Epidemiology and clinical profile of pathogens responsible for the hospitalization of children in Sousse area, Tunisia

<div><p>This study aimed to identify a broad spectrum of respiratory pathogens from hospitalized and not-preselected children with acute respiratory tract infections in the Farhat Hached University-hospital of Sousse, Tunisia. Between September 2013 and December 2014, samples from 372 children aged between 1 month and 5 years were collected, and tested using multiplex real-time RT-PCR by a commercial assay for 21 respiratory pathogens. In addition, samples were screened for the presence of <i>Streptococcus pneumoniae</i> 16S rDNA using real-time PCR. The viral distribution and its association with clinical symptoms were statistically analyzed. Viral pathogens were detected in 342 (91.93%) of the samples of which 28.76% were single positive and 63.17% had multiple infections. The most frequent detected viruses were rhinovirus (55.64%), respiratory syncytial virus A/B (33.06%), adenovirus (25.00%), coronavirus NL63, HKU1, OC43, and 229E (21.50%), and metapneumovirus A/B (16.12%). Children in the youngest age group (1–3 months) exhibited the highest frequencies of infection. Related to their frequency of detection, RSV A/B was the most associated pathogen with patient’s demographic situation and clinical manifestations (p<0.05). Parainfluenza virus 1–4 and parechovirus were found to increase the risk of death (p<0.05). Adenovirus was statistically associated to the manifestation of gastroenteritis (p = 0.004). Rhinovirus infection increases the duration of oxygen support (p = 0.042). Coronavirus group was statistically associated with the manifestation of bronchiolitis (p = 0.009) and laryngitis (p = 0.017). <i>Streptococcus pneumoniae</i> DNA was detected in 143 (38.44%) of tested samples. However, only 53 samples had a concentration of C-reactive protein from equal to higher than 20 milligrams per liter, and 6 of them were single positive for <i>Streptocuccus pneumoniae</i>. This study confirms the high incidence of respiratory viruses in children hospitalized for acute respiratory tract infections in the Sousse area, Tunisia.</p></div

Impact of individual viral infection on patient’s clinical data and demographic information^a.

<p>Impact of individual viral infection on patient’s clinical data and demographic information<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188325#t006fn001" target="_blank">^a</a>.</p

Characteristics of <i>S</i>. <i>pneumoniae</i> infected subjects in relation to viral infection (negative, single and multiple) and CRP concentrations^a.

<p>Characteristics of <i>S</i>. <i>pneumoniae</i> infected subjects in relation to viral infection (negative, single and multiple) and CRP concentrations<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188325#t003fn001" target="_blank">^a</a>.</p

Summary of the statistical comparisons between positive viral infection and patient’s medical history, demographic data and clinical manifestations.

<p>Summary of the statistical comparisons between positive viral infection and patient’s medical history, demographic data and clinical manifestations.</p

Summary of the statistical associations comparing single and multiple viral infections with patient’s data.

<p>Summary of the statistical associations comparing single and multiple viral infections with patient’s data.</p