Contexte : Les infections respiratoires aiguës (ARI) sont reconnues comme une cause importante de morbidité, de mortalité et d'hospitalisation chez les enfants dans les pays en développement. Le virus respiratoire syncytial humain (HRSV) est l’agent étiologique principal de maladie sévère des voies respiratoires basses chez les nourrissons, les jeunes enfants et les personnes âgées. Identifié en 2001, le Metapneumovirus humain (HMPV) est un nouveau paramyxovirus. Les études ont montré la cocirculation des sous groupes de ces deux virus avec la domination de l’un des sous groupes selon les zones géographiques et selon les années. Les données restent cependant limitées dans les pays de l’Afrique subsaharienne, sur la prévalence, la saisonnalité et la caractérisation génétique de ces deux virus respiratoires. Au Cameroun, ces deux virus ont été décrits seulement une seule fois (5,7 et 5% pour HRSV et HMPV respectivement) chez des patients présentant des syndromes grippaux en 2012. Objectif : Cette étude rapporte la prévalence, la saisonnalité et la variabilité génétique des souches HRSV et HMPV chez des enfants camerounais pendant 3 saisons épidémiques consécutives (de Septembre 2011 à Octobre 2014). Par ailleurs, la diversité génétique d’autres virus respiratoires détectés au cours de ce travail est présentée comme objectif secondaire.Méthodes : Une surveillance prospective a été menée pour identifier les enfants hospitalisés et ambulatoires âgés de moins de 15 ans présentant des symptômes respiratoires ≤ 5 jours. Les échantillons nasopharyngés ont été testés pour 17 virus respiratoires en utilisant une réaction multiplex de polymérisation en chaîne. La distribution virale et les données démographiques ont été analysées statistiquement. Les échantillons positifs du HRSV et HMPV ont été amplifiés par polymérisation en chaine semi nichée puis séquencés partiellement au niveau du gène G. Des analyses phylogénétiques ont été effectuées sur les séquences nucléotidiques et protéiques partielles du gène G.Résultats : De septembre 2011 à octobre 2014, 822 enfants âgés de moins de 15 ans ont été inscrits dans l’étude. Au moins un virus a été identifié chez chacun des 72,6% (597/822) d'enfants, dont 31,7% (189/597) étaient des codétections; 28,5% (226/822) étaient positifs pour l'adénovirus humain, 21,4% (176/822) pour le virus Influenza, 15,5% (127.822) pour le rhinovirus/entérovirus, 9,4% (77/822) pour le bocavirus, 9% (74/822) pour le HRSV, 8,2% (67/822) pour les coronavirus humain, 6,2% (50/822) pour le parainfluenzavirus humain et 3,9% (32/822) pour le HMPV. L’infection HRSV était plus fréquente chez les enfants de moins de 2 ans (70,3% ; 52/74) et chez les participants hospitalisés (70,3% ; 52/74). Alors que le HRSV a montré un profil saisonnier avec une circulation de septembre à décembre, des cas sporadiques de HMPV ont été détectés tout au long de l'année. HRSV-A (19,1%, 9/47) et HRSV-B (17% ; 8/47) ont été observés relativement à la même fréquence avec (63,8% ; 30/47) de cas en codétection HRSV-A/HRSV-B alors que HMPV-A (71,4% ; 10/14) était majoritaire comparé à HMPV-B (28,6 ; 4/14). L'analyse phylogénétique a révélé que les souches HRSV de l’étude sont groupées au sein du sous groupe NA-1 (pour HRSV-A) et BA-9 (pour HRSV-B). Les souches HMPV camerounaises sont groupés parmi les membres du génotype A2b (pour HMPV-A), B1 et B2 (pour HMPV-B).Conclusion : Cette étude suggère qu’environ 70% des ARI enregistrés chez des enfants au Cameroun sont causés par des virus. La présente étude est également le premier rapport sur la variabilité génétique du gène G des souches de HRSV et HMPV dans la région. Bien que ce travail comble partiellement certaines lacunes d’informations, des études supplémentaires sont requises pour une clarification de l’épidémiologie moléculaire et du mode d’évolution des virus respiratoires présents en Afrique subsaharienne en général et plus singulièrement au Cameroun. / Background: Acute respiratory infections (ARI) are recognized as an important cause of morbidity, mortality and hospitalization among children in developing countries. Human respiratory syncytial virus (HRSV) is the main cause of severe lower respiratory tract disease in infants, young children and the elderly. Identified in 2001, Human Metapneumovirus (HMPV) is a new paramyxovirus. Studies have shown the co-circulation of the subgroups of these two viruses with domination of one of the sub-groups according to the geographical zones and according of years. These two viruses encode two major surface glycoproteins, the highly conserved fusion F protein and the highly variable attachment G protein. Data are still limited in sub-Saharan African countries on prevalence, seasonality and genetic characterization of these two respiratory viruses. In Cameroon, these two viruses have been described only once (5.7 and 5% for HRSV and HMPV respectively) in patients with influenza-like illness in 2012.Objective: This study reports the prevalence, seasonality and the genetic variability of HRSV and HMPV strains in Cameroonian children for 3 consecutive epidemic seasons (September 2011-October 2014). Moreover, the genetic diversity of other respiratory viruses detected during this work is presented as a secondary objective.Methods: A prospective surveillance was conducted to identify inpatient and outpatient children less than 15 years with respiratory symptoms ≤ 5 days. The nasopharyngeal samples were tested for 17 respiratory viruses using a multiplex polymerase chain reaction. Viral distribution and demographic data were analyzed statistically. Positive samples for HRSV and HMPV were amplified by semi-nested polymerize chain reaction and then partially sequenced at the G gene. Phylogenetic analyzes were performed on the partial nucleotide and protein sequences of the G gene.Results: From September 2011 to October 2014, 822 children under 15 years were enrolled in the study. At least one virus was identified in each of 72.6% (577/822) of children, 31.7% (189/597) of whom were co-detections; 28.5% (226/822) were positive for human adenovirus, 21.4% (176/822) for influenza virus, 15.5% (127.822) for rhinovirus/enterovirus, 9.4% (77/822) for bocavirus, 9% (74/822) for HRSV, 8.2% (67/822) for human coronavirus, 6.2% (50/822) for human parainfluenzavirus, and 3.9% (32/822) for HMPV. HRSV infection was more frequent in children under 2 years (70.3%, 52/74) and hospitalized participants (70.3%, 52/74). While HRSV showed a seasonal pattern with circulation from September to December, sporadic cases of HMPV were detected throughout the year. HRSV-A (19.1%, 9/47) and HRSV-B (17%; 8/47) were observed relatively at the same frequency with (63.8%, 30/47) codetections of HRSV-A/HRSV-B. HMPV-A (71.4%; 10/14) was predominant compared to HMPV-B (28.6; 4/14). Phylogenetic analysis revealed that the HRSV strains of the study are grouped within subgroup NA-1 (for HRSV-A) and BA-9 (for HRSV-B). Cameroonian HMPV strains are grouped among the members of genotype A2b (for HMPV-A), B1 and B2 (for HMPV-B).Conclusion: This study suggests that about 70% of ARI recorded in children in Cameroon are caused by viruses. The present study is also the first report on the genetic variability of the G gene of HRSV and HMPV strains in the region. Although this work partially fills gaps for some information, additional studies are required to clarify the molecular epidemiology and evolutionary pattern of respiratory viruses in sub-Saharan Africa in general and more particularly in Cameroon.

Objetivo: Describir la distribución de patógenos responsables de IRA durante el período 2009-2010 en Cajamarca, Perú: en el contexto de la pandemia del virus de la Influenza AH1N1 2009. Resultados: Se encontraron 17 patógenos respiratorios (14 virus y 3 bacterias) en 124 niños, de los cuales el 50% eran hombres y el 50% mujeres, con un 55,6% (69/124) de 1 a 5 años y un 15,3% (19/124) de 6 a 11 años. Los patógenos más comunes fueron: Influenza A (20,2%, 25/124), Mycoplasma pneumoniae (14,5%, 18/124), RSV-A (12,1%, 15/124), Chlamydia pneumoniae (9,7%, 12/124). No se pudo identificar un patógeno específico en el 33,8% de los pacientes (42/124). Los signos y síntomas más comunes fueron fiebre 90,3%, tos 85,5%, rinorrea 74,2% y malestar 66,9%. El distrés respiratorio y la hospitalización fueron las complicaciones más comunes con 37,1% y 28,2% de los casos. Se informó una sola muerte de un niño diagnosticado con el virus de la influenza A. Además, se identificaron 12 casos de coinfecciones: 9 con 2 patógenos, 2 con tres patógenos y 1 con 4. Conclusión: Los patógenos respiratorios más comunes encontrados durante la pandemia de la Influenza AH1N1 2009-2010 fueron Influenza A, Mycoplasma pneumoniae, RSV-A y Chlamydia pneumoniae. La mayoría de patógenos presentan un perfil clínico similar Se detectaron varios casos de coinfecciones, con hasta 4 patógenos en un solo paciente. / Objective: To describe the distribution of pathogens responsible for ARI during the 2009-2010 period in Cajamarca, Peru: in the context of the 2009 AH1N1 influenza virus pandemic. Results: 17 respiratory pathogens (14 viruses and 3 bacteria) were found in 124 children, of which 50% were men and 50% women, with 55.6% (69/124) aged 1 to 5 years and a 15.3% (19/124) from 6 to 11 years old. The most common pathogens were Influenza A (20.2%, 25/124), Mycoplasma pneumoniae (14.5%, 18/124), RSV-A (12.1%, 15/124), Chlamydia pneumoniae (9,7%, 12/124). A specific pathogen could not be identified in 33.8% of patients (42/124). The most common signs and symptoms were fever 90.3%, cough 85.5%, rhinorrhea 74.2% and discomfort 66.9%. Respiratory distress and hospitalization were the most common complications with 37.1% and 28.2% of the cases. A single death was reported in a child diagnosed with influenza A virus. In addition, 12 cases of coinfections were identified: 9 with 2 pathogens, 2 with 3 pathogens, and 1 with 4. Conclusion: The most common respiratory pathogens encountered during the 2009-2010 AH1N1 influenza pandemic were influenza A, Mycoplasma pneumoniae, RSV-A, and Chlamydia pneumoniae. Most pathogens have a similar clinical profile. Several cases of coinfections were detected, with up to 4 pathogens in a single patient. / Tesis

No description available.

Objetivo: describir y analizar la percepción sobre factores predisponentes a Infecciones Respiratorias Agudas en madres de preescolares de una comunidad de Pomalca. Método: Investigación cualitativa, descriptiva, en una muestra de 12 madres de preescolares de la comunidad el Combo, determinada por saturación y redundancia de datos, el muestreo fue no probabilístico por conveniencia. Los datos se recolectaron a través de la entrevista semiestructurada, la cual fue validada por juicio de expertos y por una prueba piloto en 2 madres que cumplían con los criterios de inclusión. Los datos fueron procesados por el método de análisis de contenido temático. Resultados: Se obtuvieron 4 categorías: identificación de factores individuales, reconocimiento de factores en la vivienda, asimismo, identificación de los factores familiares y reconocimiento de factores ambientales como factor predisponente. Conclusión: En su mayoría, las madres de familia tienen una percepción adecuada y reconocen los diversos factores que predisponen a presentar una IRA en los menores de 5 años. Reconocen de manera correcta dentro de los factores familiares, la presencia de algún familiar fumador debido a las sustancias tóxicas que pueden inhalar los preescolares; pero existe una percepción incorrecta sobre la asociación del fumador pasivo (inhala el humo del cigarrillo) con presentar TBC. / Objective: to describe and analyze the perception of predisposing factors to Acute Respiratory Infections in mothers of preschoolers in a community of Pomalca. Method: Qualitative, descriptive research, in a sample of 12 mothers of preschoolers from the Combo community, determined by data saturation and redundancy, sampling was non-probabilistic for convenience. The data were collected through a semi-structured interview, which was validated by expert judgment and by a pilot test on 2 mothers who met the inclusion criteria. The data were processed by the thematic content analysis method. Results: 4 categories were obtained: identification of individual factors, recognition of factors in the home, also, identification of family factors and recognition of environmental factors as a predisposing factor. Conclusion: For the most part, mothers have an adequate perception and recognize the various factors that predispose children under 5 years of age to having an ARI. They correctly recognize within family factors, the presence of a family member who smokes due to the toxic substances that preschoolers can inhale; But there is an incorrect perception about the association of passive smoking (inhaling cigarette smoke) with developing TB.

Thesis (MScMedSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined. / AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly. / Harry Crossley Foundation / Poliomyelitis Research Foundation (PRF) / National Health Laboratory Services Research Trust

O Vírus Respiratório Sincicial Humano (HRSV) é considerado o principal causador de doenças agudas do trato respiratório inferior durante a infância, sendo o principal responsável por um elevado índice de hospitalização de crianças com até cinco anos de idade. Possui distribuição mundial, podendo acometer todas as faixas etárias, entretanto as crianças de 6 semanas a 9 meses são as que desenvolvem problemas mais sérios, como pneumonia e bronquiolite. A epidemia de HRSV apresenta uma sazonalidade bem clara, ocorrendo anualmente no período de outono tardio, inverno ou início da primavera, mas não durante o verão. No presente estudo foi realizada a análise da região G2 da glicoproteína G do HRSV. Um total de 44 amostras positivas para o HRSV do Hospital Universitário (HU) da Universidade de São Paulo (USP), nos anos de 2007-2008, foram seqüenciadas e posteriormente analisadas, sendo então comparadas com seqüências obtidas do NCBI/GeneBank. A análise filogenética mostrou que os genótipos GA2 e GA5, do grupo A, foram os predominantes nos anos de 2007 e 2008, alternando o padrão verificado nos anos anteriores, onde os genótipos do grupo B foram altamente predominantes. A comparação das mutações sinônimas e não sinônimas mostrou uma grande evidência de seleção positiva nos genótipos GA2 e GA5 do grupo A. / Human Respiratory Syncytial Virus (HRSV) is considered the most common cause of lower respiratory tract disease in infants and young children and are the main guilty for the elevated children hospitalizations rate under 5 years of age. The HRSV has a world-wide distribution, being able to attack all the ages however the 6 weeks to 9 months children of are the ones that develop more serious problems as pneumonia and bronquiolite. The HRSV outbreak presents a well defined season, occurring annually in the delayed falls period, winter or springs beginning, but not during the summer. In the present study, we performed a phylogenetic analysis from G2 region of HRSV G glycoprotein. Forty four samples positive for HRSV from University Hospital (UH) of University of Sao Paulo (USP) in 2007-2008, were submitted to sequencing by PCR and compared with GenBank sequences. Phylogenetic analysis revealed that HRSV group A genotypes GA2 and GA5 was the predominant in 2007-2008, alternating the standard verified in the previous years, where the group B genotypes had been highly predominant. Comparison of the synonymous/nonsynonymous mutation ratios showed greater evidence for positive selection pressure for group A genotypes GA2 and GA5.

O HBoV é um novo parvovírus que foi isolado pela primeira vez em 2005 nas secreções respiratórias de pacientes humanos que tiveram pneumonia. Desde então, é associado a doenças do trato respiratório superior e doença gastrointestinal em pacientes adultos e pediátricos, desde a sua descoberta na Suécia e posteriormente em diversos países no Mundo. Quase todos os estudos foram realizados em amostras de secreção do trato respiratório, normalmente, de crianças com menos de 2 anos de idade e a maioria com infecção respiratória. As taxas de prevalência variam de 1,5% a 19% nos diferentes países. A Análise filogenética deste novo vírus demonstrou que tratava-se de um parvovirus, mais estreitamente relacionado ao parvovírus bovino e ao minuto vírus canino e por isso foi denominado de Bocavírus Humano. A variabilidade genética do HBoV é baixa e estudos filogenéticos indicam que duas linhagens circulam paralelamente ao redor do mundo. Entretanto, como ainda é um vírus relativamente novo, devem se feitos estudos mais detalhados de suas variantes. Em nosso estudo, com a finalidade de determinar a prevalência e conhecer a variabilidade genética do HBoV circulante, foram analisados de janeiro de 2008 a fevereiro de 2010, 935 amostras de aspirado de nasofaringe de crianças com menos de 2 anos de idade, com doença respiratória aguda, internadas no Hospital da Santa Casa de Misericórdia de São Paulo. Pela técnica de PCR, obtivemos 47 (4,7%) amostras positivas para HBoV e dessas 27 amostras apresentaram coinfecção com outros vírus respiratórios, 45 amostras foram seqüenciadas na região da VP1/VP2 de um fragmento de 658 nt. A análise filogenética, quando comparada com seqüência do genBank representativas de vários países, mostrou a circulação, em nossa amostragem, de grupos de HBoV semelhantes aos que circulam no Japão e Taiwan. A variabilidade genética entre as nossas amostras foram inferiores a 1%, tanto entre si como quando comparadas com as amostras do genBank. / HBoV is a new parvovirus which was first isolated in 2005 from respiratory secretions from human patients who had pneumonia. It has been associated with respiratory and gastrointestinal diseases in adult and pediatric patients since its discovery in Sweden and later in several countries worldwide. Almost all studies were performed on samples of secretions from the respiratory tract, usually in children under 2 years of age. Prevalence rates vary from 1.5% to 19% in different countries. The phylogenetic analysis of this new virus showed that it was a parvovirus, more closely related to bovine parvovirus and canine minute virus, and therefore called Human Bocavirus. The genetic variability of HBoV is low and phylogenetic studies indicate that there are two strains circulating alongside around the world. However, as it is still a relatively new virus, more detailed studies of its variants should be carried out. In our study, 935 samples of nasopharyngeal aspirate from children under 2 years old with acute respiratory disease, patients at Santa Casa de Misericordia Hospital, São Paulo, were analyzed from February 2008 to February 2010 in order to determine the prevalence and genetic variability of HBoV stock. Using the PCR method, we obtained 47 (4.7%) positive samples for HBoV from which 27 showed coinfection with other respiratory viruses; 45 samples from a fragment of 658 nt were sequenced in the VP1/VP2 region. The phylogenetic analysis, when compared with GenBank sequences representing several countries, showed the presence in our samples of groups of HBoV similar to those circulating in Japan and Taiwan. Genetic variation in our samples were below 1%, both among themselves and when compared with samples from GenBank.

Introduction. Stone crushing in Dar-es-Salaam Tanzania is largely an informal occupational activity, with approximately 7000 workers exposed to varying level of respirable dust. A highly marginalized, self employed, informal stonecrusher is prone to multiple work related risks, particularly dust related respiratory diseases. Aim. This study, the first to be done among informal stone crushers in Southern Africa, aimed at determining the prevalence of dust related respiratory outcomes and relationships between these health endpoints and exposure to respirable dust in this sample of stonecrushers. Methods. This was primarly a cross-sectional descriptive study with analytic components. This study analysed a subset of data collected in a health survey of stone crushers in Kigamboni informal stone quarry in Dar-es-Salaam, Tanzania in 2007. All 200 workers working in the quarry were interviewed. A subset of 86 and 59 workers underwent exposure assessment and health assessments (spirometry and chest radiography) respectively. Associations were investigated between exposure measures and respiratory outcomes. Results. The average age of the workers was 36.3 years with 51.5% males participating in the study. Smoking was common with 30.1% male, 8.25% female smokers, with 2% ex-smokers. Personal dust sampling showed varying dust levels ranging from 0.5-2.8mg/m3 with geometric mean of 1.2gm/m3. The exposure duration of workers in the quarry ranged from 1-62 years with mean of 7.8 years. No single worker was found to use personal protective equipment at work. Reported prevalence of doctor diagnosed respiratory diseases was low: pulmonary tuberculosis (2%), chronic bronchitis (2%), asthma (3%), pneumonia (3%). In contrast, there was high prevalence of respiratory symptoms: chronic cough (13.5%), phlegm production (14.5%), productive cough (10%), wheezing (14%), mild breathlessness (9.5% ) and coughing blood (7.5%). Mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) adjusted for age, height and sex was 2.6L/min and 3.7 L respectively, among males and 2.1L/min and 3.0L respectively among females. Adjusted exposure odds ratios for symptoms were statistically significant for mild and moderate breathlessness with odds ratios of 3.4 and 3.1 respectively. Linear regression showed statistically significant decline of 2.3mls in FEV1 with years of exposure while controlling for sex, age, height , doctor diagnosed TB and smoking showing that with prolonged exposure in the quarry, workers are at a risk of developing obstructive lung disease. This trend was not evident for FVC. The majority of films were normal (60.9%), with 19.6% read as 1/0 and 19.9% as 0/1. Discussion. This study identified adverse respiratory outcomes among informal stonecrushers, particularly a high prevalence of respiratory symptoms and clinically important lung function deficits. These are in keeping with other environment studies where workers were exposed to respirable dust. Recommendations. Urgent policy initiatives for developing cost effective hazard control, engineering interventions to protect these marginalized self-employed informal sector stonecrushers are needed. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

Investigation of the relationship between iron deficiency, iron supplementation and susceptibility to infection, was suggested by the author's initial observations of an association of anaemia with serious bacterial infections in infancy in Papua New Guinea. The bulk of previous longitudinal clinical intervention studies in infancy showed beneficial effects of iron supplementation. However, defects of control and design and recording in these studies and contradictory anecdotal reports left the question unresolved. A prospective, placebo-controlled, randomised, double-blind trial of iron prophylaxis (3ml intramuscular iron dextran = 150mg Fe) to two month old infants was carried out on the North Coast of Papua New Guinea where there is high transmission of malaria. A literature review, pilot studies, protocol, demography, geography and laboratory methods developed are described. Findings indicate that the placebo control group became relatively iron deficient over the first year of life and that the iron dextran group had adequate, although not excessive iron stores and a higher mean haemoglobin; however, the prevalence and effects of malaria recorded in the field were higher in the iron dextran group. Analysis of field and hospital infectious morbidity in the trial indicated a deleterious association with iron dextran for all causes including respiratory infections (the main single reason for admission). Total duration of hospitalisation was significantly increased in the iron dextran group. Analysis of other factors showed (1) a higher admission rate associated with low weight-for-height recorded at the start of the trial; (2) a significant positive correlation between birth haemoglobin and hospital morbidity rates; (3) increased malaria rates in primiparous mothers of the cohort infants who received iron infusion during pregnancy; (4) lower relative risk of malaria associated with iron prophylaxis in individuals with alpha thalassaemia, which was found to be highly prevalent in this region. In conclusion, it is suggested that policies of iron supplementation, total dose iron injection and routine presumptive iron therapy for anaemia which are widely in practice in malaria endemic areas should be closely reviewed.

As infecções respiratórias agudas são uma importante causa de morbidade e mortalidade infantil em todo o mundo. Algumas dessas infecções podem resultar em Síndrome Respiratória Aguda Grave (SRAG). Os vírus respiratórios são os principais responsáveis por esta doença. O monitoramento e a vigilância das SRAG e dos vírus respiratórios são importantes para a gestão em saúde minimizando o impacto destas infecções respiratórias. O presente estudo buscou analisar a sazonalidade e impacto clínico das infecções causadas por vírus respiratórios em crianças internadas em hospital pediátrico do Paraná. Foram incluídos no estudo 229 pacientes de 0 até 15 anos de idade, de janeiro de 2012 a dezembro de 2015, com diagnóstico clínico de SRAG e amostra respiratória coletada e enviada ao Laboratório Central do Estado do Paraná para diagnóstico do agente etiológico. A busca dos casos de SRAG foi realizada utilizando o prontuário eletrônico GSUS (Gestão da Assistência de Saúde do SUS), arquivos do setor de fisioterapia e informações do Núcleo de Controle de Infecções hospitalares do hospital do estudo. Dos pacientes incluídos na pesquisa, foi preenchido um formulário de coleta de dados e posteriormente estes foram analisados de acordo com os objetivos da pesquisa. As análises estatísticas foram efetuadas com o pacote estatístico GRAPHPAD PRISM e foi considerado um nível de significância de 5%. A maioria dos pacientes da amostra pertencia à faixa etária de 0 a 6 meses de idade, não houve sexo predominante. No presente estudo as amostras positivas para pelo menos um agente etiológico contabilizaram 76,41%, e o vírus mais prevalente foi o Vírus Sincicial respiratório (VSR). Quanto à sazonalidade da detecção viral, houve predominância no final de outono e início do inverno, mais acentuada para o VSR. Quando analisada as três temperaturas ambientais da região, a incidência de SRAG foi significativamente maior no quartil descendente da temperatura média para mínima. Não foi observada diferença significativa entre os grupos etiológicos pesquisados com relação ao tempo desde o início dos sintomas até a internação. Houve predominância de internamentos em Unidade de Terapia Intensiva. O tempo de internamento foi significativamente maior naqueles pacientes com doença de base e não alterou conforme os agentes etiológicos identificados ou presença de codetecção. Os pacientes que apresentaram padrão misto na radiografia de tórax tiveram um tempo de internamento significativamente maior do que aqueles que apresentaram o padrão infiltrado intersticial. O tempo total foi significativamente menor no grupo Metapneumovírus em relação aos grupos Bordetella pertussis, Influenza, Rinovírus e grupo dos pacientes sem agentes infecciosos detectados. O tempo de ventilação mecânica não apresentou diferenças significativas entre os grupos etiológicos nem com relação à presença ou não de codetecção. A maior parte dos pacientes recebeu alta hospitalar, mas ocorreram três óbitos devido a SRAG, todos em pacientes com alguma doença de base ou condições de risco. / Acute respiratory infections are the most important cause of children morbidity and mortality worldwide. Some of these infections can result in Severe Acute Respiratory Syndrome (SARS). Respiratory viruses are primarily responsible for SARS. The monitoring and surveillance of SARS and respiratory viruses are important for health management, minimizing the impact of these respiratory infections. The present study was about the seasonality and clinical impact of respiratory viruses in children admitted to a pediatric reference hospital. The study included 229 children from 0 to 15 years old, from January 2012 to December 2015, with clinical diagnosis of SARS and respiratory sample collected and sent to the Central Laboratory of the State of Paraná for etiological agent analysis. The search for SARS cases was performed using the GSUS (Health Care Management of SUS) electronic filesystem, records of the center of physiotherapy and information of the Hospital Infection Control Center of the studied hospital. Of the patients included in the research, data collection forms were filled out and later analyzed according to the research objectives. Statistical analyzis were performed with the statistical package GRAPHPAD PRISM and a significance level of 5% was considered. The majority of patients in the sample belonged to the age group 0-6 months of age, and there was no predominant sex. Regarding the risk factors for viral infection, the presence of comorbidity or underlying disease was the most prevalent factor. In the present study, the positive samples for at least one etiological agent accounted for 76.41%, and the most prevalent virus was Respiratory Syncytial Virus (RSV). As for the seasonality of viral detection, there was a predominance in the late fall and early winter, which was more pronounced for RSV. When the environmental temperatures of the region were analyzed, the incidence of SARS was significantly higher in the descending quartile of the average minimum temperature. No significant difference was observed between the studied etiological groups in relation to the time from the beginning of the symptoms until the hospitalization. There was a predominance of hospitalizations in the Intensive Care Unit. The hospitalization time was significantly higher in patients with underlying disease or comorbidities and did not change according to the identified etiological agents or the presence of codetection. Patients who presented a mixed pattern on chest radiography had a significantly longer hospitalization time than those who had the interstitial infiltrate pattern. The total time was significantly lower in the Metapneumovirus group than in the Bordetella pertussis, Influenza, Rhinovirus and group of patients without detected infectious agents. Most patients were discharged from hospital, but there were three deaths due to SARS, all in patients with some underlying disease or risk conditions.