BackgroundThe purpose of this study was to determine the incidence and seasonal distribution of viral etiological agents and to compare their clinical manifestations and disease severity, including single and co infections.MethodsMultiplex reverse-transcription PCR was performed for the detection of viruses in nasopharyngeal aspirat. Disease severity was grouped using a categorization index as very mild/mild, and moderate/severe. Clinical and laboratory characteristics of hospitalized children with viral respiratory tract infection were analyzed.ResultsViral pathogens were detected in 103/155 (66.5%) of patients. In order of frequency, identified pathogens were respiratory syncytial virus (32.0%), adenovirus (26.2%), parainfluenza viruses type 1–4 (19.4%), rhinovirus (18.4%), influenza A and B (12.6%), human metapneumovirus (12.6%), coronavirus (2.9%), and bocavirus (0.9%). Coinfections were present in 21 samples. Most of the children had very mild (38.8%) and mild disease (37.9%). Severity of illness was not worse with coinfections. The most common discharge diagnoses were "URTI" with or without LRTI/asthma (n=58). Most viruses exhibited strong seasonal patterns. Leukocytosis (22.2%) and neutrophilia (36.6%) were most commonly detected in patients with adenovirus and rhinovirus (p<0.05). Monocytosis was the most remarkable finding in the patients (n=48, 53.3%), especially in patients with adenovirus (p<0.05).ConclusionsRSV and RhV were associated with higher severity of illness in hospitalized children. RSV found to account for half of LRTI hospitalizations. In AdV and FluA and B infections, fever lasted longer than in other viruses. Coinfections were detected in 21 of the patients. The presence of coinfections was not associated with increased disease severity.

Although etiology of Kawasaki disease has not been precisely determined, it has been speculated that there was an association with a variety of bacterial and viral agents because of the seasonality of this disease. Some viruses including human adenovirus have been isolated from patients with Kawasaki Disease. Adenoviral infection may mimic Kawasaki disease clinically but it may also be detected in patients with Kawasaki disease. We have presented two patients with Kawasaki disease who infected with human adenovirus in this case report.

Background:Acute gastroenteritis is responsible observed in all age groups, especially infants and children. The etiology and clinical course of acute gastroenteritis may vary with age and etiological agents. In developing countries, the morbidity and mortality associated with infectious diarrhea is higher in children younger than five-years-of-age.Objectives:The aim of this study was to determine the prevalence and seasonal distribution of the major agents of acute gastroenteritis in children who were admitted to a Turkish university hospital pediatric emergency unit during 2009.Patients and Methods:Seasonal distribution within a one year period and quantitative distribution were analyzed with demographic data and laboratory findings. A total of 644 subjects were enrolled in the study, with a mean age of 4.14 years. Pathogens were detected in 183 (28.4%) stool samples in children less than 16 years, admitted with acute gastroenteritis.Results:Pathogens were detected in 184 (28.4%) stool samples. The age distributions of the cases were 0 - 24 months (n = 59), 2 - 5 years (n = 100), and > 5 years (n = 25). The detection rate of rotavirus, norovirus and adenovirus were; 12.7% (75/588), 9.8% (51/520) and 4.9% (28/575), respectively. Bacterial agents were detected in 36 cases. The main agent was norovirus in the 0 - 24 months group (n = 25, 42.4%), and rotavirus for ages 2 - 5 years (n = 43, 43%) and > 5 years. On the monthly distribution, cases of rotavirus were found to be more frequent in the first four months of the year.Discussion:Viruses were the major pathogens in all age groups. Norovirus was the leading pathogen in the first two years. For the age groups 2 - 5 years and 6 - 16 years, rotavirus was the major pathogen.

The low sensitivity of the RADT may be related to streptococcal carriage in some patients. The throat culture should be repeated after treatment to detect streptococcal carriage.

Upper respiratory tract infections caused by adenoviruses present long lasting fever for five days and elevated acute phase reactant levels. They are generally misdiagnosed as bacterial infections and are mistreated with antibiotics. The diagnosis of adenovirus infections mainly depends on direct antigen tests, virus isolation and detection of viral DNA using polymerase chain reaction (PCR). The aim of this study was to evaluate the clinical and laboratory findings of the children diagnosed as adenoviral respiratory tract infection by multiplex PCR (mPCR). A total of 27 children (18 male, 9 female; age range: 1-7 years, mean age: 4.4 years) whose nasopharyngeal swab samples were found positive for adenovirus DNA with a commercial mPCR method (Seeplex® RV15 ACE Detection Kit, Seegene Inc, Korea) were included in the study. The throat cultures of the patients revealed no bacterial pathogens and EBV VCA-IgM antibodies were negative. The clinical and laboratory data of the children with long lasting high fever diagnosed as adenovirus infection were evaluated retrospectively in terms of their complaints on admission, symptoms detected in physical examination, laboratory findings and therapy protocols. The patients were categorized according to hospitalization period (< 3 days or ≥ 3 days) and also according to the symptoms compatible with upper or lower respiratory tract infections. The quantity of clinical symptoms (≤ 2 or > 2) and the presence of upper or lower respiratory tract findings were evaluated if there were a difference by means of hospitalization rate and period. The most common complaint of the patients with adenoviral respiratory diseases was fever (27/27; 100%), and the most common admittance season was april-may-june period (20/27; 74%). The mean temperature was 38.4°C (range: 38-39.8°C) and the fever continued for 1-5 days after hospitalization. The most common physical examination finding was tonsillary hyperemia and hypertrophy (63%), followed by lower respiratory tract disease symptoms (37%), otitis media (14.8%), conjunctivitis (7.4%), and rash (3.7%). Laboratory tests could be performed for 24 cases and 95.8% of them yielded high CRP level, 87.5% high sedimentation rate, 62.5% neutrophilia, 33.4% leukocytosis and 20.8% lymphocytosis. It was noticed that 85.2% (23/27) of the patients were under antibiotic treatment on admission. Twenty-three patients (85.2%) were hospitalized, and the duration of hospitalization was between 1-8 (mean: 3.78) days. When the hospitalization rate was evaluated in terms of different measures, it was found that the rate was 81.8% (18/22) in patients with ≤ 2 symptoms, 100% in patients with > 2 symptoms (5/5); 100% (10/10) in patients with lower respiratory tract disease symptoms; 100% (15/15) in patients with neutrophilia, 88.2% (15/17) in patients with CRP levels of ≥ 2.8 - < 100 mg/L, and 100% (6/6) in patients with CRP levels of ≥ 100 mg/L. Neutrophilia and high CRP levels were found to be the main factors related to the hospitalization rate (p< 0.05). In conclusion,...