Pertussis:History of the disease and current prevention failure[J].Adv Exp Med Biol,2016,934:77.