Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection.

Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, and the Division of Infectious Diseases, Children's Hospital of Buffalo, New York 14222, USA.
Journal of Pediatrics (Impact Factor: 3.74). 12/2003; 143(5 Suppl):S112-7. DOI: 10.1067/S0022-3476(03)00508-0
Source: PubMed

ABSTRACT Respiratory syncytial virus (RSV) infection is the most frequent reason for hospitalization of infants in developed countries. Premature birth without or, especially, with chronic lung disease of prematurity, congenital heart disease, and T-cell immunodeficiency are conditions that predispose to more severe forms of RSV infection. Incomplete development of the airway, damage to the airway, and airway hyperreactivity underlie the increased morbidity of RSV infection in prematurely born infants. Pulmonary hypertension and cyanosis are associated with worse outcomes in infants with congenital heart disease, and prolonged viral replication accounts for more severe illness in immunocompromised individuals.

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    ABSTRACT: Although influenza (flu) and respiratory syncytial virus (RSV) infections are extremely common in children under two years and resolve naturally, a subset develop severe disease resulting in hospitalization despite having no identifiable clinical risk factors. However, little is known about inherent host-specific genetic and immune mechanisms in this at-risk subpopulation. We therefore conducted a secondary analysis of statistically significant, differentially-expressed genes from a whole genome-wide case-control study of children less than two years of age hospitalized with flu or RSV, through the use of bipartite networks. The analysis revealed three clusters of cases common to both types of infection: core cases with high expression of genes in the network core implicated in hyperimmune responsiveness; periphery cases with lower expression of the same set of genes indicating medium-responsiveness; and control-like cases with a gene signature resembling that of the controls, indicating normal-responsiveness. These results provide testable hypotheses for at-risk subphenotypes and their respective pathophysiologies in both types of infections. We conclude by discussing alternate hypotheses for the results, and insights about how bipartite networks of gene expression across multiple phenotypes can help to identify complex patterns related to subphenotypes, with the translational goal of identifying targeted therapeutics.
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    ABSTRACT: Atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila are increasingly recognized as important causes of community acquired pneumonia (CAP) worldwide. Such etiological data for Vietnam is scarce and clinical doctors lack accurate information on which to base their diagnosis and treatment of pneumonia. This study identifies the prevalence and risk factors of severe community acquired pneumonia due to these atypical pathogens (severe-ApCAP) in children aged 1-15 years with CAP in a pediatric hospital in Hanoi, Vietnam. 722 hospitalized children with CAP were recruited for detecting those atypical pathogens, using multiplex PCR and ELISA. Clinical and epidemiological data were collected. Multivariate logistic-regression analyses were performed to evaluate the associations of potential risk factors with severe-ApCAP. Among 215 atypical pathogen-positive CAP cases, 45.12% (97/215) were severe-ApCAP. Among the severe-ApCAP group, 55.67% (54/97) cases were caused by pure atypical pathogens and 44.33% (43/97) resulted from a co-infection with typical respiratory pathogens. M. pneumoniae was the most common, with 86.6% cases (84/97) in the severe-ApCAP group, whereas C. pneumoniae and L. pneumophila were less frequent (6.19% and 7.22%, respectively). The highest rate of severe-ApCAP was in children younger than two years (65.98%). The differences related to age are statistically significant (P = 0.008).The factors significantly associated with severe-ApCAP were age (OR = 0.84, 95%CI = 0.75-0.93, P = 0.001), co-infection with typical bacteria (OR = 4.86, 95%CI = 2.17-10.9, P < 0.0001), co-infection with respiratory viruses (OR = 4.36, 95%CI = 1.46-13.0, P = 0.008), respiratory/cardiac system malformation (OR = 14.8, 95%CI = 1.12 -196, P = 0.041) and neonatal pneumonia (OR = 11.1, 95%CI = 1.06 -116, P = 0.044). Severe-ApCAP presented at a significant rate in Vietnamese children. More than 50% of severe-ApCAP cases were associated with pure atypical pathogen infection. M. pneumoniae appeared most frequently. The highest rate of severe-ApCAP was in children younger than two years. Younger age and co-infection with typical bacteria or viruses were the most significant risk factors, while respiratory/cardiac system malformation and neonatal pneumonia were additional potential risk factors, associated with severe-ApCAP in Vietnamese children.
    BMC Public Health 12/2014; 14(1):1304. DOI:10.1186/1471-2458-14-1304 · 2.32 Impact Factor
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