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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.

Respiratory syncytial virus (RSV) is an important viral pathogen causing lower respiratory tract infection (LRI) in infants. This study describes the clinical and genetic epidemiology of RSV infection among Tunisian neonates. Nasopharyngeal aspirates collected from 268 newborns with LRI were screened for RSV by immunofluorescence assay. Positive samples were analysed by RT-PCR-hybridisation assay for subgroup classification of RSV genomes. RSV infection was present in 23.1% of neonates, with a predominance in males. Peak incidence occurred in winter. Subgroup classification showed a higher prevalence of group B than group A strains. Nosocomially acquired RSV infection was present in 37% of neonates, 54.3% had an underlying condition predisposing to severe disease and 13% died. The average duration of hospital stay was 10 days and 87% of newborns required supplemental oxygen. As no currently effective treatment is available, preventive measures are a priority in high-risk infants.

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Summary The aim of our study was to assess epidemiological features of neonatal invasive candidiasis in Farhat Hached hospital of Sousse, Tunisia, including incidence, risk factors, mortality, species distribution and antifungal susceptibility. Laboratory data from 1995 to 2010 and medical records of 127 invasive candidiasis cases were reviewed. We tested the susceptibility of 100 Candida sp isolates by using ATB fungus®3 and to fluconazole by using E‐test® strips. A total of 252 cases of neonatal invasive candidiasis occurred over the study period. The incidence increased 1.8‐fold from 1995 to 2006 and decreased fourfold from 2007 to 2010. Candida albicans was the predominant species up to 2006 and a shift in the species spectrum was observed with increase of the non‐albicans species mainly C. parapsilosis. The agreement between the ATB Fungus® and the E‐test® for determining fluconazole susceptibility was high. All tested isolates were susceptible to fluconazole, flucytosine, amphotéricine B and voriconazole and the itraconazole resistance rate was 5%. The mortality rate was 63%. The invasive candidiasis incidence increased from 1995 to 2006 and decreased from 2007 to 2010. The spectrum of Candida species and the lack of fluconazole‐resistant strains argue for the usefulness of fluconazole as an empiric treatment.