Clínica e epidemiologia das infecções agudas por vírus respiratórios em crianças atendidas em um hospital público de Uberlândia MG

Abstract

Acute respiratory infection (ARI) have an important disease burden for humans and viruses are causes of 50-90% of these infections in children up to five years of age who usually presents 6 to 9 infections per year. The objectives of this study was to describe the clinical aspects and its clinical-etiological correlation, assessment of severity and clinical progressives outcomes of viral ARI in children under five years of age; to assess patient´s risk factors related to the frequency and severity of viral ARI, and outline preventive measures and appropriate treatment for these infections. From 2000 to 2010, nasopharyngeal aspirate (NPA) from children up to five years old with ARI was collected within the 5th day of symptoms. Demographic data, signs and symptoms, comorbidities, clinical evaluation, assessment of severity and discharge diagnosis were obtained through a questionnaires and review of medical records. The specimens were analyzed by indirect immunofluorescence assay for the detection of common respiratory viruses and/orpolymerase chain reaction (RT)-PCR. During the study period 535 specimens of NPA were collected: 46.5% inpatients (mean age 6.6 months) and 53.5% outpatients (mean age 17.8 months). Upper respiratory tract infection (URTI) represented 28% of the cases whereas lower respiratory tract infection (LRTI) for 72%. In 430 of the viral positive samples, single infection were 85.1% and 14.9% were codetections cases. Rhinovirus (HRV) was detected in 37.9% of the samples (either in single or codetections), followed by respiratory syncytial virus (RSV - 35.6%), parainfluenza virus (PIV - 9.3%), influenza virus (FLU - 7.3%), adenovirus (AdV- 6.3 %) and human metapneumovirus (hMPV- 3.4%). In 64 codetections, HRV was present 62 times, half of it with RSV. For either outpatients or inpatients, HRV and RSV were the most common respiratory virus identified. Young children showed to be the group with more frequent ARI, more severe diseases and, therefore, are those that are more frequently hospitalized. RSV and HRV in single infections and coinfections were the most important agents identified. Moderate to severe disease has been linked to RSV, HRV and coinfections in a similar frequency. Our data could reinforce the importance of respiratory viruses in children causing serious nosocomial infection or aggravating coexisting disease. Identify groups of patients at high risk for severe disease may allow the implementation of preventive measures and the adoption of appropriate care assistance, reduzing the burden of viral ARI in children. Caregivers of inpatients should be alerted to the unnecessary use of antibiotics in many situations.