2002 1 40 1 Chin J Pediatr January 2002 Vol 40 No. 1 45 2 294 1 906 (PCR) (MP) ;307 ;81 (NPS) (RSV) (ADV) 1 906 28 1147 % ;544 107 19167 % P < 01001 A ( GAS) 1816 % 615 % 213 % 210 % 210 % ;34 GAS 26 7615 % P < 0100181 3 317 % 3 7 1 112 % ;136 RSV 51 3715 % P < 01001 A ; ; ; ; ; Nasopharyngeal carriage status of common pathogenic microorganisms in healthy children and its clinical significance HOU Ancun LIU Yuhua XIN Deli et al. Department of Pediatrics Bejing Friendship Hospital Capital University of Medicine Sciences Beijing 100050 China Abstract Objective To understand carriage status of common pathogenic microorganisms in nasopharynx of healthy children and to explore the values of microbiological examinations on nasopharyngeal secretions in etiologic diagnosis of childhood respiratory tract infections.methods Totally 2 294 healthy children from kindergartens and primary schools in the city and suburban areas of Beijing were enrolled in this study. The age of the children ranged from 0 to 13 years. Pharyngeal swabs and aspirated nasopharyngeal secretions (NPS) were collected from each subject. Mycoplasma pneumoniae (Mp) specific DNA was detected by using polymerase chain reaction (PCR) in 1 906 of the specimens during the period from June 1995 to December 1996 ; bacterial culture was performed for 307 specimens collected from November 1998 to January 1999 ; viral isolation for respiratory syncytial virus (RSV) and adenovirus (AdV) was done for NPS from 81 children between November 1999 and April 2000. At the same time corresponding examinations were also performed for patients with acute respiratory infections. Results Carriage of Mp was found in 28/ 1 906 subjects (1. 47 %) but the positive rate was 19. 67 % in acute lower respiratory tract infection patients (107/ 544 P < 0. 001). The positive rates of Streptococcus pneumonia ( S. pneumoniae) Hemophilus influenzae ( H. influenzae) Staphylococcus aureus ( S. aureus) Staphylococcus epidermidis ( S. epidermidis) and Group A streptococcus ( GAS) were 18. 6 % 6. 5 % 213 % 2. 0 % 2. 0 % respectively. However in 186 cases chosen at random for bacterial culture lower positive rates for bacterial pathogens were found although there was a higher positive rate in acute tonsillitis (76 %) for GAS compared with that in healthy children ( P < 0. 001). In none of the specimens was Neisseria meningitidis (N. meningitidis) found. In 81 healthy children under 3 years of age the positive rates of RSV and AdV were 4 % and 1 % respectively. But in 136 patients the positive rate of RSV was 37. 5 % ; so there was statistically significant difference for RSV between the two groups ( P < 0. 001). However only 5 patients were positive for AdV and there was no significant difference between the healthy children and the cases with acute respiratory infection. Conclusions the carriage rates of MP AdV RSV GAS and N. meningitidis in NPS in healthy :100050 ( ) ( ) ( )
46 2002 1 40 1 Chin J Pediatr January 2002 Vol 40 No. 1 children were very low. Therefore the positive findings for these pathogenic agents in NPS and pharyngeal swab probably have a high diagnostic value. However having a higher carriage rate of S. pneumoniae and H. influenzae in upper respiratory tract in healthy children the positive findings for these pathogens in pharyngeal swab have little clinical value. It is necessary to consider the laboratory findings together with clinical manifestations for making diagnosis. Additionally the carriage rates were related to age. Key words Nasopharyn ; Polymerase chain reaction ; Child ; Mycoplasma pneumoniae ; Respiratory synytial vineses : (1) EAGLE : Grand 1995 6 2000 8 ; (3) : ; (4) Hela 2 294 10 %CO 2 (35 ) 1824 h 013 : (1) 1 ; ; (2) 1 ; (3) ( ) 1 1995 6 1996 12 1 906 PCR ;1996 112 544 ( 23 d ) PCR ) ( 3 1998 11 1999 1 307 2 1014 d 186 41 :SPSS 910 186 : 2 58 42 52 34 ( 26 ) 1999 11 2000 4 81 3 136 1 906 PCR 28 1147 % 3 2 ;413 26 11 PCR 19167 % (107/ 544) ( 2 = 269124 P < 01001) 21 : (1) 5 % ; (2) 5 % 307 300 mg ; (3) 1 2915 % 1816 % Oxoid (615 %) ;A 31 (RSV) (ADV) Island N1Y114072 USA ; (2) : 11 PCR 21 : 35 1824 h ; 31 : 4 ) PCR 2 % 186
2002 1 40 1 Chin J Pediatr January 2002 Vol 40 No. 1 47 ; 1998 70 A 1 7615 % ( 2 = 140139 P < [2 ] 19951996 1 906 01001) (1 2) 1147 % 1996 112 1 544 ( %) () () 1 78 0 29149 0 3185 6141 4 112 0 18175 3157 0189 8104 7 58 5117 8162 3145 1172 1172 1013 59 5108 13156 0 3139 8147 307 1195 18157 1195 2128 6151 MP 2 1 8 5 2 GAS 10 % ( %) 186 1108 3176 0 2115 5191 34 76147 0 0 0 0 3 RSV [6 ] 162 1 GAS ; A 81 RSV 3 313 % [7 ] 1999 1 317 % ;1 ADV2 [8 ] 16 156 7 112 % 136 51 RSV (3715 %) ; 5 ADV (317 %) 3 4 5 1 Principi [9 ] 18 1 723 7 RSV ( 2 = 17 311023 P < 01001) 315 % ( P > 1119 % ;De Lencastre [10 ] 586 6 6 0105) 47 %72 % ;Liassine [11 ] 1 765 PCR 28 PCR 107 1917 % McMillan [3 ] 1986 308 53 MP 1716 % 26 % [4 ] 25 % 30 % [5 ] ; 307 ( GAS) 2 % [2 ] 1997 Turner GAS 1 (016 %) 219 %3911 % A 613 % Glezen 1967 218 %Hokama [12 ] 1 % ;1993 Kai 113 [1 ] 33 PCR 1 MP
48 2002 1 40 1 Chin J Pediatr January 2002 Vol 40 No. 1 ; (colonization) 1 RSV 3 1 2915 % 1816 % 615 % [8 13 ] ; McMillan [3 ] RSV ADV 3 1613 % ; 216 % (0519 %) 1 RSV ADV 1 013 % 81 3 RSV (4 %) ;1 ADV (1 %) 136 A RSV 3715 % ; 102 RSV [14 2814 % ] Hsu [15 ] 61 ; 27 (4413 %) 52 [18 2 (318 %) ] [16 ] PCR 50 20 DNA 7814 % 20 1 ADV RSV MP [16 ] GAS NPS 20 5070 80 [17 RSV ] [19 ] 351 3 2 ; 1 555 4 1 ADV 2 7615 % 13 26 RSV GAS 5 %
2002 1 40 1 Chin J Pediatr January 2002 Vol 40 No. 1 49 1 Kai M Kamiya H Yabe B et al. Rapid detection of Mycoplasma pneumoniae in clinical samples by the polymerase chain reaction. J Med Microbiol 1993 38 :1662170. 2 Homoe P Prag J Olsen CB et al. Nasopharyngeal bacteria found on blood agar plats from healthy children in Greenland. Int J Circumpolar Health 1998 57 :32239. 3 McMillan JA Sandstrom C Weiner LB et al. Viral and bacterial organisms associated with acute pharyngitis in a school2aged population. J Pediatr 1986 109 :7472752. 4 Mar CD. Managing sore throat : a literature review. Med J Aust 1992 156 :5722575. 5.. 1989. 1992. 6 Turner JC Hayden FG Lobor MC et al. Epidemiologic evidence for lancefield group C beta2hemolitic streptococci as a cause of exudative pharyngitis in college students. J Clin Microbiol 1997 35 :124. 7.. 1997 12 :104. 8. 1999 37 :502. 9 Principi N Marchisio P Schito GC et al. Risk factors for carriage of respiratory pathogens in the nasopharynx of healthy children. Pediatr Infect Dis J 1999 18 :5172523. 10 De Lencastre H Kristinsson KG Brito Avo A et al. Carriage of : respiratory tract pathogens and molecular epidemiology of Streptococcus pneumonia colonization in healthy children attending day care centers in Lisbon Portugal. Microb Drug Resist 1999 5 :19229. 11 Liassine N Gervaix A Hegi R et al. Antimicrobial susceptibility of bacterial pathogens in the oropharynx of healthy children. Eur J Clin Microbial Infect Dis 1999 18 : 2172220. 12 Hokama T Yara A Hirayama K et al. Isolation of respiratory bacterial pathogens from the throats of healthy infants fed by different methods. J Trop Pediatr 1999 45 : 1732176. 13 Lopez B Cima MD Vazquez F et al. Epidemiological study of Streptococcus pneumonia carriers in healthy primary2school children. Eur J Clin Microbiol Infect Dis 1999 18 :7712776. 14.. 2000 38 : 1592162. 15 Hsu HY Kao CL Huang LM et al. Viral etiology of intussusception in Taiwanese childhood. Pediatr Infect Dis J 1998 17 : 8932898. 16 Marin J Jeler K D Levstek V et al. Persistence of viruses in upper respiratory tract of children with asthma. J Infect 2000 41 :69272. 17. A. 1997 37 : 4392442. 18... 1999 37 :223. 19.. 1992 30 :2412242. ( :2000210218) ( : ) 2002 9 1519 ( 400 1 ) :2002 6 31 1 : 100045 06 ( ) : 2002 5 2 ICU( :100034) :010266171122 3200 NICU PICU : 2002 4