Clinical presentation and severity of viral community-acquired pneumonia in young Nepalese children.
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.
Mathisen
Maria
M
Centre for International Health, University of Bergen, N-5020 Bergen, Norway.
Strand
Tor A
TA
Sharma
Biswa N
BN
Chandyo
Ram K
RK
Valentiner-Branth
Palle
P
Basnet
Sudha
S
Adhikari
Ramesh K
RK
Hvidsten
Dag
D
Shrestha
Prakash S
PS
Sommerfelt
Halvor
H
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