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Clinical Presentation and Severity of Viral Community-Acquired Pneumonia in Young Nepalese Children

Mathisen, Maria MD*; Strand, Tor A. PhD*†‡; Sharma, Biswa N. BSc§; Chandyo, Ram K. MD; Valentiner-Branth, Palle PhD; Basnet, Sudha MD; Adhikari, Ramesh K. MD; Hvidsten, Dag MD**; Shrestha, Prakash S. MD; Sommerfelt, Halvor PhD*‡

The Pediatric Infectious Disease Journal: January 2010 - Volume 29 - Issue 1 - p e1-e6
doi: 10.1097/INF.0b013e3181c2a1b9
Online-Only: Original Studies

Background: Most deaths from pneumonia in children <5 years of age occur in developing countries, where information about the clinical impact and severity of viral causes of respiratory infections is limited.

Methods: From June 29, 2004 to June 30, 2007 we evaluated 2230 cases of pneumonia (World Health Organization criteria) in children aged 2 to 35 months in Bhaktapur, Nepal. A nasopharyngeal aspirate from each case was examined for 7 respiratory viruses using reverse-transcription polymerase chain reaction. We compared illness duration, severity, and treatment failure between cases positive and negative for the individual viruses in multiple regression models.

Results: A total of 2219 cases had a valid polymerase chain reaction result and were included in the analyses. Overall, 46.1% of cases were 2 to 11 months of age. Being infected with respiratory syncytial virus (RSV) was associated with lower chest indrawing (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.42–3.30) and, among infants, oxygen saturation <93% (OR: 1.88; CI: 1.32–2.69). Among the 2088 nonsevere pneumonia cases, those positive for RSV had a longer time to recovery (hazard ratio 0.82; CI 0.75–0.90; P < 0.001) and an increased risk of treatment failure (OR: 1.75; CI: 1.34–2.28; P < 0.001) than the RSV negative cases.

Conclusions: Being infected with RSV was associated with a more severe clinical presentation of pneumonia, longer illness duration, and increased risk of treatment failure. The severity of RSV infection was age related, infants being more severely affected.

From the *Centre for International Health, University of Bergen, Bergen, Norway; †Department of Laboratory Medicine, Medical Microbiology, Sykehuset Innlandet Lillehammer, Norway; ‡Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway; §Department of Microbiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu Nepal; ¶Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; ∥Statens Serum Institut, Department of Epidemiology, Division of Epidemiology, Copenhagen, Denmark; and **Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.

Accepted for publication September 22, 2009.

Supported by the European Commission (EU-INCO-DC contract number INCO-FP6û003740), as well as grants from the Research Council of Norway (NRC project no 151054 and 172226) and the Norwegian Council of Universities' Committee for Development Research and Education (NUFU project number PRO 36/2002 and 2007/10177), and funding from the Danish Council of Developmental Research (91128). The sponsors of the study had no role in study design, collection, analysis and interpretation of data, or writing of the report.

Address for correspondence: Tor A. Strand, PhD, Centre for International Health, University of Bergen, PO Box 7804, N-5020 Bergen, Norway. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.