title: Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city.
abstract: The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1-5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P<0.0001). Human rhinovirus, HPIV-3, adenovirus, Streptococcus pneumonia, and Klebsiella pneumaniae had significant involvement in coinfections with P values of 0.0001, 0.009 and 0.0001, 0.0001 and 0.001 respectively. Further investigations are required to better understand the clinical roles of the isolated pathogens and their seasonality.
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Golam Sarower
authors.initials: GS
authors.lastname: Bhuyan
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Mohammad Amir
authors.initials: MA
authors.lastname: Hossain
authors.affiliation: Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Suprovath Kumar
authors.initials: SK
authors.lastname: Sarker
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Asifuzzaman
authors.initials: A
authors.lastname: Rahat
authors.affiliation: Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Md Tarikul
authors.initials: MT
authors.lastname: Islam
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Tanjina Noor
authors.initials: TN
authors.lastname: Haque
authors.affiliation: Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Noorjahan
authors.initials: N
authors.lastname: Begum
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Syeda Kashfi
authors.initials: SK
authors.lastname: Qadri
authors.affiliation: Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh.
authors.forename: A K M
authors.initials: AK
authors.lastname: Muraduzzaman
authors.affiliation: Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Nafisa Nawal
authors.initials: NN
authors.lastname: Islam
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Mohammad Sazzadul
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Sultana
authors.affiliation: Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh.|Department of Virology, Mymensingh Medical College, Dhaka, Bangladesh.
authors.forename: Manjur Hossain Khan
authors.initials: MH
authors.lastname: Jony
authors.affiliation: Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
authors.forename: Farhana
authors.initials: F
authors.lastname: Khanam
authors.affiliation: Department of Pediatrics, Suhrawardy Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Golam
authors.initials: G
authors.lastname: Mowla
authors.affiliation: Department of Child Health, Dhaka Medical College Hospital, Dhaka, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Matin
authors.affiliation: Department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Firoza
authors.initials: F
authors.lastname: Begum
authors.affiliation: Department of Virology, Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh.
authors.forename: Tahmina
authors.initials: T
authors.lastname: Shirin
authors.affiliation: Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
authors.forename: Dilruba
authors.initials: D
authors.lastname: Ahmed
authors.affiliation: Pediatric Neurology, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh.
authors.forename: Narayan
authors.initials: N
authors.lastname: Saha
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.|Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
authors.forename: Firdausi
authors.initials: F
authors.lastname: Qadri
authors.affiliation: Infectious diseases Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.|Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Mohakhali, Dhaka, Bangladesh.
authors.forename: Kaiissar
authors.identifier: http://orcid.org/0000-0002-2394-0447
authors.initials: K
authors.lastname: Mannoor
mesh_terms: D000208:Acute Disease; D001459:Bangladesh; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007709:Klebsiella / Q000302:isolation & purification*; D008297:Male; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D012229:Rhinovirus / Q000302:isolation & purification*; D013291:Streptococcus / Q000302:isolation & purification*