Respiratory infections have a significant impact on health worldwide. Viruses are major causes of acute respiratory infections among children. Limited information regarding its prevalence in Egypt is available. This study investigated prevalence of 10 respiratory viruses; Adenovirus, influenza A, B, respiratory syncytial virus (RSV), Parainfluenza virus (PIV)type 1-4, enterovirus, and human coronavirus OC43 (HCoV-OC43) among children in Alexandria, Egypt presenting with acute lower respiratory tract infections.
The study was conducted on children <14 years of age selected from ElShatby Pediatric Hospital, Alexandria University, Egypt. One hundred children presenting during winter season with influenza-like illness were eligible for the study. Oropharyngeal swabs were collected and subjected to viral RNA and DNA extraction followed by polymerase chain reaction.
Viral infections were detected in 44% of cases. Adenovirus was the most common, it was found in 19% of the patients. Prevalence of PIV (3 and 4) and enterovirus was 7% each. Prevalence of RSV and HCoV-OC43 was 5% and 3% respectively. Two percentage were Influenza A positive and 1% positive for influenza B. Mixed viral infection was observed in 7%.
To the best of our knowledge, this is the first report of the isolation of HCoV-OC43 from respiratory infections in Alexandria, Egypt.
Pientong C, Ekalaksananan T, Teeratakulpisarn J, Tanuwattanachai S, Kongyingyoes B, Limwattananon C. Atypical bacterial pathogen infection in children with acute bronchiolitis in northeast Thailand. J Microbiol Immunol Infect 2011; 44(2 ): 95–100.
Bariffi F, Sanduzzi A, Ponticiello A. Epidemiology of lower respiratory tract infections. J chemother 1995; 7(4): 263–276.
Kusel MM, de Klerk NH, Holt PG, Kebadze T, Johnston SL, Sly PD. Role of respiratory viruses in acute upper and lower respiratory tract illness in the first year of life: a birth cohort study. Pediatr Infect Dis J 2006; 25(8): 680–686.
Tazinya AA, Halle-Ekane GE, Mbuagbaw LT, Abanda M, Atashili J, Obama MT. Risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon. BMC Pulm Med 2018; 18(1): 7.
Rajatonirina S, Razanajatovo NH, Ratsima EH, Orelle A, Ratovoson R, Andrianirina ZZ, et al. Outcome risk factors during respiratory infections in a paediatric ward in Antananarivo, Madagascar 2010-2012. PLoS One 2013; 8(9): e72839.
Ho NT, Thompson C, Nhan LNT, Van HMT, Dung NT, Tran MP, et al. Retrospective analysis assessing the spatial and temporal distribution of paediatric acute respiratory tract infections in Ho Chi Minh City, Vietnam. BMJ Open 2018; 8(1): e016349.
Liu WK, Liu Q, Chen DH, Liang HX, Chen XK, Chen MX, et al. Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study. PLoS One 2014; 9(5): e96674.
Cui B, Zhang D, Pan H, Zhang F, Farrar J, Law F, et al. Viral etiology of acute respiratory infections among children and associated meteorological factors in southern China. BMC Infect Dis 2015; 15: 124.
Berman S. Epidemiology of acute respiratory infections in children of developing countries. Rev Infect Dis 1991; 13(Suppl. 6): S454-S462.
Naghipour M, Cuevas LE, Bakhshinejad T, Dove W, Hart CA. Human bocavirus in Iranian children with acute respiratory infections. J Med Virol 2007; 79(5): 539–543.
Al-Sonboli N, Hart CA, Al-Aghbari N, Al-Ansi A, Ashoor O, Cuevas LE. Human metapneumovirus and respiratory syncytial virus disease in children, Yemen. Emerg Infect Dis 2006; 12(9): 1437–1439.
Kaplan NM, Dove W, Abu-Zeid AF, Shamoon HE, Abd-Eldayem SA, Hart CA. Evidence of human metapneumovirus infection in Jordanian children. Saudi Med J 2006; 27(7): 1081–1083.
Khuri-Bulos N, Williams JV, Shehabi AA, Faouri S, Al Jundi E, Abushariah O, et al. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. Scand J Infect Dis 2010; 42(5): 368–374.
El Sayed Zaki M, Raafat D, El-Metaal AA, Ismail M. Study of human metapneumovirus-associated lower respiratory tract infections in Egyptian adults. Microbiol Immunol 2009; 53(11): 603–608.
Yahia S, Kandeel AY, Hammad E, El-Gilany AH. Human Metapneumovirus (hMPV) in acute respiratory infection: a clinic-based study in Egypt. Indian J Pediatr 2012; 79(10): 1323–1327.
Hatipoglu N, Somer A, Badur S, Unuvar E, Akcay-Ciblak M, Yekeler E, et al. Viral etiology in hospitalized children with acute lower respiratory tract infection. Turk J Pediatr 2011; 53(5): 508–516.
Imam IZ, Labib A, Hassan A, Fathy M. Etiology of viral pneumonia in Cairo 1967–1968. J Egypt Public Health Assoc 1969; 44(5): 486–497.
El Sayed Zaki M, Goda T. Clinico-pathological study of atypical pathogens in community-acquired pneumonia: a prospective study. J Infect Dev Ctries 2009; 3(3): 199–205.
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.
Gad NM, Refaay D, Gad NM, Mohamed AZ. Viral infections in Egyptian hospitalized children with acute respiratory tract infections. J Clin Cell Immunol 2017; 8: 526.
Osiowy C. Direct detection of respiratory syncytial virus, parainfluenza virus, and adenovirus in clinical respiratory specimens by a multiplex reverse transcription-PCR assay. J Clin Microbiol 1998; 36(11): 3149–3154.
Bellau-Pujol S, Vabret A, Legrand L, Dina J, Gouarin S, Petitjean-Lecherbonnier J, et al. Development of three multiplex RT-PCR assays for the detection of 12 respiratory RNA viruses. J Virol Methods 2005; 126(1): 53–63.
Zoll GJ, Melchers WJ, Kopecka H, Jambroes G, Van der Poel HJ, Galama JM. General primer-mediated polymerase chain reaction for detection of enteroviruses: application for diagnostic routine and persistent infections. J Clin Microbiol 1992; 30(1): 160–165.
Drummond P, Clark J, Wheeler J, Galloway A, Freeman R, Cant A. Community acquired pneumonia–a prospective UK study. Arch Dis Child 2000; 83(5): 408–412.
Juven T, Mertsola J, Waris M, Leinonen M, Meurman O, Roivainen M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 2000; 19(4): 293–298.
Korppi M, Heiskanen-Kosma T, Jalonen E, Saikku P, Leinonen M, Halonen P, et al. Aetiology of community-acquired pneumonia in children treated in hospital. Eur J Pediatr 1993; 152(1): 24–30.
Hatipoglu N, Somer A, Badur S, Unuvar E, Akcay-Ciblak M, Yekeler E, et al. Viral etiology in hospitalized children with acute lower respiratory tract infection. Turk J Pediatr 2011; 53(5): 508–516.
Sutmoller F, Ferro ZP, Asensi MD, Ferreira V, Mazzei IS, Cunha BL. Etiology of acute respiratory tract infections among children in a combined community and hospital study in Rio de Janeiro. Clin Infect Dis 1995; 20(4): 854–860.
Erdman DD,Weinberg GA, Edward KM, Walker FJ, Anderson BC,Winter J, et al. GenScan reverse transcriptase-PCR assay for detection of six common respiratory viruses in young children hospitalized with acute respiratory illness. J Clin Microbiol 2003; 41: 4298–4303.
Van der Zalm MM, van Ewijk BE, Wilbrink B, Uiterwaal CS, Wolfs TF, van der Ent CK. Respiratory pathogens in children with and without respiratory symptoms. J Pediatr 2009; 154: 396–400.
Huijskens EG, Biesmans RC, Buiting AG, Obihara CC, Rossen JW. Diagnostic value of respiratory virus detection in symptomatic children using real-time PCR. Virol J 2012; 9: 276.
Kwofie TB, Anane YA, Nkrumah B, Annan A, Nguah SB, Owusu M. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana. Virol J 2012; 9: 78.
Bicer S, Giray T, Coel D, Erdağ GC, Vitrinel A, Gürol Y, et al. Virological and clinical characterizations of respiratory infections in hospitalized children. Ital J Pediatr 2013; 39: 22.
Huang G, Yu D, Mao N, Zhu Z, Zhang H, Jiang Z, et al. Viral etiology of acute respiratory infection in Gansu Province, China, 2011. PLoS One 2013; 8: e64254.
Suryadevara M, Cummings E, Bonville CA, Bartholoma N, Riddell S, Kiska D, et al. Viral etiology of acute febrile respiratory illnesses in hospitalized children younger than 24 months. Clin Pediatr (Phila) 2011; 50: 513–517.
Al-Ayed MS, Asaad AM, Qureshi MA, Ameen MS. Viral etiology of respiratory infections in children in southwestern Saudi Arabia using multiplex reverse-transcriptase polymerase chain reaction. Saudi Med J 2014; 35(11): 1348–1353.
El Baroudy NR, El Refay AS, Abdel Hamid TA, Hassan DM, Soliman MS, Sherif L. Respiratory viruses and atypical bacteria co-infection in children with acute respiratory infection. Open Access Maced J Med Sci 2018; 6(9): 1588–1593.
Hatipoğlu N, Somer A, Badur S, Unüvar E, Akçay-Ciblak M, Yekeler E, et al. Viral etiology in hospitalized children with acute lower respiratory tract infection. Turk J Pediatr 2011; 53(5): 508–516.
Khuri-Bulos N, Williams JV, Shehabi AA, Faouri S, Al Jundi E, Abushariah O, et al. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. Scand J Infect Dis 2010; 42(5): 368–374.
Muenchhoff M, Goulder PJ. Sex differences in pediatric infectious diseases. The J Infect Dis 2014; 209(Suppl. 3): S120–S126.
Ljubin-Sternak S, Marijan T, Ivković-Jureković I, Čepin-Bogović J, Gagro A, Vraneš J. Etiology and clinical characteristics of single and multiple respiratory virus infections diagnosed in Croatian children in two respiratory seasons. J Pathog 2016; 20: 6–11.
Liu WK, Liu Q, Chen DH, Liang HX, Chen XK, Chen MX, et al. Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study. PLoS One 2014; 9(5): e96674.
Thomazelli LM, Vieira S, Leal AL, Sousa TS, Oliveira DB, Golono MA, et al. Surveillance of eight respiratory viruses in clinical samples of pediatric patients in southeast Brazil. J Pediatr 2007; 83(5): 422–428.
Anders KL, Nguyen HL, Nguyen NM, Van Thuy NT, Van NT, Hieu NT, et al. Epidemiology and virology of acute respiratory infections during the first year of life: a birth cohort study in Vietnam. Pediatr Infect Dis J 2015; 34(4): 361.
Tsai HP, Kuo PH, Liu CC, Wang JR. Respiratory viral infections among pediatric inpatients and outpatients in Taiwan from 1997 to 1999. J Clin Microbiol 2001; 39(1): 111–118.
Kajon AE, Mistchenko AS, Videla C, Hortal M, Wadell G, Avendaño LF. Molecular epidemiology of adenovirus acute lower respiratory infections of children in the south cone of South America (1991–1994). J Med Virol 1996; 48(2): 151–156.
Hatem A, Mohamed S, Abu Elhassan UE, Ismael EAM, Magda S, Rizk MS, et al. Clinical characteristics and outcomes of patients with severe acute respiratory infections (SARI): results from the Egyptian surveillance study 2010–2014. Multidiscip Respir Med 2019; 14: 11.
Giamberardin HI, Homsani S, Bricks LF, Pacheco AP, Guedes M, Debur MC, et al. Clinical and epidemiological features of respiratory virus infections in preschool children over two consecutive influenza seasons in southern Brazil. J Med Virol 2016; 88(8): 1325–1333.
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 2011; 378(9807): 1917–1930.
Viboud C, Alonso WJ, Simonsen L. Influenza in tropical regions. PLoS Med 2006; 3: e89.
Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000–2005. Clin Infect Dis. 2006; 43(5): 585–592.
Downham MA, McQuillin J, Gardner PS. Diagnosis and clinical significance of parainfluenza virus infections in children. Arch Dis Child 1974; 49(1): 8–15.
Lindquist SW, Darnule A, Istas A, Demmler GJ. Parainfluenza virus type 4 infections in pediatric patients. Pediatr Infect Dis J 1997; 16(1): 34–38.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Bur-den of Disease Study 2010. Lancet 2012; 380: 2095–2128.
Bonzel L, Tenenbaum T, Schroten H, Schildgen O, Schweitzer-Krantz S, Adams, O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. The Pediatr Infect Dis J 2008; 27(7): 589–594.
Jean A, Quach C, Yung A, Semret M. Severity and outcome associated with human coronavirus OC43 infections among children. Pediatr Infect Dis J 2013; 32(4): 325–329.
Kristoffersen AW, Nordbø SA, Rognlien A-GW, Christensen A, Døllner H. Coronavirus causes lower respiratory tract infections less frequently than RSV in hospitalized Norwegian children. Pediatr Infect Dis J 2011; 30(4): 279–283.
Isaacs D, Flowers D, Clarke JR, Valman HB, MacNaughton MR. Epidemiology of coronavirus respiratory infections. Arch D Child 1983; 58(7): 500–503.
Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814–1820.
WHO Factsheet March. Middle East respiratory syndrome coronavirus (MERS-CoV); 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov).
Essa S, Owayed A, Altawalah H, Khadadah M, Behbehani N, Al-Nakib W. Mixed viral infections circulating in hospitalized patients with respiratory tract infections in Kuwait. Hindawi Publishing Corporation. Adv Virol 2015: 8. 714062
Harada Y, Kinoshita F, Yoshida LM, Minh le N, Suzuki M, Morimoto K. Does respiratory virus coinfection increases the clinical severity of acute respiratory infection among children infected with respiratory syncytial virus? Pediatr Infect Dis J 2013; 32: 441–445.
Chorazy ML, Lebeck MG, McCarthy TA, Richter SS, Torner JC, Gray GC: Polymicrobial acute respiratory infections in a hospital-based pediatric population. Pediatr Infect Dis J 2013; 32: 460–466.
Martin ET, Kuypers J, Wald A, Englund JA. Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Influenza Respi Viruses. 2012; 6: 71–77.