title: Relationships between rhinitis symptoms, respiratory viral infections and nasopharyngeal colonization with Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus in children attending daycare.
abstract: BACKGROUND
  Nasal bacterial colonization is often dubbed "asymptomatic." We hypothesized that rhinitis, common in preschool children, is associated with bacterial colonization and that respiratory viruses, which cause rhinitis, interact with bacteria in ways which promote transmission.
  
  
  METHODS
  Five hundred eighty-five children (4.2-73.6 months) attending daycare had clinical information, a rhinitis score and nasal swabs collected in February 2009. Swabs in soya tryptone glucose glycerine broth were cultured for Streptococcus pneumoniae (Sp), Haemophilus influenzae (Hi) and Staphylococcus aureus and analyzed by real-time polymerase chain reaction for respiratory viruses, both semiquantitatively.
  
  
  RESULTS
  Rhinitis symptoms, carriage of Sp and Hi and viral detection fell, whereas S. aureus carriage rates rose with age. Significant, age-independent associations between rhinitis symptoms and detection of Hi (P < 0.033) and Hi colonization density (P < 0.027) were observed. Of the 42% with detected viruses, most (78%) had picornavirus detection. There was a significant age-independent association between viral detection (and viral load, picornavirus detection and picorn aviral load) and detection of Sp (P = 0.020, 0.035, 0.005, 0.014) and between viral detection and viral load and Sp colonization density (P = 0.024, 0.028) [corrected].
  
  
  CONCLUSIONS
  Hi may promote its own transmission by inducing or ampli¬fying rhinitis in children. There isa close quantitative relationship between respiratory viral detection, including picornavirus detection and Spcoloni¬zation. These findings have implications for understanding disease patho¬genesis and formulating prevention strategies using vaccines [corrected].
authors.affiliation: Infectious Diseases Unit and Emergency Service, Centro de Investigação e Formação Clinica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal. frodrigues@chc.min-saude.pt
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodrigues
authors.forename: Dona
authors.initials: D
authors.lastname: Foster
authors.forename: Emily
authors.initials: E
authors.lastname: Nicoli
authors.forename: Caroline
authors.initials: C
authors.lastname: Trotter
authors.forename: Barry
authors.initials: B
authors.lastname: Vipond
authors.forename: Peter
authors.initials: P
authors.lastname: Muir
authors.forename: Guilherme
authors.initials: G
authors.lastname: Gonçalves
authors.forename: Luís
authors.initials: L
authors.lastname: Januário
authors.forename: Adam
authors.initials: A
authors.lastname: Finn
mesh_terms: D001424:Bacterial Infections / Q000382:microbiology*; D002353:Carrier State / Q000382:microbiology*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D060085:Coinfection / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D012220:Rhinitis / Q000382:microbiology / Q000473:pathology* / Q000821:virology; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014780:Viruses / Q000145:classification / Q000302:isolation & purification