The pattern of clinical presentation and viral isolates in under five children presenting with ARI in Khartoum State .

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Research type: Research Paper

Authors: Malik, Amel Abed Al Aziz Mohamed .

Abstract: Acute respiaroty infections are a major cause of morbidity among Sudanese children and it is estimated that each child have an average of 5-6 espisodes of ARI per year. A prospective study was conducted in Khartoum Emergency Hospital in under five chldren with acute respiratory infection of less than two weeks dration over a period of one year. The study was planned to investigate the viral aetiological agents, predisposing factors, clinical presentation, and seasonal variation of different respiratory virsuses as well as the parents attitudes and practices in children with ARI. Nasopharyneal aspirates (NPA) or throat swabs were obtained from 353 children with ARI and 47 controls. Samples were collected from patients and transported to the virology departlment national laboratory within two hours for cell culture technique. The presence of respiratory viruses was determined by observation of cytopathic effect in HP - 2 Monolayer cells. RSV isolates were confirmed by ELISA. The mean age of the group was 14.1 months. Male to female ration was 1.25 : Viruses were isolated from 81 children (22.6 percent). Adenovirus was the most frequntly isolated virus, it was isolated from 31 children (88 percent), followed by Enterovirus 29 (8.3 percent, RSV was isolated in 18 (5.1 percent) while PIV was isolated in 3 children (0.8 percent). RSV and PIV showed definite seasonal variation. It was exclusively isolated in winter months (December - February) only. All viruses were isolated more frequently in males than females with the exception of PIV. In the present study, children with proven firus infection could no be distinguished clinically from other children of which a signigicant proportion might have had bacterial infection, although bronchiolitis was the most common clinical manifestation of viral positive cases occuring in 40 percent it was equally caused by Adeno and RSV with few cases caused by Enterovirus. All PIV and nearly all Enteroviruses (69 percent) were isolated from URI cases. More than half the children (55.8 percent), had 3-5 attacks/ year, 30.6 percent had 2 attacks or less, while 13.6 percent had 6 attacks or more during the last year. Contact with an ill sibling showed significant association with all viral groups. No significant difference was found between the viral group, the non - viral group for other risk factors; contact with an ill parent, smoking, indoor pollution and over crowding. Guardian knowledge of ARI needing assessment is satisfactory and is reflected on care seeking from appropriate health provider in 81 percent. Nearly half the patients used home remdies and/or traditional medicines before presenting to the casualty. From the results it is concluded that Adeno, Entro and RSV viral pathogens, seem to be the main cause of ARI in sudanese children. The lmain recommedations were to adopt standard ARI case management and the aviodance of unnecessary drug use. Availing necessary supportive measures for children with lower respiratory infection and adopting preventive measures for viral infection.