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    • br Conflict of interests br Acknowledgments We gratefully

    2018-10-29


    Conflict of interests
    Acknowledgments We gratefully acknowledge all the staff who participated in this study. This work was supported by Grants from National Natural Science Foundation of China (No. 81460323).
    Introduction Respiratory tract infection (RTI) is a common disease in all ages of the population, especially in children. The severity of RTI varies from mild pharyngolaryngitis to pneumonia or even death. RTIs result in high pediatric hospitalization and morbidity rates. In 2013, up to 0.9 million children aged under 5years died from pneumonia globally, which ranks as the second leading cause of childhood death. Rhinovirus (RV), Mycoplasma pneumonia (MP), adenovirus (ADV), and parainfluenza cancer (PIV) were reported to be detected commonly in RTIs. Traditional detection methods, such as viral or bacterial culture, usually require 3–5days and depend on the biological properties of the pathogens. Immunoassays provide faster diagnosis for pathogens but suffer from poor specificity of the antigen–antibody reactions. With the development of molecular diagnosis techniques, PCR-based methods with preferable sensitivity and efficiency can detect co-infection, which is common in children with an RTI. Filmarray is a nested PCR-based platform for pathogen detection. It can complete the detection of 18 respiratory pathogens automatically, with good sensitivity and specificity within 1.2h Differences in the pathogen spectrum between upper and lower respiratory tract infections remain controversial. It has been demonstrated in several studies that RV, respiratory syncytial virus (RSV), ADV, and MP were detected frequently in both nasopharyngeal swabs (NPS) and bronchoalveolar lavage fluid (BALF) from patients with an RTI. However, some pathogens, such as influenza A virus, were detected more frequently in NPS than in BALF. An ex-vivo study by Nicholls et al. demonstrated that Influenza A virus (H5N1) could not only infect, but also replicate in tissue from the human upper respiratory and lower respiratory tract. There may be an association between the pathogen spectrum in the upper respiratory tract and lower respiratory tract; however, the different detection rates for pathogen between NPS and BALF might be attributed to the tropism of pathogens in respiratory tract. Few studies have demonstrated the pathogen spectrum in the upper and lower respiratory tract of the same individual. In the present study, we used the Filmarray assay and real-time PCR methods for pathogen detection to investigate pathogens in children with an RTI. Furthermore, we detected pathogens in the NPS and BALF from the same individual, which could help to better understand pathogen distribution and association between the upper respiratory and lower respiratory tract.
    Material and methods
    Results
    Discussion In this study, pathogens in 55 NPS and 30 BALF samples obtained from 55 hospitalized children with an RTI were detected. Using the Filmarray, 74.5% of the children were found to be infected with at least one pathogen, among which 53.7% of cases were co-infected. Co-infection has been reported to be common in children with an RTI. Previous studies showed that co-infection was found more frequently in children under 2years old than in older age groups. However, Peng et al. stated that children aged from 3 to 6years might be more susceptible to co-infection. This may be explained by the increased exposure to shared childcare groups. However, our study showed no significant increase in co-infection in children aged over 2years. The correlation between co-infection and age in children with an RTI remains controversial and requires further study. RV was the most prevalent pathogen overall and in the co-infection cases in this study. Other studies showed similar results, which highlighted the important role of RV in RTIs. RSV and MP were also found commonly in children with an RTI. Our study showed that children younger than 2years old were more susceptible to RSV, which agreed with other studies. In addition, MP was detected more frequently in children aged over 2years. Some studies also showed that MP was detected more commonly in pre-school-aged children and adolescents with community-acquired pneumonia. Our findings may improve diagnosis and lead to better clinical care.