IMPATTO DI RINOVIRUS ED ENTEROVIRUS NELLA POLMONITE DI COMUNITÀ IN ETÀ PEDIATRICA: STUDIO DEI CEPPI VIRALI CIRCOLANTI E CORRELAZIONE CON IL QUADRO CLINICO.

Background: Community-acquired pneumonia (CAP) is one of the most important causes of childhood mortality in developing countries and, despite the availability of effective, preventive and therapeutic measures, remains a significant cause of morbidity and hospitalization in the industrialized world. Little in known about the prevalence of viral infections in children with CAP. Detailed information concerning the etiology of CAP in required in order to formulate treatment reccomendations and implement preventive measures. Evaluating the role played by each potential pathogen may also contribute to improving our understanding of the pathogenesis of the disease. Objectives: To describe the clinical and virological data collected from children with radiographically confirmed CAP in whom samples from respiratory secretions were analyzed for 17 respiratory viruses. Patients and method: a nasopharyngeal swab was taken from children admitted to hospital because of CAP during five consecutive winter and early spring seasons (2007-2012). Samples were tested using the Luminex xTAG Respiratory Virus Panel Fast assay, which detects influenza A virus, influenza B virus, respiratory syncytial virus (RSV) -A and -B, parainfluenzavirus-1, -2, -3, and -4, adenovirus, human metapneumovirus, coronaviruses 229E, NL63, OC43, and HKU1, enterovirus/rhinovirus (RV), and bocavirus. A real-time reverse transcriptase polymerase chain reaction (RT-PCR) was used to identify the RV in the enterovirus/RV positive swabs. Samples which were positive for RV were used for sequencing analysis and to reconstruct the phylogenetic tree. In addition, a total of twelve enterovirus C 104 (EV-C104) strains were analyzed for a complete genome sequence. Nasopharyngeal swabs positive for RSV and RV were analyzed by means of RT-PCR for autolysin-A and wzg genes of Streptooccus pneumoniae. Results: A total of 435 children (73,5%) were positive for at least one virus: the most frequently detected was RSV, which was found in 188 (31,7%), followed by RV (n = 144, 24,3%), bocavirus (n = 60, 10,1%), influenza viruses (n = 57, 9,6%), and human metapneumovirus (n = 49, 8,2%). Viral co-infections were found in 117 children (19,7% of the enrolled children; 26,9% of those with viral infections). Marginal differences were found between the infections owing to a single virus. Co-infections showed radiographic evidence of alveolar pneumonia significantly more frequently than single infections. RV was identified in 198 samples (42.2%), and the VP4/VP2 region was successfully amplified in 151 (76.3%). RV-A was identified in 78 samples (51.6%), RV-B in 14 (9.3%) and HRV-C in 59 (39.1%). Forty-seven (31.1%) of the children with RV infection were aged