title: Viral and atypical bacterial aetiologies of infection in hospitalised patients admitted with clinical suspicion of influenza in Thailand, Vietnam and Indonesia.
abstract: BACKGROUND
  Influenza constitutes a leading cause of morbidity and mortality worldwide. There is limited information about the aetiology of infection presenting clinically as influenza in hospitalised adults and children in South-East Asia. Such data are important for future management of respiratory infections.
  
  
  OBJECTIVE
  To describe the aetiology of infection presenting clinically as influenza in those hospitalised in South-East Asia.
  
  
  METHODS
  Respiratory specimens archived from July 2008 to June 2009 from patients hospitalised with suspected influenza from Indonesia, Thailand and Vietnam were tested for respiratory viruses and atypical bacteria by polymerase chain reaction.
  
  
  RESULTS
  A total of 1222 patients' samples were tested. Of 1222, 776 patients (63·5%) were under the age of 5. Viruses detected included rhinoviruses in 229 of 1222 patients (18·7%), bocaviruses in 200 (16·4%), respiratory syncytial viruses in 144 (11·8%), parainfluenza viruses in 140 (11·5%; PIV1: 32; PIV2: 12; PIV3: 71; PIV4: 25), adenovirus in 102 (8·4%), influenza viruses in 93 (7·6%; influenza A: 77; influenza B: 16) and coronaviruses in 23 (1·8%; OC43: 14; E229: 9). Bacterial pathogens were Mycoplasma pneumoniae (n = 33, 2·7%), Chlamydophila psittaci (n = 2), C. pneumoniae (n = 1), Bordetella pertussis (n = 1) and Legionella pneumophila (n = 2). Overall, in-hospital case fatality rate was 29 of 1222 (2·4%).
  
  
  CONCLUSIONS
  Respiratory viruses were the most commonly detected pathogens in patients hospitalised with a clinical suspicion of influenza. Rhinovirus was the most frequently detected virus, and M. pneumoniae, the most common atypical bacterium. The low number of detected influenza viruses demonstrates a low benefit for empirical oseltamivir therapy, unless during an influenza outbreak.
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Heiman F L
authors.initials: HFL
authors.lastname: Wertheim
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Behzad
authors.initials: B
authors.lastname: Nadjm
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.
authors.forename: Sherine
authors.initials: S
authors.lastname: Thomas
authors.affiliation: National Institute of Health Research and Development, Jakarta, Indonesia.
authors.lastname: Agustiningsih
authors.affiliation: National Institute of Health Research and Development, Jakarta, Indonesia.
authors.forename: Suhud
authors.initials: S
authors.lastname: Malik
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.
authors.forename: Diep Ngoc Thi
authors.initials: DNT
authors.lastname: Nguyen
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.
authors.forename: Dung Viet Tien
authors.identifier: http://orcid.org/0000-0003-3159-2064
authors.initials: DVT
authors.lastname: Vu
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Vietnam.
authors.forename: Kinh
authors.initials: K
authors.lastname: Van Nguyen
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Chau Vinh
authors.initials: CV
authors.lastname: Van Nguyen
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Liem Thanh
authors.initials: LT
authors.lastname: Nguyen
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Sinh Thi
authors.initials: ST
authors.lastname: Tran
authors.affiliation: National Hospital of Pediatrics, Hanoi, Vietnam.
authors.forename: Thuy Bich Thi
authors.initials: TBT
authors.lastname: Phung
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Vietnam.
authors.forename: Trung Vu
authors.initials: TV
authors.lastname: Nguyen
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Tran Tinh
authors.initials: TT
authors.lastname: Hien
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.
authors.forename: Uyen Hanh
authors.initials: UH
authors.lastname: Nguyen
authors.affiliation: Mahidol Oxford University Clinical Research Unit, Bangkok, Thailand.
authors.forename: Walter
authors.initials: W
authors.lastname: Taylor
authors.affiliation: Children's Hospital No 1, Ho Chi Minh City, Vietnam.
authors.forename: Khanh Huu
authors.initials: KH
authors.lastname: Truong
authors.affiliation: Children's Hospital No 2, Ho Chi Minh City, Vietnam.
authors.forename: Tuan Manh
authors.initials: TM
authors.lastname: Ha
authors.affiliation: Siriraj Hospital, Bangkok, Thailand.
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Menno D
authors.initials: MD
authors.lastname: de Jong
authors.affiliation: Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.|Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK.
authors.forename: H Rogier
authors.identifier: http://orcid.org/0000-0002-9807-1821
authors.initials: HR
authors.lastname: van Doorn
authors.affiliation: Siriraj Hospital, Bangkok, Thailand.
authors.forename: Pilaipan
authors.initials: P
authors.lastname: Puthavathana
keywords: 
  Mycoplasma pneumoniae
  ; 
  RSV
  ; Hospitalisation; influenza; respiratory tract infections; rhinovirus