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Pathogen Clearance and New Respiratory Tract Infections Among Febrile Children in Zanzibar Investigated With Multitargeting Real-Time Polymerase Chain Reaction on Paired Nasopharyngeal Swab Samples

Journal article
Authors Kristina Elfving
D Shakely
Maria Andersson
K. Baltzell
M. I. Msellem
A. Bjorkman
A. Martensson
Max Petzold
Birger Trollfors
Magnus Lindh
Published in Pediatric Infectious Disease Journal
Volume 37
Issue 7
Pages 643-648
ISSN 0891-3668
Publication year 2018
Published at Institute of Clinical Sciences, Department of Pediatrics
Institute of Biomedicine, Department of Infectious Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages 643-648
Language en
Keywords children, respiratory tract infection, fever, polymerase chain reaction, pathogen shedding, syncytial virus, western kenya, ct-values, rt-pcr, rhinovirus, severity, duration, malaria, illness, association, Immunology, Infectious Diseases, Pediatrics, biaggi m, 2012, virol j, v9
Subject categories Infectious Medicine


Background: New molecular methods have revealed frequent and often polymicrobial respiratory infections in children in low-income settings. It is not known whether presence of multiple pathogens is due to prolonged infections or to frequent exposure. The aim of this study was to analyze short-term pathogen clearance from nasopharynx and the rate of new respiratory tract infections in febrile preschool children. Methods: Children (n = 207) with uncomplicated acute febrile illness 2-59 months of age presenting to a health center in Zanzibar, Tanzania, April-July 2011, were included. Paired nasopharyngeal swab samples, collected at enrolment and after 14 days, were analyzed by multiple real-time polymerase chain reaction for Adenovirus, bocavirus, Bordetella pertussis, Chlamydophila pneumoniae, Coronaviruses, Enterovirus, influenza A and B virus, metapneumovirus, measles virus, Mycoplasma pneumoniae, parainfluenza virus, Parechovirus, respiratory syncytial virus and Rhinovirus. An age-matched and geographically matched healthy control group (n = 166) underwent nasopharyngeal sampling on 1 occasion. Results: At baseline, 157/207 (76%) patients had at least 1 pathogen detected, in total 199 infections. At follow-up (day 14), 162/199 (81%) of these infections were not detected, including >95% of the previously detected infections with Enterovirus, influenza A virus, influenza B virus, metapneumovirus or parainfluenza virus. Still 115 (56%) children were positive for at least 1 pathogen at follow-up, of which 95/115 (83%) were not found at baseline. Detection of influenza B on day 14 was significantly associated with fever during follow-up. Conclusion: The results suggest that children with acute febrile illness in Zanzibar rapidly clear respiratory tract infections but frequently acquire new infections within 14 days.

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