Acute lower respiratory tract illnesses in Cali, Colombia: a two-year ambulatory study
Berman, S.; Duenas, A.; Bedoya, A.; Constain, V.; Leon, S.; Borrero, I.; Murphy, J.
Pediatrics 71(2): 210-218
1983
ISSN/ISBN: 0031-4005 PMID: 6823422 Document Number: 217832
A surveillance system for acute lower respiratory tract illnesses was implemented February 1977 in 5 neighborhood health clinics. Of the 1229 patients with an illness identified during the 25 mo. from Feb. 1, 1977 to Feb. 28, 1979, there were 38 with croup, 451 with tracheobronchitis, 339 with bronchiolitis, and 401 with pneumonia. Of the illnesses, 42% occurred in children < 1 yr of age and 66% occurred in children < 2 yr of age. A viral infection was diagnosed in 20% of the patients by viral cultures and/or 4-fold rises in complement fixation antibody titers in acute and convalescent sera. A viral agent was identified in 29% of patients with croup, 20% with tracheobronchitis, 22% with bronchiolitis and 17% with pneumonia. Four viral agents, respiratory syncytial virus (RSV) adenovirus, parainfluenza viruses, and influenza viruses accounted for 94% of the cases associated with a viral infection. RSV was associated with 9% of the cases, adenovirus with 6.8%, parainfluenza with 2.1% and influenza with 1.3%. These 4 viral agents had slightly different clinical patterns. The majority of RSV infections were diagnosed in children < 2 yr of age with bronchiolitis or pneumonia. Yearly outbreaks of RSV were noted during periods corresponding to RSV peaks in northern temperate climates. Adenoviral infections occurred most frequently in children 1-5 yr of age with tracheobronchitis or pneumonia in association with high fever. Parainfluenza viral infections were usually associated with tracheobronchitis and pneumonia. Influenza infections usually occurred in older children with pneumonia associated with high fever, headache and myalgias. Bacteremias were identified in 4 patients with lower respiratory tract infections. Twenty percent of children with moderate or severe malnutrition and an acute respiratory illnes were bacteremic. Three of the 4 children with moderate or severe malnutrition, pneumonia and fever > 38.9.degree. C had a positive blood culture. There were 17 children seen who required hospitalization and 3 subsequent deaths in this group.