Main Article Content
Background: Acute respiratory infections (ARI) are the leading cause of death worldwide especially among children. The majority of these infections in children are of viral etiology. In this study, we evaluated the incidence of viral ARI among children in Lebanon. Methods: Children presenting with symptoms of ARI were prospectively recruited between September 2009 to February 2012. Nasopharyngeal aspirates were obtained from patients and screened for 11 respiratory viruses using a multiplex Luminex-based PCR assay. Results: Two hundred twenty-one patients were recruited with a median age of 1 year (IQR: 0 - 5). Out of 221 patients, 116 (52.5%) were positive for at least one virus, the majority (103/116; 88.8%) of which were in children under 6-year of age. Overall 188 viruses were detected. Rhinovirus (RhV) was the most common virus detected in 81 (69.8%) patients followed by coxsackie virus and echovirus (CVEV) which were detected as one target in the panel in 45 (38.8%), and parainfluenza viruses (PIV types: 1, 2, 3, 4) in 24 (20.7%) patients. Coinfection with more than one virus was detected in 49 (42.9%) patients. RhV and CVEV were the most common viruses associated with co-infections and higher risk of rhinorrhea. Conclusion: Viral pathogens account for at least half of the ARIs in Lebanon, with a high frequency of co-infections being detected.
Downloads month by month
2. WHO | The global burden of disease: 2004 update [Internet]. WHO. [cited 2016 May 11]. Available from: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/
3. Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002 Jan;2(1):25–32.
4. Nichols WG, Campbell AJP, Boeckh M. Respiratory Viruses Other than Influenza Virus: Impact and Therapeutic Advances. Clin Microbiol Rev. 2008 Apr 1;21(2):274–90.
5. Mahony JB. Detection of Respiratory Viruses by Molecular Methods. Clin Microbiol Rev. 2008 Oct 1;21(4):716–47.
6. Goldmann DA. Epidemiology and prevention of pediatric viral respiratory infections in health-care institutions. Emerg Infect Dis. 2001;7(2):249–53.
7. Berry M, Gamieldien J, Fielding BC. Identification of New Respiratory Viruses in the New Millennium. Viruses. 2015 Mar 6;7(3):996–1019.
8. Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet Lond Engl. 2011 Dec 3;378(9807):1917–30.
9. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. The Lancet. 2010 May 7;375(9725):1545–55.
10. Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003 Feb 24;163(4):487–94.
11. Bawage SS, Tiwari PM, Pillai S, Dennis V, Singh SR. Recent Advances in Diagnosis, Prevention, and Treatment of Human Respiratory Syncytial Virus. Adv Virol [Internet].
2013 [cited 2016 May 11];2013. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872095/
12. Hayden F. Developing New Antiviral Agents for Influenza Treatment: What Does the Future Hold? Clin Infect Dis. 2009 Jan 1;48(Supplement 1):S3–13.
13. Hayden FG. Advances in antivirals for non-influenza respiratory virus infections. Influenza Other Respir Viruses. 2013 Nov 1;7:36–43.
14. Gill JM, Fleischut P, Haas S, Pellini B, Crawford A, Nash DB. Use of antibiotics for adult upper respiratory infections in outpatient settings: A national ambulatory network study. Fam Med. 2006 May;38(5):349–54.
15. Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive Antibiotic Use for Acute Respiratory Infections in the United States. Clin Infect Dis. 2001 Sep 15;33(6):757–62.
16. Pavia AT. Viral Infections of the Lower Respiratory Tract: Old Viruses, New Viruses, and the Role of Diagnosis. Clin Infect Dis. 2011 May 1;52(suppl 4):S284–9.
17. Li H, McCormac MA, Estes RW, Sefers SE, Dare RK, Chappell JD, et al. Simultaneous detection and high-throughput identification of a panel of RNA viruses causing respiratory tract infections. J Clin Microbiol. 2007 Jul;45(7):2105–9.
18. Finianos M, Issa R, Curran MD, Afif C, Rajab M, Irani J, et al. Etiology, seasonality and clinical characterization of viral respiratory infections among hospitalized children in Beirut, Lebanon. J Med Virol. 2016 Apr 1;n/a-n/a.
19. Wertheim HFL, Nadjm B, Thomas S, Agustiningsih A, Malik S, Diep NNT, et al. Viral and atypical bacterial aetiologies of infection in hospitalised patients admitted with clinical suspicion of influenza in Thailand, Vietnam and Indonesia. Influenza Other Respir Viruses. 2015 May 16;
20. Regamey N, Kaiser L, Roiha HL, Deffernez C, Kuehni CE, Latzin P, et al. Viral Aetiology of Acute Respiratory Infections With Cough in Infancy: A Community-Based Birth Cohort Study. Pediatr Infect Dis J [Internet]. 2008 Jan [cited 2015 Jul 20];PAP. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006454-900000000-99976
21. Ali SA, Williams JV, Chen Q, Faori S, Shehabi A, Jundi EA, et al. Human metapneumovirus in hospitalized children in Amman, Jordan. J Med Virol. 2010 May 1;82(6):1012–6.
22. Shafik CF, Mohareb EW, Yassin AS, Amin MA, El Kholy A, El-Karaksy H, et al. Viral etiologies of lower respiratory tract infections among Egyptian children under five years of age. BMC Infect Dis. 2012;12:350.
23. Al-Thani A, Azzam SB, Al-Sheik Abboubaker HM, Abdel-Hadi FG, Elsheikh M, Janahi IA. The role of human metapneumovirus in pediatric respiratory tract infection in Qatar. Future Virol. 2010 May;5(3):355–60.
24. Garcia J, Espejo V, Nelson M, Sovero M, Villaran MV, Gomez J, et al. Human rhinoviruses and enteroviruses in influenza-like illness in Latin America. Virol J. 2013;10:305.
25. Laguna-Torres VA, Sánchez-Largaespada JF, Lorenzana I, Forshey B, Aguilar P, Jimenez M, et al. Influenza and other respiratory viruses in three Central American countries. Influenza Other Respir Viruses. 2011 Mar 1;5(2):123–34.
26. Diaz J, Morales-Romero J, Pérez-Gil G, Bedolla-Barajas M, Delgado-Figueroa N, García-Román R, et al. Viral coinfection in acute respiratory infection in Mexican children treated by the emergency service: A cross-sectional study. Ital J Pediatr. 2015 Apr 18;41(1):33.
27. Tregoning JS, Schwarze J. Respiratory Viral Infections in Infants: Causes, Clinical Symptoms, Virology, and Immunology. Clin Microbiol Rev. 2010 Jan 1;23(1):74–98.
28. Esper FP, Spahlinger T, Zhou L. RATE AND INFLUENCE OF RESPIRATORY VIRUS CO-INFECTION ON PANDEMIC (H1N1) INFLUENZA DISEASE. J Infect. 2011 Oct;63(4):260–6.
29. Semple MG, Cowell A, Dove W, Greensill J, McNamara PS, Halfhide C, et al. Dual Infection of Infants by Human Metapneumovirus and Human Respiratory Syncytial Virus Is Strongly Associated with Severe Bronchiolitis. J Infect Dis. 2005 Feb 1;191(3):382–6.
30. Aberle JH, Aberle SW, Pracher E, Hutter H-P, Kundi M, Popow-Kraupp T. Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J. 2005 Jul;24(7):605–10.
31. Wilkesmann A, Schildgen O, Eis-Hübinger AM, Geikowski T, Glatzel T, Lentze MJ, et al. Human metapneumovirus infections cause similar symptoms and clinical severity as respiratory syncytial virus infections. Eur J Pediatr. 2006 Jul;165(7):467–75.
32. Bezerra PGM, Britto MCA, Correia JB, Duarte M do CMB, Fonceca AM, Rose K, et al. Viral and atypical bacterial detection in acute respiratory infection in children under five years. PloS One. 2011;6(4):e18928.
33. Shinjoh M, Omoe K, Saito N, Matsuo N, Nerome K. In vitro growth profiles of respiratory syncytial virus in the presence of influenza virus. Acta Virol. 2000 Apr;44(2):91–7.