Akut Solunum Yolu Enfeksiyonu Olan Hastalarda Solunum Viruslarının Prevalansı ve Mevsimsel Dağılımı, 2002-2014
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2015
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info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı, yaklaşık 12 yıllık sürede, üst ve alt solunum yolu enfeksiyonu semptomları ile hastaneye başvuran, ayaktan veya yatarak izlenen, çocuk ve erişkin hastalarda solunum viruslarının prevalansının ve mevsimsel dağılımının belirlenmesidir. Çalışmada, 1 Ocak 2002-17 Temmuz 2014 tarihleri arasında laboratuvarımızda incelenen 5102 klinik örnek (4372 nazofarengeal sürüntü, 316 bronkoalveoler lavaj, 219 transtrakeal aspirat, 163 nazofarengeal aspirat, 20 balgam, 10 burun sürüntüsü) retrospektif olarak değerlendirilmiştir. Örneklerin 1107 (%21.7)’si poliklinik, 3995 (%78.3)’i yatan hastalara aittir. Hastaların 2251 (%44.1)’i kadın, 2851 (%55.9)’i erkek olup, 1233 (%24.2)’ü erişkin ve 3869 (%75.8)’u çocuk olgudan oluşmaktadır (yaş aralığı: 1 gün - 93 yıl; medyan: 3 yıl). Solunum yolu örnekleri; solunum sinsityal virusu (RSV), infl uenza virus tip A ve B (INF-A, INF-B), adenovirus (AdV), parainfl uenza viruslar (PIV tip 1-4), insan rinovirusları (HRV), insan koronavirusları (HCoV), insan metapnömovirusu (HMPV) ve insan bokavirusu (HBoV) varlığı açısından araştırılmıştır. Tüm örneklere; hem direkt immünofl oresan antikor (DFA) hem de shell vial hücre kültürü (SVHK) yöntemleri uygulanmıştır. DFA yönteminde örnekler önce fl oresanla işaretli poliklonal antikorların kullanıldığı kit ile taranmış, pozitif sonuç verenler monoklonal antikorların kullanıldığı kit (Light Diagnostics, Merck Millipore, ABD) ile tiplendirilmiştir. SVHK yönteminde virusların izolasyonu için HEp-2, MDCK, A-549 ve Vero hücre dizileri kullanılmıştır. Bu yöntemlere ek olarak, 2007-2014 yılları arasında gelen klinik örneklere (n= 2104), gerçek zamanlı multipleks polimeraz zincir reaksiyonu yöntemi de (RealAccurate®, Respiratory RT PCR, PathoFinder, Hollanda ve Seeplex® RV15 ACE Detection, Seegene, Güney Kore) uygulanmıştır. Çalışmamızda, 967 (%19)’si erkek, 738 (%14.4)’i kadın olmak üzere toplam 1705 (%33.4) hastada solunum virusları tespit edilmiştir. Hastaların %18.6 (318/1705)’sının birden fazla solunum virusu ile enfekte olduğu belirlenmiş; çoklu etken enfeksiyonlarında en sık RSV + INF-A (40/318; %12.6) ve RSV + PIV (33/318; %10.4) birlikteliği gözlenmiştir. Pediatrik grupta solunum viruslarının pozitifl ik oranı %35.4 (1369/3869), erişkin grupta ise %27.3 (336/1233) olarak saptanmıştır (p< 0.000). Çocuk hastalarda en sık saptanan solunum virusu RSV (336/1369; %24.5) olmuş, bunu infl uenza virusları (314/1369; %22.9), PIV (197/1369; %14.4), HRV (118/1369; %8.6), AdV (75/1369; %5.5) ve diğerleri (49/1369; %3.6) izlemiştir. Erişkin hastalarda ise ilk sırayı infl uenza virusları (181/336; %53.8) almış; AdV %11 (37/336), RSV %7.1 (24/336), PIV %7.1 (24/336), HRV %6.8 (23/336) ve diğer viruslar %2.7 (9/336) oranında tespit edilmiştir. Çoklu enfeksiyon oranı çocuklarda %7.2 (280/3869), erişkinlerde ise %3 (38/1233) olarak saptanmış; çoklu enfeksiyonların %88 (280/318)’i pediatrik grupta görülmüştür. Solunum virusları, poliklinik hastalarının %40.2 (445/1107)’sinde, yatan hastaların %31.5 (1260/3995)’inde pozitif olarak bulunmuştur (p< 0.000). Pediatri poliklinik hastalarında en sık HRV, servis hastalarında en sık RSV saptanırken; erişkinler için hem poliklinik hem de servis hastalarında en sık infl uenza virusları tespit edilmiştir. Çalışma döneminde, Aralık 2004-Nisan 2005 tarihleri arasında PIV-3 salgını (n= 96), Kasım 2009-Ocak 2010 tarihleri arasında ise infl uenza A (H1N1)pdm09 salgını (n= 207) ortaya çıkmıştır. Mevsimsel dağılıma bakıldığında; pozitif bulunan 1705 solunum virusunun %44.4’ü kış, %27’si ilkbahar, %8.3’ü yaz ve %20.3’ü sonbahar aylarında izole edilmiştir. RSV’nin Aralık-Mart; infl uenza viruslarının Kasım-Mart, HRV’nin Kasım-Haziran ve çoklu etken enfeksiyonlarının Ocak-Şubat ayları arasında yoğunluk gösterdiği izlenmiştir. Sonuç olarak, yaklaşık 12 yıllık süre içinde elde edilen verilere göre, bölgemizde akut solunum yolu enfeksiyonlarında solunum viruslarının prevalansı %33.4 olarak bulunmuş, solunum viruslarının genellikle kış ve erken ilkbahar aylarında aktif olduğu izlenmiştir.
The aim of this study was to investigate the prevalence and seasonal distribution of respiratory viruses in pediatric and adult outpatients and inpatients who were admitted to hospital with the symptoms of upper and lower respiratory tract infections, during a 12-year period. A total of 5102 clinical samples (4372 nasopharyngeal swabs, 316 bronchoalveolar lavages, 219 transtracheal aspirates, 163 nasopharyngeal aspirates, 20 sputum, 10 nasal swabs) examined in our laboratory between January 1st 2002 and July 17th 2014, were evaluated retrospectively. Of the specimens, 1107 (21.7%) were obtained from outpatients and 3995 (78.3%) from hospitalized patients. Of the patients, 2851 (55.9%) were male and 2251 (44.1%) were female, while 1233 (24.2%) were adults and 3869 (75.8%) were children (age range: 1 day - 93 years; median: 3 years). Respiratory samples were investigated for the presence of respiratory syncytial virus (RSV), infl uenza virus type A and B (INF-A, INF-B), adenovirus (AdV), parainfl uenza viruses (PIV types 1-4), human rhinoviruses (HRV), human coronaviruses (HCoV), human metapneumovirus (HMPV) and human bocavirus (HBoV). All specimens were tested by both direct immunofl uorescence antibody (DFA) and shell vial cell culture (SVCC) methods. In DFA assay the samples were initially screened by fl uorescent-labeled polyclonal antibodies, and the positive ones were typed by using monoclonal antibodies (Light Diagnostics, Merck Millipore, USA). In SVCC, HEp-2, MDCK, A-549 and Vero cell lines were used for the isolation of viruses. In addition to these methods, real-time multiplex PCR methods (RealAccurate®, Respiratory RT PCR, PathoFinder, Netherlands and Seeplex® RV15 ACE Detection, Seegene, South Korea) were used for the detection of respiratory viruses in samples (n= 2104) obtained from 2007 to 2014. Respiratory viruses were detected in a total of 1705 (33.4%) patients, of them 967 (19%) were male and 738 (14.4%) were female. Three hundred and eighteen (18.6%) of the 1705 patients were infected with multiple respiratory viruses. The most frequently observed co-infections were RSV+INF-A (40/318; 12.6%), and RSV+PIV (33/318; 10.4%). The rate of positivity for the respiratory viruses in pediatric and adult groups were 35.4% (1369/3869) and 27.3% (336/1233), respectively (p< 0.000). The most frequently detected virus in pediatric group was RSV (336/1369; 24.5%), followed by infl uenza viruses (314/1369; 22.9%), PIV (197/1369; 14.4%), HRV (118/1369; 8.6%), AdV (75/1369; 5.5%) and the others (49/1369; 3.6%). On the other hand the most frequently detected virus in adult group was infl uenza viruses (181/336; 53.8%) followed by AdV (37/336; 11%), RSV (24/336; 7.1%), PIV (24/336; 7.1%), HRV (23/336; 6.8%) and the others (9/336; 2.7%). The rate of multiple virus infections in pediatric and adult groups were 7.2% (280/3869) and 3% (38/1233), respectively. Most of the coinfections (280/318; 88%) were detected in children. Respiratory viruses were detected positive in 40.2% (445/1107) of outpatients, and in 31.5% (1260/3995) of inpatients (p< 0.000). The most frequent viruses detected in pediatric outpatients and inpatients were HRV and RSV, respectively, while infl uenza viruses were the fi rst in line among both adult outpatients and inpatients. During the study period, a PIV-3 outbreak (n= 96) have emerged between December 2004- April 2005, and an infl uenza A (H1N1)pdm09 outbreak (n= 207) between November 2009-January 2010. When the seasonal distribution was considered, the isolation rates of 1705 respiratory viruses in winter, spring, summer and autumn were 44.4%, 27%, 8.3% and 20.3%, respectively. RSV was most frequently detected from December to March, infl uenza viruses from November to March, HRV from December to June, and mixed infections from January to February. In conclusion, the data of our study obtained in about 12-year period indicated that the prevalence of respiratory viruses in acute respiratory infections is 33.4%, and they typically active during the months of winter and early spring in our region.
The aim of this study was to investigate the prevalence and seasonal distribution of respiratory viruses in pediatric and adult outpatients and inpatients who were admitted to hospital with the symptoms of upper and lower respiratory tract infections, during a 12-year period. A total of 5102 clinical samples (4372 nasopharyngeal swabs, 316 bronchoalveolar lavages, 219 transtracheal aspirates, 163 nasopharyngeal aspirates, 20 sputum, 10 nasal swabs) examined in our laboratory between January 1st 2002 and July 17th 2014, were evaluated retrospectively. Of the specimens, 1107 (21.7%) were obtained from outpatients and 3995 (78.3%) from hospitalized patients. Of the patients, 2851 (55.9%) were male and 2251 (44.1%) were female, while 1233 (24.2%) were adults and 3869 (75.8%) were children (age range: 1 day - 93 years; median: 3 years). Respiratory samples were investigated for the presence of respiratory syncytial virus (RSV), infl uenza virus type A and B (INF-A, INF-B), adenovirus (AdV), parainfl uenza viruses (PIV types 1-4), human rhinoviruses (HRV), human coronaviruses (HCoV), human metapneumovirus (HMPV) and human bocavirus (HBoV). All specimens were tested by both direct immunofl uorescence antibody (DFA) and shell vial cell culture (SVCC) methods. In DFA assay the samples were initially screened by fl uorescent-labeled polyclonal antibodies, and the positive ones were typed by using monoclonal antibodies (Light Diagnostics, Merck Millipore, USA). In SVCC, HEp-2, MDCK, A-549 and Vero cell lines were used for the isolation of viruses. In addition to these methods, real-time multiplex PCR methods (RealAccurate®, Respiratory RT PCR, PathoFinder, Netherlands and Seeplex® RV15 ACE Detection, Seegene, South Korea) were used for the detection of respiratory viruses in samples (n= 2104) obtained from 2007 to 2014. Respiratory viruses were detected in a total of 1705 (33.4%) patients, of them 967 (19%) were male and 738 (14.4%) were female. Three hundred and eighteen (18.6%) of the 1705 patients were infected with multiple respiratory viruses. The most frequently observed co-infections were RSV+INF-A (40/318; 12.6%), and RSV+PIV (33/318; 10.4%). The rate of positivity for the respiratory viruses in pediatric and adult groups were 35.4% (1369/3869) and 27.3% (336/1233), respectively (p< 0.000). The most frequently detected virus in pediatric group was RSV (336/1369; 24.5%), followed by infl uenza viruses (314/1369; 22.9%), PIV (197/1369; 14.4%), HRV (118/1369; 8.6%), AdV (75/1369; 5.5%) and the others (49/1369; 3.6%). On the other hand the most frequently detected virus in adult group was infl uenza viruses (181/336; 53.8%) followed by AdV (37/336; 11%), RSV (24/336; 7.1%), PIV (24/336; 7.1%), HRV (23/336; 6.8%) and the others (9/336; 2.7%). The rate of multiple virus infections in pediatric and adult groups were 7.2% (280/3869) and 3% (38/1233), respectively. Most of the coinfections (280/318; 88%) were detected in children. Respiratory viruses were detected positive in 40.2% (445/1107) of outpatients, and in 31.5% (1260/3995) of inpatients (p< 0.000). The most frequent viruses detected in pediatric outpatients and inpatients were HRV and RSV, respectively, while infl uenza viruses were the fi rst in line among both adult outpatients and inpatients. During the study period, a PIV-3 outbreak (n= 96) have emerged between December 2004- April 2005, and an infl uenza A (H1N1)pdm09 outbreak (n= 207) between November 2009-January 2010. When the seasonal distribution was considered, the isolation rates of 1705 respiratory viruses in winter, spring, summer and autumn were 44.4%, 27%, 8.3% and 20.3%, respectively. RSV was most frequently detected from December to March, infl uenza viruses from November to March, HRV from December to June, and mixed infections from January to February. In conclusion, the data of our study obtained in about 12-year period indicated that the prevalence of respiratory viruses in acute respiratory infections is 33.4%, and they typically active during the months of winter and early spring in our region.
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Mikrobiyoloji Bülteni
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49
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