High rate of respiratory viral co-infection in children with lower and upper respiratory tract infections in rural Gambia.

Stefan Achim Unger, K. Templeton, A Hardie

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Viral infections form a large burden of acute respiratory infections in low-income settings. Data on viral infection in children with community-acquired pneumonia is limited and how this compares to children with upper respiratory infection is also not known.

Induced sputum samples of children under 5 with a lower respiratory tract infection (LRTI) whom presented to a rural primary health care centre in The Gambia were tested for 16 viruses (Flu A, Flu B, RSV, PIV 1-4, Rhino, hMP, measles, EP 229E, HKU1, NL63, OC43, Adeno, HBoV) and B.pertussis and mycoplasma. In addition induced sputum samples from fifteen children with an upper respiratory tract infection (URTI) were collected. Samples were collected at initial presentation (day1) and repeated for all children during recovery on day 5 and when clinically well at 6 weeks. Clinical and reported morbidity data were also collected for all participants. Those with a LRTI were treated with a standard regime of antibiotics whereas those with an URTI only received antipyrexial medication. Data was analysed using STATA 12.1.

Forty-nine patients were recruited of whom 69% (34) were diagnosed with LRTI and 31% (15) with URTI. 45% (22) were female and the majority of children were of Mandinka ethnicity (86%). Mean age was 2.4 years (95% CI 2.1-2.8). Overall 11 of the 16 viruses tested were present. Most common viruses were RSV (25%), rhinovirus (51%) and Adenovirus (25%). Pertussis was present in 28% of children (8/15 in URTI, 6/35 in LRTI group). 47% of the total study population had 2 or more viruses present, rising to 59% with 2 or more infective agents when B. pertussis was included. Only 9 participants with LRTI and none with URTI had complete viral clearance by day 5 of the illness. Six weeks after initial presentation when deemed clinically well 35% if children still had viral PCR detected in induced sputum (8/15 URTI, 9/35 LRTI), most common viruses being rhinovirus and adenovirus.

Viral co-infection in children with lower and upper respiratory infection is common and this data provides an insight into the viral aetiology of children with community acquired pneumonia in rural sub-Saharan Africa.
Original languageEnglish
JournalJournal of Clinical Virology
Issue numberS69
Publication statusPublished - 2015


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