Perfil clínico-epidemiológico das infecções respiratórias agudas causadas por vírus parainfluenza em crianças atendidas em um hospital de referência da cidade de Fortaleza–CE

Abstract

Acute respiratory infections (ARI) are an important public health problem throughout the world and parainfluenza viruses are among the major etiologic agents. The objectives of this study were: a) to determine the frequency of parainfluenza infections among children attending Hospital Infantil Albert Sabin, a major pediatric hospital in Fortaleza - CE, from January 2001 to December 2006; b) to describe the seasonal pattern and the clinical and epidemiological characteristics of these infections; and c) to compare clinical and epidemiological characteristics of parainfluenza infections and infections caused by other respiratory viruses. Nasopharyngeal aspirates from children with acute respiratory symptoms were collected and submitted to indirect immunofluorescence assays to detect human parainfluenza virus 1, 2 and 3 (HPIV-1, 2 and 3), respiratory syncytial virus (RSV), influenza A and B and adenovirus. During the six-year study period, samples were collected from 3,070 generally healthy children and respiratory viruses were demonstrated in 933 cases (30.39%), of which 117 were positive for parainfluenza virus (3.81%). HPIV-3 was the most frequently detected type of parainfluenza virus accounting for 83.76% of cases, followed by HPIV-1 (11.96%) and HPIV-2 (4.27%). HPIV-3 infections were seasonal with most cases observed from September to November. Although the total number of ARIs was directly associated with the time of the rainy season, HPIV-3 infections were inversely related with rainfall indices. Most HPIV-3 infections were seen in outpatients. The mean age of patients infected by HPIV-3 was 20 months, which is significantly younger than for influenza A (mean age: 34 months) and significantly older than for RSV (mean age: 15 months). HPIV-3 patients presented significantly lower indices of dyspnea, cough, crackles, chest retractions and radiologic abnormalities than RSV patients. Upper airway infection was the most frequent clinical syndrome among HPIV-3 patients. HPIV-3 patients needed less oxygen, salbutamol, antibiotics, corticosteroids and nebulization than RSV patients. In contrast with earlier observations for Northeastern Brazil, our results demonstrate a seasonal pattern for the occurrence of HPIV-3 infections with most cases observed during the dry season. The results also suggest that infections caused by HPIV-3 are milder than infections caused by RSV in previously healthy children.