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. 2019 Apr;91(4):570-581.
doi: 10.1002/jmv.25347. Epub 2018 Nov 21.

Demographic and seasonal characteristics of respiratory pathogens in neonates and infants aged 0 to 12 months in the Central-East region of Tunisia

Ines Brini Khalifa  1   2   3   4 , Naila Hannachi  1   2 , Aida Guerrero  4 , Dorothea Orth-Höller  5 , Sana Bhiri  6 , Jihene Bougila  7 , Lamia Boughamoura  7 , Sonia Nouri Merchaoui  8 , Hassen Sboui  8 , Nabiha Mahdhaoui  8 , Britta Schiela  4 , Dorothee Holm-von Laer  4 , Jalel Boukadida  1   2 , Heribert Stoiber  4
Affiliations

Demographic and seasonal characteristics of respiratory pathogens in neonates and infants aged 0 to 12 months in the Central-East region of Tunisia

Ines Brini Khalifa et al. J Med Virol. 2019 Apr.

Abstract

Background: This study aimed to characterize the epidemiology of pathogenic respiratory agents in patients aged 0 to 12 months and hospitalized for acute respiratory infections in Tunisia between 2013 and 2014.

Methods: A total of 20 pathogens, including viruses, Mycoplasma pneumoniae, and Streptococcus pneumoniae, were detected using molecular sensitive assays, and their associations with the patient's demographic data and season were analyzed.

Results: Viral infectious agents were found in 449 (87.2%) of 515 specimens. Dual and multiple infectious agents were detected in 31.4% and 18.6% of the samples, respectively. Viral infection was predominant in the pediatric environment (90.8%, P < 0.001), male patients (88.0%), and spring (93.8%). Rhinovirus was the most detected virus (51.8%) followed by respiratory syncytial virus A/B (34.4%), coronavirus group (18.5%), adenovirus (17.9%), and parainfluenza viruses 1-4 (10.9%). Respiratory Syncytial virus A/B was significantly associated with gender (38.0% male cases vs 28.3% female cases, P = 0.02). Infections by Adenovirus, Bocavirus, and Metapneumovirus A/B increased with increasing age of patients (predominated cases aged 6-12 months, P < 0.001). S. pneumoniae was detected in 30.9% of th tested samples. In 18.2% of the negative viral infections, only S. pneumoniae was identified.

Conclusion: A predominance of the rhinovirus infection was observed in this study. Coronavirus subtypes were described for the first time in Tunisia. The observed different pathogenic profiles across age groups could be helpful to avoid the misclassification of patients presenting with ARIs at the triage level when no standardized protocol is available. This study will provide clues for physicians informing decisions regarding preventive strategies and medication in Tunisia.

Keywords: demography; infants; molecular assays; neonates; respiratory agents; seasonality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Seasonal distribution of the total tested pathogens between September 31, 2013 and December 31, 2014. The percentages were calculated as a fraction of the total pathogens detected in each season: 288 pathogens in the period of September‐December 2013 (A), 496 in January‐March 2014 (B), 119 in April‐June 2014 (C), 29 in July‐September 2014 (D), and 62 in October‐December 2014 (E). Influenza viruses were not included in this figure. Not a single M.pneumoniae infection was found. The Coronavirus and Parainfluenza virus types were grouped in CoVs and PIVs groups, respectively. AdV, adenovirus; BoV, bocavirus; CoVs, coronavirus group; EV, enterovirus genus; MPV A/B, metapneumovirus A/B; PeV, parechovirus genus; PIVs, parainfluenza virus group; RV, rhinovirus; RSV A/B, respiratory syncytial virus A/B; S. pneumoniae, Streptococcus pneumoniae
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