Abstract
Objetivo
Estudiar las diferencias en la sintomatología de las infecciones respiratorias virales confirmadas por laboratorio, especialmente en cuanto a las manifestaciones clínicas de gastroenteritis, en función de la edad y el tipo de virus aislado, durante 5 temporadas gripales, de 1999 a 2004.
Material y métodos
El período de estudio ha sido de 5 temporadas gripales, desde 1999-2000 hasta 2003-2004. Se revisaron los informes de recogida de datos correspondientes a las muestras obtenidas por 24 equipos de atención primaria distribuidos por el territorio de Cataluña, con resultados positivos para alguno de los virus estudiados (virus de la gripe A [VGA], virus de la gripe B [VGB], virus respiratorio sincitial [VRS] y adenovirus [ADV]). Se estudiaron las siguientes variables clínicas: inicio brusco, fiebre, sintomatología respiratoria, odinofagia, artromialgias, sintomatología gastrointestinal para cada tipo de virus en 2 grupos de edad: menores o iguales y mayores de 14 años. Como medidas de asociación se calcularon las odds ratio (OR) y sus intervalos de confianza (IC) del 95%.
Resultados
Del total de 1.591 muestras analizadas durante las 5 temporadas gripales estudiadas, un 42,68% (679) de las muestras obtenidas procedía de pacientes cuya edad era ≤ 14 años y el 57,32% (912) pertenecía a pacientes > 14 años de edad. Se obtuvieron 286 positividades a VGA (166/286 [58,04%] en ≤ 14 años, y 120/286 [41,95%] en > 14 años), 107 muestras positivas a VGB (78/107 [72,90%] en ≤ 14 años y 29/107 [27,10%] en > 14 años), 53 a VRS (39/53 [73,58%] en ≤ 14 años y 12/53 [22,64%] en > 14 años) y 40 a ADV (36/40 [90%] en ≤ 14 años y 4/40 [10%] en > 14 años). Las diferencias de sintomatología entre ambos grupos de edad se pudieron comparar para el VGA, la fiebre (OR = 16,536; IC del 95%, 4,893-55,887; p = 0,001) y la sintomatología gastrointestinal (OR = 4,664; IC del 95%, 1,569-13,868; p < 0,036) resultaron ser significativamente más frecuentes en los ≤ 14 años que en los mayores de esa edad, mientras que las artromialgias (OR = 0,048; IC del 95%, 0,026-0,089; p = 0,001) lo fueron para los mayores de 14 años.
Conclusiones
Los datos obtenidos en este trabajo indican que entre las manifestaciones clínicas de las infecciones respiratorias agudas de etiología viral en la población pediátrica, a diferencia de lo que ocurre en la población adulta, la fiebre se encuentra asociada a todos los virus estudiados mientras que los síntomas gastrointestinales se asocian, en mayor grado, a las infecciones producidas por virus de la gripe A y B y que el grupo de edad de < 5 años es el que muestra una mayor frecuencia de dichos síntomas.
Palabras clave: Infección respiratoria aguda, Síndrome gripal, Sintomatología gastrointestinal, Virus respiratorios
Abstract
Objective
To study differences in the presentation of laboratory-confirmed acute viral respiratory infections, especially gastroenteritis symptoms, according to age and causative viral agent during five influenza seasons (1999 to 2004.)
Material and methods
Five influenza seasons (1999-2000 to 2003-2004) were studied. Data from samples taken at 24 primary care sentinel centres for influenza surveillance distributed throughout Catalonia (Spain), which were positive for any of the viruses studied (influenza virus A, [IVA], influenza virus B [IVB], syncytial respiratory virus [SRV], adenovirus [ADV] and parainfluenza 1,2,3 viruses), were analyzed. The following clinical variables were evaluated: sudden onset, fever, respiratory symptoms, sore throat, malaise and gastrointestinal symptoms. These variables were studied for each virus and for two age groups: age 14 years or younger and older than 14 years. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.
Results
Of a total of 1,591 samples tested during the influenza seasons studied, 42.68% (679) samples belonged to subjects aged ≤ 14 years and 57.32% (912) to subjects aged > 14 years. There were 286 IVA (166/286 [58.04%] in subjects aged ≤ 14 years and 120/286 [41.95%] in subjects aged > 14 years), 107 were positive for IVB (78/107 [72.90%] in subjects aged ≤ 14 years and 29/107 [27.10%] in subjects aged > 14 years), 53 SRV (39/53 [73.58%] in subjects aged ≤ 14 years and 12/53 [22.64%] in subjects aged > 14 years) and 40 ADV (36/40 [90%] in subjects aged ≤ 14 years and 4/40 [10%] in subjects aged > 14 years). The differences in symptoms between the two age groups could be compared for IVA: fever (OR = 16.536; 95% CI = 4.893-55.887; p = 0.001) and gastrointestinal symptoms (OR = 4.664; 95% CI = 1.569-13.868; p < 0.03) were significantly more frequent in subjects aged ≤ 14 years, while malaise (OR = 0.048; 95% CI = 0.026-0.089; p = 0.001) was more frequent in subjects aged > 14 years.
Conclusions
The results indicate that acute viral respiratory infections always present with fever in children, whatever the virus, but not in adults. Gastrointestinal symptoms were more strongly associated with IVA and IVB and these symptoms were most frequent in children aged under 5 years.
Key words: Acute respiratory infection, Influenza-like illness, Gastrointestinal symptoms, Respiratory viruses
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