title: Clinical presentation and severity of viral community-acquired pneumonia in young Nepalese children.
abstract: BACKGROUND
  Most deaths from pneumonia in children <5 years of age occur in developing countries, where information about the clinical impact and severity of viral causes of respiratory infections is limited.
  
  
  METHODS
  From June 29, 2004 to June 30, 2007 we evaluated 2230 cases of pneumonia (World Health Organization criteria) in children aged 2 to 35 months in Bhaktapur, Nepal. A nasopharyngeal aspirate from each case was examined for 7 respiratory viruses using reverse-transcription polymerase chain reaction. We compared illness duration, severity, and treatment failure between cases positive and negative for the individual viruses in multiple regression models.
  
  
  RESULTS
  A total of 2219 cases had a valid polymerase chain reaction result and were included in the analyses. Overall, 46.1% of cases were 2 to 11 months of age. Being infected with respiratory syncytial virus (RSV) was associated with lower chest indrawing (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.42-3.30) and, among infants, oxygen saturation <93% (OR: 1.88; CI: 1.32-2.69). Among the 2088 nonsevere pneumonia cases, those positive for RSV had a longer time to recovery (hazard ratio 0.82; CI 0.75-0.90; P < 0.001) and an increased risk of treatment failure (OR: 1.75; CI: 1.34-2.28; P < 0.001) than the RSV negative cases.
  
  
  CONCLUSIONS
  Being infected with RSV was associated with a more severe clinical presentation of pneumonia, longer illness duration, and increased risk of treatment failure. The severity of RSV infection was age related, infants being more severely affected.
authors.affiliation: Centre for International Health, University of Bergen, N-5020 Bergen, Norway.
authors.forename: Maria
authors.initials: M
authors.lastname: Mathisen
authors.forename: Tor A
authors.initials: TA
authors.lastname: Strand
authors.forename: Biswa N
authors.initials: BN
authors.lastname: Sharma
authors.forename: Ram K
authors.initials: RK
authors.lastname: Chandyo
authors.forename: Palle
authors.initials: P
authors.lastname: Valentiner-Branth
authors.forename: Sudha
authors.initials: S
authors.lastname: Basnet
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Adhikari
authors.forename: Dag
authors.initials: D
authors.lastname: Hvidsten
authors.forename: Prakash S
authors.initials: PS
authors.lastname: Shrestha
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000821:virology; D009390:Nepal / Q000453:epidemiology; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D012328:RNA Viruses / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods