Respiratory pathogens in infants less than two months old hospitalized with acute respiratory infection

array:24 ["pii" => "S0325754120300663" "issn" => "03257541" "doi" => "10.1016/j.ram.2020.05.001" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "407" "copyright" => "Asociación Argentina de Microbiología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2021;53:20-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0325754120300912" "issn" => "03257541" "doi" => "10.1016/j.ram.2020.07.001" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "416" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2021;53:27-33" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Bordetella pertussis, a reemerging pathogen in pediatric respiratory infections. A study in Quito, Ecuador" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "33" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bordetella pertussis, un patógeno reemergente en infecciones respiratorias pediátricas, un estudio en Quito, Ecuador" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2083 "Ancho" => 1341 "Tamanyo" => 132741 ] ] "descripcion" => array:1 [ "en" => "Amplification of IS481 and IS1001 to confirm the co-infection of Bordetella pertussis and Bordetella parapertussis (BP17-82). PCR products were analyzed in a 2% agarose gel by electrophoresis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Saidy Vásconez Noguera, Katherine Jaramillo, Andrés Zabala, José E. Villacís" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Saidy" "apellidos" => "Vásconez Noguera" ] 1 => array:2 [ "nombre" => "Katherine" "apellidos" => "Jaramillo" ] 2 => array:2 [ "nombre" => "Andrés" "apellidos" => "Zabala" ] 3 => array:2 [ "nombre" => "José E." "apellidos" => "Villacís" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Presence of positive cases of B. pertussis infections in pediatric population ranging from 0-12 months of age of Quito, Ecuador.</li><li class="elsevierStyleListItem" id="lsti0010">•Accurate diagnosis of the disease to reduce the time response for the treatment of the infection.</li></ul>This work emphasizes the need for an active surveillance for the early detection of Bordetella infections." ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754120300912?idApp=UINPBA00004N" "url" => "/03257541/0000005300000001/v1_202103140751/S0325754120300912/v1_202103140751/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0325754120300572" "issn" => "03257541" "doi" => "10.1016/j.ram.2020.06.004" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "398" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2021;53:11-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Baseline prevalence and type distribution of Human papillomavirus in sexually active non-vaccinated adolescent girls from Argentina" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "19" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia basal y distribución por tipo específica del virus del papiloma humano en mujeres adolescentes sexualmente activas y no vacunadas de Argentina" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2367 "Ancho" => 2791 "Tamanyo" => 397094 ] ] "descripcion" => array:1 [ "en" => "Prevalence, with 95% CI, of all identified HPV types in non-vaccinated sexually active 15–17-year old girls from Argentina." ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Joaquín Víctor González, Gerardo Daniel Deluca, Domingo Javier Liotta, Rita Mariel Correa, Jorge Alejandro Basiletti, María Celeste Colucci, Nathalia Katz, Carla Vizzotti, María Alejandra Picconi" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Joaquín Víctor" "apellidos" => "González" ] 1 => array:2 [ "nombre" => "Gerardo Daniel" "apellidos" => "Deluca" ] 2 => array:2 [ "nombre" => "Domingo Javier" "apellidos" => "Liotta" ] 3 => array:2 [ "nombre" => "Rita Mariel" "apellidos" => "Correa" ] 4 => array:2 [ "nombre" => "Jorge Alejandro" "apellidos" => "Basiletti" ] 5 => array:2 [ "nombre" => "María Celeste" "apellidos" => "Colucci" ] 6 => array:2 [ "nombre" => "Nathalia" "apellidos" => "Katz" ] 7 => array:2 [ "nombre" => "Carla" "apellidos" => "Vizzotti" ] 8 => array:2 [ "nombre" => "María Alejandra" "apellidos" => "Picconi" ] 9 => array:1 [ "colaborador" => "on behalf of the MALBRAN HPV Surveillance Study Group" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "MALBRAN HPV Surveillance Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754120300572?idApp=UINPBA00004N" "url" => "/03257541/0000005300000001/v1_202103140751/S0325754120300572/v1_202103140751/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Respiratory pathogens in infants less than two months old hospitalized with acute respiratory infection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "26" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Débora N. Marcone, Guadalupe Carballal, Noelia Reyes, Alejandro Ellis, Yamile Rubies, Santiago Vidaurreta, Marcela Echavarria" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Débora N." "apellidos" => "Marcone" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Guadalupe" "apellidos" => "Carballal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Noelia" "apellidos" => "Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Ellis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Yamile" "apellidos" => "Rubies" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Santiago" "apellidos" => "Vidaurreta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:4 [ "nombre" => "Marcela" "apellidos" => "Echavarria" "email" => array:1 [ 0 => "mechavarria@cemic.edu.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Virology Unit, Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, CONICET, Buenos Aires City, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatrics, Sanatorio Mater Dei, Buenos Aires City, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Pediatrics, Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, Buenos Aires City, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patógenos respiratorios en infantes menores de dos meses internados por infección respiratoria aguda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 2175 "Tamanyo" => 104394 ] ] "descripcion" => array:1 [ "en" => "Respiratory pathogens detected in hospitalized infants less than 2 months old by site of ARI acquisition: (A) community-acquired ARI (n=117), (B) nosocomial ARI (n=20). RSV: respiratory syncytial virus; RV/EV: rhinovirus/enterovirus; FluA: influenza A; FluB: influenza B; PIV: parainfluenza; AdV: adenovirus; HMPV: human metapneumovirus; HCoV: human coronavirus; B. pertussis: Bordetella pertussis." ] ] ] "textoCompleto" => "IntroductionAcute respiratory infections (ARIs) are the most frequent cause of morbidity in children, while lower respiratory tract infections (LRTIs) are a common cause of hospitalization and mortality in young children. In Argentina, LRTIs are the third cause of death in infants less than one year old and the second cause in children from 1 to 5 years old, respectively<a class="elsevierStyleCrossRef" href="#bib0190">18</a>. Upper respiratory tract infections (URTIs) can be frequent in neonates<a class="elsevierStyleCrossRef" href="#bib0185">17</a>.Preterm infants are at an increased risk of perinatal morbidity and mortality and serious LRTIs impose an additional burden of illness causing hospitalization and leading to a higher admission rate to neonatal intensive care units (NICUs) and increased need for oxygen and mechanical ventilation compared to term infants<a class="elsevierStyleCrossRef" href="#bib0145">9</a>.Respiratory virus detection in newborn during birth hospitalization can range from 4% to 52%, Rhinovirus (RV), Respiratory syncytial virus (RSV), Parainfluenza (PIV) and Human coronavirus (HCoV) being the most frequently detected respiratory viruses<a class="elsevierStyleCrossRefs" href="#bib0105">1,4,17,19</a>. These infections may exacerbate underlying clinical conditions leading to increased oxygen requirement, even mechanical ventilation in severe cases, and extend the length of stay (LOS) in hospital.Molecular methods have significantly improved viral diagnosis and some commercial multiplexed nested PCR assays allow the simultaneous detection of several respiratory pathogens. The purpose of this study was to determine the frequency of 17 respiratory viruses and 3 atypical bacteria using a molecular respiratory panel (FilmArray®) in infants less than 2 months old hospitalized with ARI and to evaluate clinical characteristics, hospitalization course and outcomes.Material and methodsInfants included in this investigation were part of a larger prospective multicenter study performed at two private hospitals in Buenos Aires City, Argentina, evaluating children <6 years old with ARI from June 2008 to December 2011<a class="elsevierStyleCrossRef" href="#bib0165">13</a> and from May 2014 to June 2016. Classical respiratory viruses (RSV, Adenovirus [AdV], Influenza A [FluA] & B [FluB], PIV) were detected by immunofluorescence and RV were detected by PCR. Inclusion criteria were the following: either LRTI and/or URTI, a nasopharyngeal aspirate obtained within 3 days of symptom onset and informed consent signed by parents/tutors. Exclusion criteria included underlying conditions such as cardiopathy, congenital malformation, metabolic or genetic disease or immunosuppression.Of 1400 enrolled patients, 137 (9.8%) were less than 2 months old. Frozen samples of these 137 patients were further assessed in this study using a rapid molecular assay for 20 pathogens. Specifically, the Respiratory Panel (FilmArray®-RP, BioFire/bioMèrieux, Salt Lake City, UT) can simultaneously detect RSV, FluA, FluA-H1, FluA-H1 pandemic 2009, FluA-H3, FluB, AdV, PIV 1–4, RV/Enterovirus (EV), Human metapneumovirus (HMPV), HCoV-OC43, HCoV-229E, HCoV-NL63, HCoV-HKU1, Bordetella pertussis, Mycoplasma pneumoniae and Chlamydiapneumoniae<a class="elsevierStyleCrossRef" href="#bib0180">16</a>.The demographic and social characteristics, signs and symptoms, clinical diagnosis (in accordance with the International Classification of Diseases: ICD-10) and the course of hospitalization were recorded for each infant in a specifically designed form.Laboratory diagnosisNasopharyngeal aspirates from patients with ARI that were submitted for viral diagnosis (standard care) were retrospectively tested using the FilmArray®-RP. Blood and urine samples from infants with sepsis suspicion or fever without an apparent source were collected and bacterial cultures were performed.Statistical analysisAll demographic, clinical and etiological data were entered in MS Excel. Values were given as percentages for categorical variables or as median and interquartile range (IQR) for continuous variables. Coinfection was defined as a sample with a positive test result for two or more respiratory pathogens. Data were analyzed using either the Chi-square test, the Fisher's exact test, the student's T test or the Mann–Whitney test as appropriate. Statistical significance was assumed for p values less than 0.05. Statistical analyses were performed using STATA 12.0 (StataCorp, College Station, TX, USA).ResultsPopulation characteristicsAll 137 infants less than 2 months old hospitalized with ARI studied were Caucasian, well-nourished and belonged to a middle-income population. Seventy-seven infants were male (56.2%), median age was 41 days old (range: 11–60 days) and median birth weight was 3200g (range: 825–4700g) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Thirty-nine infants (28.5%) were preterm (gestational age <38 weeks); 2 (1.5%) of them were extremely preterm (<28 weeks), 13 (9.5%) very preterm (28–31 weeks) and 24 (17.5%) late preterm (32–37 weeks). Most infants had updated schedules of mandatory vaccines (BCG and Hepatitis B vaccines) (92.7%) and were breastfed (94.9%).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Two groups of infants were identified in this population: 20 (14.6%) who had never been discharged since they were born and developed a respiratory infection while being in the NICU, and 117 (85.4%) who developed the respiratory infection at home and required hospitalization. Therefore, the first patients were defined as having a nosocomial (hospital-acquired) infection and the latter patients as having a community-acquired infection.Of the 117 infants with community-acquired infection, most were term-born (82.1%) and had normal birth weight (90.6%). The median age of respiratory infection onset was 42 days (IQR: 32–54). Among them, 81.2% reported a viral exposure at home, 64% had siblings at school, 10% were exposed to passive smoking and none attended day care. In contrast, almost all infants in the NICU were preterm (95%), all had low birth weight (<2.500g) and the median age of respiratory infection onset was 34 days (IQR: 27–43), significantly lower than in the community-acquired group (p=0.041).Clinical findingsMost infants with community-acquired infection presented a LRTI (81.2%). The most frequent diagnosis was bronchiolitis (62.4%),followed by common cold (17.1%), unspecified acute LRTI (13.7%), pneumonia (2.6%), pharyngitis (1.7%), bronchitis (1.7%), and whooping cough (0.9%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Of 20 infants with ARI in the NICU, 55.0% had URTI, 35.0% had unspecified acute LRTI and only 10.0% had bronchiolitis.Almost all patients (99%) recovered from the respiratory infection but one 45-day-old infant with community-acquired pneumonia died after 9 days of hospitalization. RSV was the only detected pathogen; bacterial cultures from blood, urine, cerebrospinal and pleural fluids were negative.EtiologyThe positivity rate was significantly different between both infants’ groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Infants with community-acquired respiratory infection had a 94.9% positivity rate, while infants in the NICU with nosocomial infection had a low positivity rate (20.0%) (p<0.001).In infants with community-acquired infection, RSV was the most frequent virus (n=61, 52.1%) followed by RV/EV (n=48, 41.0%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Other respiratory pathogens, including PIV (n=8, 6.8%), HMPV (n=6, 5.1%), HCoV (n=5, 4.3%), FluA (n=5, 4.3%), FluB (n=2, 1.7%), AdV (n=4, 3.4%) and B. pertussis (n=2, 1.7%), were also detected. Interestingly, RSV was the most prevalent pathogen both in premature infants (42%) and term-born infants (53%) with community-acquired ARI.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>All coinfections (n=30) were detected in infants with community-acquired ARI. RSV, RV/EV, FluA, PIV and HMPV were more frequently detected as single infections than in coinfections (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In contrast, all AdV, PIV-4 and HCoV were detected in coinfections, except for one infant in whom HCoV-HKU1 was present as a single infection. B. pertussis was detected in 2 infants (1.7%), as the only agent in one patient and in coinfection with RV/EV in the second case. The most frequent viral coinfection was RSV with RV/EV (n=16, 53.3%) (Supplemental table). Other viral coinfections were detected at lower frequencies and included RSV with either FluA, FluB, AdV, PIV-4 or HCoV; RV/EV with either AdV, HMPV, HCoV or B. pertussis; and HMPV with PIV-3.Most of the 20 infants in the NICU with ARI were negative for any of the respiratory pathogens, and only 4 (20.0%) had a positive pathogen detection: 2 infants had RV/EV, 1 infant had RSV and 1 infant had PIV-3. No coinfections were detected in these patients.HospitalizationThe median LOS in infants with community-acquired infection was 4 days (IQR 2–6). Of 117/31 (26.5%) were in the intensive care unit for a median of 5 days (IQR 2–9) and 2.6% required mechanical ventilation for a median of 7 days (IQR 4–9).In contrast, the median LOS in infants in the NICU who developed ARI was 62 days (IQR 49–75); 75.0% required oxygen therapy for a median of 3 days (IQR 2–7); 75.0% were in intensive care for a median of 60 days (IQR30-72) and 45.0% needed mechanical ventilation for a median of 7 days (IQR 3–18). This prolonged LOS, higher oxygen-therapy and mechanical ventilation assistance was related to their prematurity. Interestingly, infants with a positive viral respiratory diagnosis had a longer LOS (median: 71 days [IQR 42–99]) with respect to infants with a negative viral respiratory diagnosis who had a median LOS of 58 days (IQR 49–71) (p=0.507).Viral seasonalityMost infants developed their respiratory infection during the autumn and winter seasons (from March to September) (91.4% and 82.2% positive diagnosis, respectively). During spring and summer, positivity was 77.8% and 57.1%, respectively. RV/EV was detected throughout the year. RSV detection started in April and its characteristic peak was observed in June. FluA and FluB were detected in June and July while PIV, HMPV, HCoV and AdV were detected at a low frequency in winter and spring (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionWe retrospectively studied respiratory viruses and atypical bacteria in 137 infants less than 2 months old hospitalized with ARI in Buenos Aires, Argentina. We found a high positivity rate of respiratory pathogens (95%) in infants who were discharged after birth, went home and developed a community-acquired ARI that required hospitalization. Even though this population was very young, the rate was as high as that previously reported in older children (<5 years old) from our institution when using the same molecular methodology (92%)<a class="elsevierStyleCrossRef" href="#bib0160">12</a> and was also similar to the rates described in US hospital-based studies (97%)<a class="elsevierStyleCrossRef" href="#bib0150">10</a>.In contrast, a low positivity rate (20%) was detected in hospitalized infants less than 2 months old who had remained hospitalized since birth and acquired the infection in the hospital. This data was consistent with other reports from Austria (15%) and Finland (18%)<a class="elsevierStyleCrossRefs" href="#bib0140">8,19</a>.Our results demonstrated that viral exposure in the community increases the possibility of acquiring a respiratory pathogen, as compared to a protected neonatology environment. These findings highlight the importance of recognizing the high transmissibility of respiratory pathogens in this vulnerable age group and suggest the need for a rapid viral diagnosis and a stronger awareness in the improvement of hygiene measures among parents and relatives.The viral burden in infants with community-acquired infection was broad and included not only classical but also emerging respiratory viruses as well as B. pertussis. RSV remains one of the most frequent respiratory viruses in children and can lead to fatal outcomes, as it was observed in the 45-day-old infant with community-acquired infection mentioned in our study. Although the vaccine for B. pertussis is mandatory for pregnant women since 2013, we detected this bacterium in two infants with community-acquired ARI in 2008. One of them in coinfection with RV/EV, stressing the need for a bacterial diagnosis, even in the presence of a positive viral result, when there is a compatible clinical diagnosis of whooping cough.In those infants in the NICU with nosocomial infection, RSV was not the only detected virus; RV/EV and PIV were also found. Other authors reported the presence of other respiratory viruses in infants during their birth hospitalization in the NICU, including HMPV, Flu and HCoV; however, RSV, RV and PIV remained the most frequently detected viruses<a class="elsevierStyleCrossRefs" href="#bib0105">1,4,9</a>.Coinfection was only detected in infants with community-acquired infection, RSV-RV/EV being the most frequent combination, as previously described<a class="elsevierStyleCrossRefs" href="#bib0125">5,13,14</a>. The coinfection rate was similar to our previous results in outpatients less than 5 years old (31%) when using the same diagnostic method<a class="elsevierStyleCrossRef" href="#bib0130">6</a>. All AdV, PIV-4 and most HCoV were detected in coinfection with another virus. Interestingly, one mixed viral–bacterial coinfection (B. pertussis with RV/EV) was detected. Although the association of B. pertussis with RSV is the most frequently reported virus-bacterium coinfection<a class="elsevierStyleCrossRefs" href="#bib0115">3,15</a>, the coinfection of B. pertussis with RV was described in children with community-acquired infection and prolonged coughing<a class="elsevierStyleCrossRef" href="#bib0200">20</a>.Viral seasonality observed during the studied period was similar to our previous reports and the national program of virus surveillance, exhibiting the highest frequency during the autumn and winter months<a class="elsevierStyleCrossRefs" href="#bib0110">2,13</a>. Nevertheless, viral detection occurs throughout the year at lower frequencies.The most common clinical diagnosis in patients with community-acquired ARI was bronchiolitis and unspecified acute LRTI while the most frequent diagnosis was upper RTI in infants in the NICU. The prolonged LOS, intensive care and mechanical ventilation requirements in infants that remained in the NICU since birth is mainly related to their premature birth condition that can be possibly prolonged due to a respiratory infection. In our study, neonates with a positive viral diagnosis had a longer LOS and mechanical ventilation requirement compared to those with a negative result. This difference did not achieve statistical significance probably due to the low number of studied infants. Bennet et al. also demonstrated that preterm infants in the NICU with a positive respiratory virus had a significantly longer LOS and prolonged ventilation support compared to those who were negative<a class="elsevierStyleCrossRef" href="#bib0105">1</a>. Generally, viral respiratory infection in preterm neonates can cause mild or atypical symptoms but can also trigger a clinical worsening leading to oxygen therapy requirement, including mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0135">7</a>. Furthermore, we have recently described a respiratory outbreak in the NICU associated with RV worsening the patients’ underlying clinical conditions and extending their LOS<a class="elsevierStyleCrossRef" href="#bib0155">11</a>.One strength of this study was the inclusion of infants less than 2 months old with either nosocomial or community-acquired infection, throughout the year, and for 6 non-consecutive years. These results allowed a better understanding of the viral burden through different years. A significant strength was the simultaneous detection of 20 classical and emerging respiratory pathogens.However, our study has limitations. The number of infants who remained hospitalized since birth and acquired a nosocomial infection at our institution was small. Possible respiratory infection sources (healthcare workers or relatives) were not investigated. The molecular assay (FilmArray-RP) is unable to distinguish between RV and EV and does not detect typical bacteria such as Streptococcus pneumoniae, Haemophilusinfluenzae either Chlamydia trachomatis.In conclusion, a high detection rate of respiratory pathogens was observed in hospitalized infants <2 months old with community-acquired ARI, RSV and RV/EV being the most frequent identified agents. In contrast, a significant lower detection rate was observed in new born infants who had remained hospitalized in the NICU since birth and developed ARI. These findings highlight the role of respiratory pathogens in these young infants associated with high morbidity and even mortality, stress the need for a rapid viral diagnosis and reinforce the impact of hygiene and infection control measures not only in hospital settings but also among parents and relatives at home.Ethical approvalThis work was approved by the Ethics Committees from Hospital Universitario CEMIC and Sanatorio Mater Dei (No. 00001745 and IORG 001315).FundingThis work was supported by the National Scientific and Technologic Agency (ANPCYT) [PICT 2006-650 to M.E.]. The FilmArray-respiratory panels were provided by Biofire/BioMèrieux, USA, as part of a larger study.Conflict of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1480249" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1348088" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1348089" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres1480250" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1348087" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Laboratory diagnosis" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Population characteristics" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical findings" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Etiology" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Hospitalization" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Viral seasonality" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Ethical approval" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack519246" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-07" "fechaAceptado" => "2020-05-25" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1348088" "palabras" => array:5 [ 0 => "Respiratory syncytial virus" 1 => "Rhinovirus" 2 => "Bordetella pertussis" 3 => "FilmArray respiratory panel" 4 => "Hospitalized infants" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1348089" "palabras" => array:17 [ 0 => "ARI" 1 => "LRTI" 2 => "URTI" 3 => "NICU" 4 => "FilmArray-RP" 5 => "LOS" 6 => "RSV" 7 => "RV" 8 => "EV" 9 => "Flu" 10 => "PIV" 11 => "AdV" 12 => "HCoV" 13 => "HMPV" 14 => "PCR" 15 => "ICD" 16 => "IQR" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1348087" "palabras" => array:5 [ 0 => "Virus sincitial respiratorio" 1 => "Rinovirus" 2 => "Bordetella pertussis" 3 => "Panel respiratorio FilmArray" 4 => "Infantes hospitalizados" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Lower acute respiratory infections (ARI) are a frequent cause of morbidity and mortality in infants, respiratory viruses being the major causative agents. The aim of this work was to determine the respiratory pathogen frequency, the clinical characteristics and the outcome in infants <2 months old hospitalized with ARI. A retrospective study was performed during a five-year period (2008–2011, 2014–2016). Respiratory viruses and atypical bacteria were studied using the FilmArray-Respiratory Panel. Demographic and clinical characteristics, hospitalization course and outcomes were evaluated. Of the 137 infants <2 months old hospitalized with ARI studied, a 94.9% positivity rate as determined in 117 infants with community-acquired infection and 20.0% in 20 infants who acquired the infection during their birth hospitalization in the neonatal intensive care units (NICU) (nosocomial ARI) (p<0.001). In infants with community-acquired infection, Respiratory syncytial virus (RSV) (52.1%) and Rhinovirus/Enterovirus (RV/EV) (41.0%) were the most frequent detected pathogens. Coinfections were determined in one quarter of the infants, RSV-RV/EV being the most frequent combination. In infants with nosocomial infection, RV/EV, RSV or Parainfluenza-3 were detected as single pathogens. Most infants with community-acquired infection presented lower ARI (81.2%) while most infants in the NICU had upper ARI (55.0%). The median length of stay (LOS) in infants with community-acquired ARI was 4 days (IQR: 2–6). Positive infants with nosocomial infection had longer median LOS (71 days [IQR:42–99]) compared to negative infants (58 days [IQR: 49–71]) (p=0.507). Respiratory viruses were detected as the major causative agents of community-acquired infection in hospitalized infants <2-months old, RSV and RV/EV being the most frequently detected. Although a low pathogen positivity rate was observed in infants with nosocomial infection, they may prolong the LOS." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Las infecciones respiratorias agudas (IRA) son una causa habitual de morbimortalidad en infantes y los virus respiratorios son los agentes causales más frecuentes. El objetivo de este trabajo fue determinar la frecuencia de patógenos respiratorios, sus características y la evolución clínica de infantes menores de dos meses internados por IRA. Se realizó un estudio retrospectivo que comprendió 5 años (2008-2011, 2014-2016). Se estudiaron los virus respiratorios y las bacterias atípicas utilizando el panel respiratorio FilmArray. Se evaluaron las características demográficas y clínicas, así como la evolución durante la internación. En 137 infantes menores de dos meses internados por IRA se determinó una positividad del 94,9% en 117 lactantes con infección adquirida en la comunidad (IRA-C) y del 20,0% en 20lactantes que adquirieron la infección durante su hospitalización en la unidad de cuidados intensivos neonatal (IRA-N) (p<0,001). En los infantes con IRA-C los virus más frecuentes fueron sincicial respiratorio (RSV) (52,1%) y rinovirus/enterovirus (RV/EV) (41,0%). Se determinaron coinfecciones en un cuarto de los infantes, la combinación RSV-RV/EV fue la más frecuente. En los infantes con IRA-N se detectó RV/EV, RSV o parainfluenza-3 como únicos patógenos. La mayoría de los infantes con IRA-C presentaron IRA baja (81,2%), mientras que más de la mitad de los infantes en UCIN tenían IRA alta (55,0%). La mediana de la duración de la internación en infantes con IRA-C fue de 4días (RIC: 2-6). Los infantes positivos con IRA-N tuvieron una mediana de internación más larga (71 días [RIC: 42-99]) en comparación con los infantes negativos (58 días [RIC: 49-71]) (p=0,507). Los virus respiratorios fueron los principales agentes causales de IRA adquirida en la comunidad en infantes menores de dos meses que requirieron internación; los virus más frecuentes fueron RSV y RV/EV. Aunque se observó una baja tasa de positividad de patógenos en infantes con infección nosocomial, estos agentes podrían prolongar la duración de la internación." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 2175 "Tamanyo" => 104394 ] ] "descripcion" => array:1 [ "en" => "Respiratory pathogens detected in hospitalized infants less than 2 months old by site of ARI acquisition: (A) community-acquired ARI (n=117), (B) nosocomial ARI (n=20). RSV: respiratory syncytial virus; RV/EV: rhinovirus/enterovirus; FluA: influenza A; FluB: influenza B; PIV: parainfluenza; AdV: adenovirus; HMPV: human metapneumovirus; HCoV: human coronavirus; B. pertussis: Bordetella pertussis." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 892 "Ancho" => 2091 "Tamanyo" => 127865 ] ] "descripcion" => array:1 [ "en" => "Viral seasonality in 137 infants less than 2 months old hospitalized with ARI, Buenos Aires, Argentina. Period: June 2008 to August 2011 and May 2014 to June 2016. RSV: respiratory syncytial virus; RV/EV: rhinovirus/enterovirus; FluA: influenza A; FluB: influenza B; PIV: parainfluenza; AdV: adenovirus; HMPV: human metapneumovirus; HCoV: human coronavirus; B. pertussis: Bordetella pertussis." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total infants with ARI (n=137)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Community-acquired ARI (n=117)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nosocomial ARI (n=20)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Demographic characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (days)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (31–52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (32–54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (27–43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender (male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.545 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Birth weight (g)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3200 (2600–3520) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3300 (2970–3620) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1457 (1148–1660) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prematurity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breastfeeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.064 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Viral exposure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Siblings at school \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.436 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Passive smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.367 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Updated mandatory vaccination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.174 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.057 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tachypnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.050 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wheezing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.874 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyanosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.128 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rhinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.880 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical diagnosis</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">URTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common cold (J00)† \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pharyngitis (J02)† \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LRTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchiolitis (J21)† \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumonia (J12)† \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unspecified acute LRTI (J22)† \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Whooping cough (A37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchitis (J20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory pathogen diagnosis</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dual infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2547157.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Age and birth weight are given as median (IQR). † Clinical diagnosis is named as diagnosis (CID-10 code). Data were analyzed using either the Chi-square test, Fisher's exact test, student's T test or Mann–Whitney test as appropriate. Statistical significance was assumed for p values less than 0.05." ] ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical characteristics and diagnosis in 137 infants less than 2 months old hospitalized with ARI, by site of ARI acquisition." ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 81011 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unrecognized viral respiratory tract infections in premature infants during their birth hospitalization: a prospective surveillance study in two neonatal intensive care units" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:10 [ 0 => "N.J. 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Patógenos respiratorios en infantes menores de dos meses internados por infección respiratoria aguda

Débora N. Marconea, Guadalupe Carballala, Noelia Reyesa, Alejandro Ellisb, Yamile Rubiesc, Santiago Vidaurretac, Marcela Echavarriaa,

Corresponding author

mechavarria@cemic.edu.ar

Corresponding author.

a Virology Unit, Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, CONICET, Buenos Aires City, Argentina

b Department of Pediatrics, Sanatorio Mater Dei, Buenos Aires City, Argentina

c Department of Pediatrics, Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, Buenos Aires City, Argentina

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            "entidad" => "Department of Pediatrics&#44; Centro de Educaci&#243;n M&#233;dica e Investigaciones Cl&#237;nicas &#40;CEMIC&#41; University Hospital&#44; Buenos Aires City&#44; Argentina"
            "etiqueta" => "c"
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      "es" => array:1 [
        "titulo" => "Pat&#243;genos respiratorios en infantes menores de dos meses internados por infecci&#243;n respiratoria aguda"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Respiratory pathogens detected in hospitalized infants less than 2 months old by site of ARI acquisition&#58; &#40;A&#41; community-acquired ARI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&#44; &#40;B&#41; nosocomial ARI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; RSV&#58; respiratory syncytial virus&#59; RV&#47;EV&#58; rhinovirus&#47;enterovirus&#59; FluA&#58; influenza A&#59; FluB&#58; influenza B&#59; PIV&#58; parainfluenza&#59; AdV&#58; adenovirus&#59; HMPV&#58; human metapneumovirus&#59; HCoV&#58; human coronavirus&#59; <span class="elsevierStyleItalic">B&#46; pertussis</span>&#58; <span class="elsevierStyleItalic">Bordetella pertussis</span>&#46;</p>"
        ]
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute respiratory infections &#40;ARIs&#41; are the most frequent cause of morbidity in children&#44; while lower respiratory tract infections &#40;LRTIs&#41; are a common cause of hospitalization and mortality in young children&#46; In Argentina&#44; LRTIs are the third cause of death in infants less than one year old and the second cause in children from 1 to 5 years old&#44; respectively<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&#46; Upper respiratory tract infections &#40;URTIs&#41; can be frequent in neonates<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Preterm infants are at an increased risk of perinatal morbidity and mortality and serious LRTIs impose an additional burden of illness causing hospitalization and leading to a higher admission rate to neonatal intensive care units &#40;NICUs&#41; and increased need for oxygen and mechanical ventilation compared to term infants<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Respiratory virus detection in newborn during birth hospitalization can range from 4&#37; to 52&#37;&#44; <span class="elsevierStyleItalic">Rhinovirus</span> &#40;RV&#41;&#44; <span class="elsevierStyleItalic">Respiratory syncytial virus</span> &#40;RSV&#41;&#44; <span class="elsevierStyleItalic">Parainfluenza</span> &#40;PIV&#41; and <span class="elsevierStyleItalic">Human coronavirus</span> &#40;HCoV&#41; being the most frequently detected respiratory viruses<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;4&#44;17&#44;19</span></a>&#46; These infections may exacerbate underlying clinical conditions leading to increased oxygen requirement&#44; even mechanical ventilation in severe cases&#44; and extend the length of stay &#40;LOS&#41; in hospital&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Molecular methods have significantly improved viral diagnosis and some commercial multiplexed nested PCR assays allow the simultaneous detection of several respiratory pathogens&#46; The purpose of this study was to determine the frequency of 17 respiratory viruses and 3 atypical bacteria using a molecular respiratory panel &#40;FilmArray&#174;&#41; in infants less than 2 months old hospitalized with ARI and to evaluate clinical characteristics&#44; hospitalization course and outcomes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Infants included in this investigation were part of a larger prospective multicenter study performed at two private hospitals in Buenos Aires City&#44; Argentina&#44; evaluating children &#60;6 years old with ARI from June 2008 to December 2011<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> and from May 2014 to June 2016&#46; Classical respiratory viruses &#40;RSV&#44; <span class="elsevierStyleItalic">Adenovirus</span> &#91;AdV&#93;&#44; <span class="elsevierStyleItalic">Influenza A</span> &#91;FluA&#93; <span class="elsevierStyleItalic">&#38; B</span> &#91;FluB&#93;&#44; PIV&#41; were detected by immunofluorescence and RV were detected by PCR&#46; Inclusion criteria were the following&#58; either LRTI and&#47;or URTI&#44; a nasopharyngeal aspirate obtained within 3 days of symptom onset and informed consent signed by parents&#47;tutors&#46; Exclusion criteria included underlying conditions such as cardiopathy&#44; congenital malformation&#44; metabolic or genetic disease or immunosuppression&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Of 1400 enrolled patients&#44; 137 &#40;9&#46;8&#37;&#41; were less than 2 months old&#46; Frozen samples of these 137 patients were further assessed in this study using a rapid molecular assay for 20 pathogens&#46; Specifically&#44; the Respiratory Panel &#40;FilmArray&#174;-RP&#44; BioFire&#47;bioM&#232;rieux&#44; Salt Lake City&#44; UT&#41; can simultaneously detect RSV&#44; FluA&#44; FluA-H1&#44; FluA-H1 pandemic 2009&#44; FluA-H3&#44; FluB&#44; AdV&#44; PIV 1&#8211;4&#44; RV&#47;<span class="elsevierStyleItalic">Enterovirus</span> &#40;EV&#41;&#44; <span class="elsevierStyleItalic">Human metapneumovirus</span> &#40;HMPV&#41;&#44; HCoV-OC43&#44; HCoV-229E&#44; HCoV-NL63&#44; HCoV-HKU1&#44; <span class="elsevierStyleItalic">Bordetella pertussis</span>&#44; <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> and <span class="elsevierStyleItalic">Chlamydia</span><span class="elsevierStyleItalic">pneumoniae</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The demographic and social characteristics&#44; signs and symptoms&#44; clinical diagnosis &#40;in accordance with the International Classification of Diseases&#58; ICD-10&#41; and the course of hospitalization were recorded for each infant in a specifically designed form&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Laboratory diagnosis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nasopharyngeal aspirates from patients with ARI that were submitted for viral diagnosis &#40;standard care&#41; were retrospectively tested using the FilmArray&#174;-RP&#46; Blood and urine samples from infants with sepsis suspicion or fever without an apparent source were collected and bacterial cultures were performed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">All demographic&#44; clinical and etiological data were entered in MS Excel&#46; Values were given as percentages for categorical variables or as median and interquartile range &#40;IQR&#41; for continuous variables&#46; Coinfection was defined as a sample with a positive test result for two or more respiratory pathogens&#46; Data were analyzed using either the Chi-square test&#44; the Fisher&#39;s exact test&#44; the student&#39;s <span class="elsevierStyleItalic">T</span> test or the Mann&#8211;Whitney test as appropriate&#46; Statistical significance was assumed for <span class="elsevierStyleItalic">p</span> values less than 0&#46;05&#46; Statistical analyses were performed using STATA 12&#46;0 &#40;StataCorp&#44; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Population characteristics</span><p id="par0050" class="elsevierStylePara elsevierViewall">All 137 infants less than 2 months old hospitalized with ARI studied were Caucasian&#44; well-nourished and belonged to a middle-income population&#46; Seventy-seven infants were male &#40;56&#46;2&#37;&#41;&#44; median age was 41 days old &#40;range&#58; 11&#8211;60 days&#41; and median birth weight was 3200<span class="elsevierStyleHsp" style=""></span>g &#40;range&#58; 825&#8211;4700<span class="elsevierStyleHsp" style=""></span>g&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Thirty-nine infants &#40;28&#46;5&#37;&#41; were preterm &#40;gestational age &#60;38 weeks&#41;&#59; 2 &#40;1&#46;5&#37;&#41; of them were extremely preterm &#40;&#60;28 weeks&#41;&#44; 13 &#40;9&#46;5&#37;&#41; very preterm &#40;28&#8211;31 weeks&#41; and 24 &#40;17&#46;5&#37;&#41; late preterm &#40;32&#8211;37 weeks&#41;&#46; Most infants had updated schedules of mandatory vaccines &#40;BCG and Hepatitis B vaccines&#41; &#40;92&#46;7&#37;&#41; and were breastfed &#40;94&#46;9&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Two groups of infants were identified in this population&#58; 20 &#40;14&#46;6&#37;&#41; who had never been discharged since they were born and developed a respiratory infection while being in the NICU&#44; and 117 &#40;85&#46;4&#37;&#41; who developed the respiratory infection at home and required hospitalization&#46; Therefore&#44; the first patients were defined as having a nosocomial &#40;hospital-acquired&#41; infection and the latter patients as having a community-acquired infection&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 117 infants with community-acquired infection&#44; most were term-born &#40;82&#46;1&#37;&#41; and had normal birth weight &#40;90&#46;6&#37;&#41;&#46; The median age of respiratory infection onset was 42 days &#40;IQR&#58; 32&#8211;54&#41;&#46; Among them&#44; 81&#46;2&#37; reported a viral exposure at home&#44; 64&#37; had siblings at school&#44; 10&#37; were exposed to passive smoking and none attended day care&#46; In contrast&#44; almost all infants in the NICU were preterm &#40;95&#37;&#41;&#44; all had low birth weight &#40;&#60;2&#46;500<span class="elsevierStyleHsp" style=""></span>g&#41; and the median age of respiratory infection onset was 34 days &#40;IQR&#58; 27&#8211;43&#41;&#44; significantly lower than in the community-acquired group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinical findings</span><p id="par0065" class="elsevierStylePara elsevierViewall">Most infants with community-acquired infection presented a LRTI &#40;81&#46;2&#37;&#41;&#46; The most frequent diagnosis was bronchiolitis &#40;62&#46;4&#37;&#41;&#44;followed by common cold &#40;17&#46;1&#37;&#41;&#44; unspecified acute LRTI &#40;13&#46;7&#37;&#41;&#44; pneumonia &#40;2&#46;6&#37;&#41;&#44; pharyngitis &#40;1&#46;7&#37;&#41;&#44; bronchitis &#40;1&#46;7&#37;&#41;&#44; and whooping cough &#40;0&#46;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Of 20 infants with ARI in the NICU&#44; 55&#46;0&#37; had URTI&#44; 35&#46;0&#37; had unspecified acute LRTI and only 10&#46;0&#37; had bronchiolitis&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Almost all patients &#40;99&#37;&#41; recovered from the respiratory infection but one 45-day-old infant with community-acquired pneumonia died after 9 days of hospitalization&#46; RSV was the only detected pathogen&#59; bacterial cultures from blood&#44; urine&#44; cerebrospinal and pleural fluids were negative&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Etiology</span><p id="par0075" class="elsevierStylePara elsevierViewall">The positivity rate was significantly different between both infants&#8217; groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Infants with community-acquired respiratory infection had a 94&#46;9&#37; positivity rate&#44; while infants in the NICU with nosocomial infection had a low positivity rate &#40;20&#46;0&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In infants with community-acquired infection&#44; RSV was the most frequent virus &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#44; 52&#46;1&#37;&#41; followed by RV&#47;EV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#44; 41&#46;0&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Other respiratory pathogens&#44; including PIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 6&#46;8&#37;&#41;&#44; HMPV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44; 5&#46;1&#37;&#41;&#44; HCoV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44; 4&#46;3&#37;&#41;&#44; FluA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44; 4&#46;3&#37;&#41;&#44; FluB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; 1&#46;7&#37;&#41;&#44; AdV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; 3&#46;4&#37;&#41; and <span class="elsevierStyleItalic">B&#46; pertussis</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; 1&#46;7&#37;&#41;&#44; were also detected&#46; Interestingly&#44; RSV was the most prevalent pathogen both in premature infants &#40;42&#37;&#41; and term-born infants &#40;53&#37;&#41; with community-acquired ARI&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">All coinfections &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; were detected in infants with community-acquired ARI&#46; RSV&#44; RV&#47;EV&#44; FluA&#44; PIV and HMPV were more frequently detected as single infections than in coinfections &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In contrast&#44; all AdV&#44; PIV-4 and HCoV were detected in coinfections&#44; except for one infant in whom HCoV-HKU1 was present as a single infection&#46; <span class="elsevierStyleItalic">B&#46; pertussis</span> was detected in 2 infants &#40;1&#46;7&#37;&#41;&#44; as the only agent in one patient and in coinfection with RV&#47;EV in the second case&#46; The most frequent viral coinfection was RSV with RV&#47;EV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44; 53&#46;3&#37;&#41; &#40;Supplemental table&#41;&#46; Other viral coinfections were detected at lower frequencies and included RSV with either FluA&#44; FluB&#44; AdV&#44; PIV-4 or HCoV&#59; RV&#47;EV with either AdV&#44; HMPV&#44; HCoV or <span class="elsevierStyleItalic">B&#46; pertussis</span>&#59; and HMPV with PIV-3&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Most of the 20 infants in the NICU with ARI were negative for any of the respiratory pathogens&#44; and only 4 &#40;20&#46;0&#37;&#41; had a positive pathogen detection&#58; 2 infants had RV&#47;EV&#44; 1 infant had RSV and 1 infant had PIV-3&#46; No coinfections were detected in these patients&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Hospitalization</span><p id="par0095" class="elsevierStylePara elsevierViewall">The median LOS in infants with community-acquired infection was 4 days &#40;IQR 2&#8211;6&#41;&#46; Of 117&#47;31 &#40;26&#46;5&#37;&#41; were in the intensive care unit for a median of 5 days &#40;IQR 2&#8211;9&#41; and 2&#46;6&#37; required mechanical ventilation for a median of 7 days &#40;IQR 4&#8211;9&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In contrast&#44; the median LOS in infants in the NICU who developed ARI was 62 days &#40;IQR 49&#8211;75&#41;&#59; 75&#46;0&#37; required oxygen therapy for a median of 3 days &#40;IQR 2&#8211;7&#41;&#59; 75&#46;0&#37; were in intensive care for a median of 60 days &#40;IQR30-72&#41; and 45&#46;0&#37; needed mechanical ventilation for a median of 7 days &#40;IQR 3&#8211;18&#41;&#46; This prolonged LOS&#44; higher oxygen-therapy and mechanical ventilation assistance was related to their prematurity&#46; Interestingly&#44; infants with a positive viral respiratory diagnosis had a longer LOS &#40;median&#58; 71 days &#91;IQR 42&#8211;99&#93;&#41; with respect to infants with a negative viral respiratory diagnosis who had a median LOS of 58 days &#40;IQR 49&#8211;71&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;507&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Viral seasonality</span><p id="par0105" class="elsevierStylePara elsevierViewall">Most infants developed their respiratory infection during the autumn and winter seasons &#40;from March to September&#41; &#40;91&#46;4&#37; and 82&#46;2&#37; positive diagnosis&#44; respectively&#41;&#46; During spring and summer&#44; positivity was 77&#46;8&#37; and 57&#46;1&#37;&#44; respectively&#46; RV&#47;EV was detected throughout the year&#46; RSV detection started in April and its characteristic peak was observed in June&#46; FluA and FluB were detected in June and July while PIV&#44; HMPV&#44; HCoV and AdV were detected at a low frequency in winter and spring &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">We retrospectively studied respiratory viruses and atypical bacteria in 137 infants less than 2 months old hospitalized with ARI in Buenos Aires&#44; Argentina&#46; We found a high positivity rate of respiratory pathogens &#40;95&#37;&#41; in infants who were discharged after birth&#44; went home and developed a community-acquired ARI that required hospitalization&#46; Even though this population was very young&#44; the rate was as high as that previously reported in older children &#40;&#60;5 years old&#41; from our institution when using the same molecular methodology &#40;92&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> and was also similar to the rates described in US hospital-based studies &#40;97&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In contrast&#44; a low positivity rate &#40;20&#37;&#41; was detected in hospitalized infants less than 2 months old who had remained hospitalized since birth and acquired the infection in the hospital&#46; This data was consistent with other reports from Austria &#40;15&#37;&#41; and Finland &#40;18&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;19</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Our results demonstrated that viral exposure in the community increases the possibility of acquiring a respiratory pathogen&#44; as compared to a protected neonatology environment&#46; These findings highlight the importance of recognizing the high transmissibility of respiratory pathogens in this vulnerable age group and suggest the need for a rapid viral diagnosis and a stronger awareness in the improvement of hygiene measures among parents and relatives&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The viral burden in infants with community-acquired infection was broad and included not only classical but also emerging respiratory viruses as well as <span class="elsevierStyleItalic">B&#46; pertussis</span>&#46; RSV remains one of the most frequent respiratory viruses in children and can lead to fatal outcomes&#44; as it was observed in the 45-day-old infant with community-acquired infection mentioned in our study&#46; Although the vaccine for <span class="elsevierStyleItalic">B&#46; pertussis</span> is mandatory for pregnant women since 2013&#44; we detected this bacterium in two infants with community-acquired ARI in 2008&#46; One of them in coinfection with RV&#47;EV&#44; stressing the need for a bacterial diagnosis&#44; even in the presence of a positive viral result&#44; when there is a compatible clinical diagnosis of whooping cough&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In those infants in the NICU with nosocomial infection&#44; RSV was not the only detected virus&#59; RV&#47;EV and PIV were also found&#46; Other authors reported the presence of other respiratory viruses in infants during their birth hospitalization in the NICU&#44; including HMPV&#44; Flu and HCoV&#59; however&#44; RSV&#44; RV and PIV remained the most frequently detected viruses<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;4&#44;9</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Coinfection was only detected in infants with community-acquired infection&#44; RSV-RV&#47;EV being the most frequent combination&#44; as previously described<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5&#44;13&#44;14</span></a>&#46; The coinfection rate was similar to our previous results in outpatients less than 5 years old &#40;31&#37;&#41; when using the same diagnostic method<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a>&#46; All AdV&#44; PIV-4 and most HCoV were detected in coinfection with another virus&#46; Interestingly&#44; one mixed viral&#8211;bacterial coinfection &#40;<span class="elsevierStyleItalic">B&#46; pertussis</span> with RV&#47;EV&#41; was detected&#46; Although the association of <span class="elsevierStyleItalic">B&#46; pertussis</span> with RSV is the most frequently reported virus-bacterium coinfection<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;15</span></a>&#44; the coinfection of <span class="elsevierStyleItalic">B&#46; pertussis</span> with RV was described in children with community-acquired infection and prolonged coughing<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Viral seasonality observed during the studied period was similar to our previous reports and the national program of virus surveillance&#44; exhibiting the highest frequency during the autumn and winter months<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;13</span></a>&#46; Nevertheless&#44; viral detection occurs throughout the year at lower frequencies&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The most common clinical diagnosis in patients with community-acquired ARI was bronchiolitis and unspecified acute LRTI while the most frequent diagnosis was upper RTI in infants in the NICU&#46; The prolonged LOS&#44; intensive care and mechanical ventilation requirements in infants that remained in the NICU since birth is mainly related to their premature birth condition that can be possibly prolonged due to a respiratory infection&#46; In our study&#44; neonates with a positive viral diagnosis had a longer LOS and mechanical ventilation requirement compared to those with a negative result&#46; This difference did not achieve statistical significance probably due to the low number of studied infants&#46; Bennet et al&#46; also demonstrated that preterm infants in the NICU with a positive respiratory virus had a significantly longer LOS and prolonged ventilation support compared to those who were negative<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46; Generally&#44; viral respiratory infection in preterm neonates can cause mild or atypical symptoms but can also trigger a clinical worsening leading to oxygen therapy requirement&#44; including mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a>&#46; Furthermore&#44; we have recently described a respiratory outbreak in the NICU associated with RV worsening the patients&#8217; underlying clinical conditions and extending their LOS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">One strength of this study was the inclusion of infants less than 2 months old with either nosocomial or community-acquired infection&#44; throughout the year&#44; and for 6 non-consecutive years&#46; These results allowed a better understanding of the viral burden through different years&#46; A significant strength was the simultaneous detection of 20 classical and emerging respiratory pathogens&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">However&#44; our study has limitations&#46; The number of infants who remained hospitalized since birth and acquired a nosocomial infection at our institution was small&#46; Possible respiratory infection sources &#40;healthcare workers or relatives&#41; were not investigated&#46; The molecular assay &#40;FilmArray-RP&#41; is unable to distinguish between RV and EV and does not detect typical bacteria such as <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#44; <span class="elsevierStyleItalic">Haemophilus</span><span class="elsevierStyleItalic">influenzae</span> either <span class="elsevierStyleItalic">Chlamydia trachomatis</span>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; a high detection rate of respiratory pathogens was observed in hospitalized infants &#60;2 months old with community-acquired ARI&#44; RSV and RV&#47;EV being the most frequent identified agents&#46; In contrast&#44; a significant lower detection rate was observed in new born infants who had remained hospitalized in the NICU since birth and developed ARI&#46; These findings highlight the role of respiratory pathogens in these young infants associated with high morbidity and even mortality&#44; stress the need for a rapid viral diagnosis and reinforce the impact of hygiene and infection control measures not only in hospital settings but also among parents and relatives at home&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical approval</span><p id="par0165" class="elsevierStylePara elsevierViewall">This work was approved by the Ethics Committees from Hospital Universitario CEMIC and Sanatorio Mater Dei &#40;No&#46; 00001745 and IORG 001315&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This work was supported by the <span class="elsevierStyleGrantSponsor" id="gs1">National Scientific and Technologic Agency</span> &#40;ANPCYT&#41; &#91;<span class="elsevierStyleGrantNumber" refid="gs1">PICT 2006-650</span> to M&#46;E&#46;&#93;&#46; The FilmArray-respiratory panels were provided by Biofire&#47;BioM&#232;rieux&#44; USA&#44; as part of a larger study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Results"
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              "titulo" => "Population characteristics"
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              "titulo" => "Viral seasonality"
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            0 => "Respiratory syncytial virus"
            1 => "Rhinovirus"
            2 => "<span class="elsevierStyleItalic">Bordetella pertussis</span>"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
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          "palabras" => array:17 [
            0 => "ARI"
            1 => "LRTI"
            2 => "URTI"
            3 => "NICU"
            4 => "FilmArray-RP"
            5 => "LOS"
            6 => "RSV"
            7 => "RV"
            8 => "EV"
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            0 => "Virus sincitial respiratorio"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lower acute respiratory infections &#40;ARI&#41; are a frequent cause of morbidity and mortality in infants&#44; respiratory viruses being the major causative agents&#46; The aim of this work was to determine the respiratory pathogen frequency&#44; the clinical characteristics and the outcome in infants &#60;2 months old hospitalized with ARI&#46; A retrospective study was performed during a five-year period &#40;2008&#8211;2011&#44; 2014&#8211;2016&#41;&#46; Respiratory viruses and atypical bacteria were studied using the FilmArray-Respiratory Panel&#46; Demographic and clinical characteristics&#44; hospitalization course and outcomes were evaluated&#46; Of the 137 infants &#60;2 months old hospitalized with ARI studied&#44; a 94&#46;9&#37; positivity rate as determined in 117 infants with community-acquired infection and 20&#46;0&#37; in 20 infants who acquired the infection during their birth hospitalization in the neonatal intensive care units &#40;NICU&#41; &#40;nosocomial ARI&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In infants with community-acquired infection&#44; <span class="elsevierStyleItalic">Respiratory syncytial virus</span> &#40;RSV&#41; &#40;52&#46;1&#37;&#41; and <span class="elsevierStyleItalic">Rhinovirus&#47;Enterovirus</span> &#40;RV&#47;EV&#41; &#40;41&#46;0&#37;&#41; were the most frequent detected pathogens&#46; Coinfections were determined in one quarter of the infants&#44; RSV-RV&#47;EV being the most frequent combination&#46; In infants with nosocomial infection&#44; RV&#47;EV&#44; RSV or <span class="elsevierStyleItalic">Parainfluenza-3</span> were detected as single pathogens&#46; Most infants with community-acquired infection presented lower ARI &#40;81&#46;2&#37;&#41; while most infants in the NICU had upper ARI &#40;55&#46;0&#37;&#41;&#46; The median length of stay &#40;LOS&#41; in infants with community-acquired ARI was 4 days &#40;IQR&#58; 2&#8211;6&#41;&#46; Positive infants with nosocomial infection had longer median LOS &#40;71 days &#91;IQR&#58;42&#8211;99&#93;&#41; compared to negative infants &#40;58 days &#91;IQR&#58; 49&#8211;71&#93;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;507&#41;&#46; Respiratory viruses were detected as the major causative agents of community-acquired infection in hospitalized infants &#60;2-months old&#44; RSV and RV&#47;EV being the most frequently detected&#46; Although a low pathogen positivity rate was observed in infants with nosocomial infection&#44; they may prolong the LOS&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las infecciones respiratorias agudas &#40;IRA&#41; son una causa habitual de morbimortalidad en infantes y los virus respiratorios son los agentes causales m&#225;s frecuentes&#46; El objetivo de este trabajo fue determinar la frecuencia de pat&#243;genos respiratorios&#44; sus caracter&#237;sticas y la evoluci&#243;n cl&#237;nica de infantes menores de dos meses internados por IRA&#46; Se realiz&#243; un estudio retrospectivo que comprendi&#243; 5 a&#241;os &#40;2008-2011&#44; 2014-2016&#41;&#46; Se estudiaron los virus respiratorios y las bacterias at&#237;picas utilizando el panel respiratorio FilmArray&#46; Se evaluaron las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#44; as&#237; como la evoluci&#243;n durante la internaci&#243;n&#46; En 137 infantes menores de dos meses internados por IRA se determin&#243; una positividad del 94&#44;9&#37; en 117 lactantes con infecci&#243;n adquirida en la comunidad &#40;IRA-C&#41; y del 20&#44;0&#37; en 20<span class="elsevierStyleHsp" style=""></span>lactantes que adquirieron la infecci&#243;n durante su hospitalizaci&#243;n en la unidad de cuidados intensivos neonatal &#40;IRA-N&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En los infantes con IRA-C los virus m&#225;s frecuentes fueron sincicial respiratorio &#40;RSV&#41; &#40;52&#44;1&#37;&#41; y rinovirus&#47;enterovirus &#40;RV&#47;EV&#41; &#40;41&#44;0&#37;&#41;&#46; Se determinaron coinfecciones en un cuarto de los infantes&#44; la combinaci&#243;n RSV-RV&#47;EV fue la m&#225;s frecuente&#46; En los infantes con IRA-N se detect&#243; RV&#47;EV&#44; RSV o parainfluenza-3 como &#250;nicos pat&#243;genos&#46; La mayor&#237;a de los infantes con IRA-C presentaron IRA baja &#40;81&#44;2&#37;&#41;&#44; mientras que m&#225;s de la mitad de los infantes en UCIN ten&#237;an IRA alta &#40;55&#44;0&#37;&#41;&#46; La mediana de la duraci&#243;n de la internaci&#243;n en infantes con IRA-C fue de 4<span class="elsevierStyleHsp" style=""></span>d&#237;as &#40;RIC&#58; 2-6&#41;&#46; Los infantes positivos con IRA-N tuvieron una mediana de internaci&#243;n m&#225;s larga &#40;71 d&#237;as &#91;RIC&#58; 42-99&#93;&#41; en comparaci&#243;n con los infantes negativos &#40;58 d&#237;as &#91;RIC&#58; 49-71&#93;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;507&#41;&#46; Los virus respiratorios fueron los principales agentes causales de IRA adquirida en la comunidad en infantes menores de dos meses que requirieron internaci&#243;n&#59; los virus m&#225;s frecuentes fueron RSV y RV&#47;EV&#46; Aunque se observ&#243; una baja tasa de positividad de pat&#243;genos en infantes con infecci&#243;n nosocomial&#44; estos agentes podr&#237;an prolongar la duraci&#243;n de la internaci&#243;n&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Respiratory pathogens detected in hospitalized infants less than 2 months old by site of ARI acquisition&#58; &#40;A&#41; community-acquired ARI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&#44; &#40;B&#41; nosocomial ARI &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; RSV&#58; respiratory syncytial virus&#59; RV&#47;EV&#58; rhinovirus&#47;enterovirus&#59; FluA&#58; influenza A&#59; FluB&#58; influenza B&#59; PIV&#58; parainfluenza&#59; AdV&#58; adenovirus&#59; HMPV&#58; human metapneumovirus&#59; HCoV&#58; human coronavirus&#59; <span class="elsevierStyleItalic">B&#46; pertussis</span>&#58; <span class="elsevierStyleItalic">Bordetella pertussis</span>&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Viral seasonality in 137 infants less than 2 months old hospitalized with ARI&#44; Buenos Aires&#44; Argentina&#46; Period&#58; June 2008 to August 2011 and May 2014 to June 2016&#46; RSV&#58; respiratory syncytial virus&#59; RV&#47;EV&#58; rhinovirus&#47;enterovirus&#59; FluA&#58; influenza A&#59; FluB&#58; influenza B&#59; PIV&#58; parainfluenza&#59; AdV&#58; adenovirus&#59; HMPV&#58; human metapneumovirus&#59; HCoV&#58; human coronavirus&#59; <span class="elsevierStyleItalic">B&#46; pertussis</span>&#58; <span class="elsevierStyleItalic">Bordetella pertussis</span>&#46;</p>"
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                  \t\t\t\t">34 &#40;27&#8211;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gender &#40;male&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Birth weight &#40;g&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1457 &#40;1148&#8211;1660&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prematurity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Breastfeeding&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">130&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">112&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;064&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Viral exposure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Siblings at school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#46;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;436&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Passive smoking&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;367&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Updated mandatory vaccination&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">127&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#46;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91&#46;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&#46;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;174&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fever&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">49&#46;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tachypnea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Wheezing&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>URTI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Common cold &#40;J00&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pharyngitis &#40;J02&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LRTI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronchiolitis &#40;J21&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia &#40;J12&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unspecified acute LRTI &#40;J22&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Whooping cough &#40;A37&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronchitis &#40;J20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Death&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The authors would like to thank all pediatricians&#44; neonatologists&#44; residents and physical therapists from both hospitals for the patients&#8217; enrollment and sample collection&#59; Carmen Ricarte and the Virology Laboratory for technical assistance&#46;</p>"
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Article information

ISSN: 03257541
Original language: English

DOI:10.1016/j.ram.2020.05.001

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Year/Month	Html	Pdf	Total

2024 November	8	0	8
2024 October	108	4	112
2024 September	186	7	193
2024 August	163	9	172
2024 July	155	2	157
2024 June	104	8	112
2024 May	135	6	141
2024 April	124	9	133
2024 March	129	8	137
2024 February	175	6	181
2024 January	214	11	225
2023 December	158	20	178
2023 November	218	10	228
2023 October	177	20	197
2023 September	149	18	167
2023 August	110	6	116
2023 July	99	10	109
2023 June	110	8	118
2023 May	101	5	106
2023 April	125	7	132
2023 March	69	13	82
2023 February	76	2	78
2023 January	58	3	61
2022 December	51	10	61
2022 November	70	8	78
2022 October	45	12	57
2022 September	65	16	81
2022 August	74	15	89
2022 July	38	12	50
2022 June	35	14	49
2022 May	35	17	52
2022 April	37	15	52
2022 March	50	17	67
2022 February	46	13	59
2022 January	65	10	75
2021 December	40	13	53
2021 November	45	11	56
2021 October	79	23	102
2021 September	68	15	83
2021 August	72	8	80
2021 July	30	14	44
2021 June	43	17	60
2021 May	69	32	101
2021 April	175	46	221
2021 March	53	13	66
2021 February	14	8	22
2021 January	13	10	23
2020 December	11	9	20
2020 November	10	9	19

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