Abstract
Introducción
En el año 2005 se ha clonado un nuevo virus respiratorio, llamado bocavirus humano (HBoV) de muestras respiratorias procedentes de lactantes y niños suecos con infección respiratoria de vías bajas.
Objetivos
Determinar si HBoV ha circulado en España, estimar la frecuencia de infecciones por HBoV en los niños hospitalizados por infección respiratoria y describir sus características clínicas y epidemiológicas.
Pacientes y métodos
Estudio descriptivo, prospectivo de las infecciones confirmadas por HBoV en niños menores de 14 años, hospitalizados por infección respiratoria desde octubre de 2004 a junio de 2005. Para el diagnóstico virológico se realizó reacción en cadena de la polimerasa-transcripción inversa (RT-PCR) múltiple para virus respiratorio sincitial (VRS) A y B, influenza A, B y C, parainfluenza 1-4, adenovirus y rinovirus; PCR para metapneumovirus humano (hMPV) y PCR para HBoV en aspirado nasofaríngeo. Se describen las características clínicas y epidemiológicas de los pacientes.
Resultados
Se detectaron 52 casos de infección por HBoV, lo que supuso el 17,1 % (IC [intervalo de confianza] 95 %: 13 a 21) de los pacientes hospitalizados por procesos respiratorios. HBoV fue el tercer agente viral tras el VRS (30 %) y el rinovirus (25 %). En 39 casos (71,1 %) se detectó coinfección con otro virus respiratorio.
El 50 % de los pacientes eran menores de 13,6 meses y el 75% menores de 2 años. Los diagnósticos más frecuentes fueron sibilancias recurrentes (55,8 %), bronquiolitis (21,2 %) y neumonía (15,4 %). Dos niños presentaron sepsis clínica con exantema petequial. El 71,2 % presentó fiebre superior a 38 °C e infiltrado radiológico el 44 %. Presentaron hipoxia el 55,8 % de los niños. Dos pacientes presentaron aislamientos positivos para HBoV en distintos episodios. Las coinfecciones fueron similares a las infecciones simples, excepto que presentaron hipoxia con más frecuencia, p = 0,038.
Conclusiones
HBoV es uno de los virus más frecuentes en las infecciones respiratorias graves de los niños, sólo precedido por VRS y rinovirus. Las coinfecciones son muy frecuentes. La mayoría de los niños son lactantes con sibilancias recurrentes y bronquiolitis.
Palabras clave: Infección respiratoria, Bocavirus, Sibilancias recurrentes, Bronquiolitis, Exantema
Abstract
Introduction
In 2005 a new respiratory virus, called human bocavirus (HBoV), was cloned from respiratory samples from Swedish infants and children with lower respiratory tract infections.
Objectives
To determine whether HBoV has circulated in Spain, estimate the frequency of HBoV infections in patients hospitalized for respiratory infection and describe the clinical and epidemiological characteristics of these patients.
Patients and methods
We performed a descriptive prospective study of confirmed HBoV infections in patients aged < 14 years old, hospitalized for respiratory infections between October 2004 and June 2005. Virologic diagnosis was based on multiple RT-PCR for respiratory syncytial virus (RSV) A and B, influenza A,B, and C, parainfluenza 1-4, adenovirus and rhinovirus; PCR was used for human metapneumovirus (hMPV) and PCR in nasopharyngeal aspirates was used for HBoV. The clinical and epidemiological characteristics of patients were analyzed.
Results
Fifty-two cases of HBoV infection were detected, representing 17.1 % (95 % CI: 13 % a 21 %) of patients hospitalized for respiratory infections. HBoV was the third most frequent viral agent after RSV (30 %) and rhinovirus (25 %). In 39 patients (71.1 %) coinfection with another respiratory virus was detected.
Fifty percent of the patients were aged less than 13.6 months and 75 % were aged less than 2 years. The most frequent diagnoses were recurrent wheezing (55.8 %), bronchiolitis (21.2 %) and pneumonia (15.4 %). Clinical sepsis with petechial exanthema was found in two patients. Fever > 38 °C was found in 72.1 % and radiological infiltrate in 44 %. Hypoxia was present in 55.8 % of the patients. HBoV was isolated in distinct episodes in two patients. Coinfections were similar to simple infections except that hypoxia was more frequent in the former (p 0.038).
Conclusions
HBoV is one of the most frequent viruses in severe respiratory infections in patients aged less than 14 years old. Only RSV and rhinovirus are more frequent. Coinfections are highly frequent. Most patients are infants with recurrent wheezing and bronchiolitis.
Key words: Respiratory infection, Bocavirus, Recurrent wheezing, Bronchiolitis, Exanthema
Footnotes
Estudio parcialmente financiado por el Fondo de Investigaciones Sanitarias. FIS N.° 98/0310.
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