Changes of respiratory pathogens in hospitalized children with respiratory tract infection before and after outbreak of COVID-19 epidemic

doi:10.3877/cma.j.issn.1673-5250.2022.06.013

Objective

To explore the changes of respiratory pathogens in hospitalized children with respiratory tract infection before and after outbreak of the coronavirus disease 2019 (COVID-19) epidemic.

Methods

From January 2019 to December 2021, a total of 1 576 hospitalized children with respiratory infections treated in the Third People′s Hospital of Chengdu were selected as research subjects. According to admission time, they were divided into study group (n=771, admission time was from January 1, 2020 to December 31, 2021, during COVID-19 epidemic period) and control group (n=805, admission time was from January 1 to December 31 in 2019, before outbreak of COVID-19 epidemic). Serum immunoglobulin (Ig)M antibodies of 9 respiratory pathogens such as Legionella pneumophila serotype 1 (LP1) and Mycoplasma pneumoniae (MP) in two groups of children were detected by indirect immunofluorescence method. Chi-square test was used to statistically compare the respiratory pathogen IgM positive rates in serum of children between 2 groups, between different genders, among different age groups and different seasons. This study was approved by the Medical Ethics Committee of the Third People′s Hospital of Chengdu (Approval No. Lun [2022] S-110, Chengdu Third Hospital). The guardians signed informed consent to the diagnosis and treatment of the children.

Results

① In this study, the positive rate of IgM of respiratory pathogens in serum of 1 576 children with respiratory tract infections was 53.2% (839/1 576). There were negative of serum Coxiella burnetii (COX) IgM in two groups of children, and children in study group were negative of serum LP1 and Chlamydia pneumoniae (CP) IgM. From 2019 to 2021, the annual hospitalized children with respiratory infections included in this study were mainly single pathogen infections, and MP was the main pathogen. The mixed infection rates of ≥2 pathogens in respiratory tract annually decreased in 2019, 2020 and 2021 (23.1%, 13.1%, 4.6%), and the differences between pairwise comparisons were statistically significant (P<0.05). ②Among the children admitted for respiratory tract infections, the top three IgM positive rates in serum of respiratory pathogens were MP, influenza B virus (INFB) and parainfluenza virus (PIV) in 2019, MP, PIV and INFB in 2020, MP, PIV and INFB in 2021. The serum IgM positive rates of MP, syncytial respiratory virus (RSV), adenovirus, influenza A virus (INFA), INFB and total pathogens in study group were all lower, while the serum PIV IgM positivity rate was higher than those in control group, and the differences were statistically significant (P<0.05). ③In study group, the IgM positive rates of serum MP and total pathogens of male children were lower than those of female children, and in control group, the IgM positive rates of serum MP, PIV and total pathogens of male children were lower than those of female children, and all of the above differences were statistically significant (P<0.05). The serum IgM positive rate of respiratory total pathogens of male and female children in study group were lower than those of same gender in control group, respectively, and the differences were statistically significant (36.2% vs 55.6%, 47.6% vs 76.1%; χ²=32.78, 60.69; all were P<0.001). ④There were significant differences among 4 age groups (0-1 years old, ≥1-3 years old, ≥3-7 years old, ≥7-18 years old) of serum IgM positive rates of MP, PIV and total pathogens in study group, also LP1, MP, RSV, INFB, PIV and total pathogens among 4 age groups in control group (P<0.05). The serum IgM positive rate of respiratory total pathogens of ≥1-3 years old, ≥3-7 years old and ≥7-18 years old children in study group were lower than those of same age group in control group, and the differences were statistically significant (P<0.05). ⑤There were significant differences among 4 seasons of spring, summer, autumn and winter of serum IgM positive rates of MP, INFB and total pathogens in study group, also MP, RSV, INFB, PIV and total pathogens among 4 seasons in control group (P<0.05). The serum IgM positive rate of respiratory total pathogens of children in spring, summer and autumn in study group were lower than those of same season in control group, and the differences were statistically significant (P<0.001), among which the serum IgM positive rate of respiratory total pathogens was the most decreased in spring.

Conclusions

MP, INFB and PIV are common pathogens of respiratory infections in hospitalized children in our hospital; MP single infection was predominant both before and after outbreak of COVID-19 epidemic, INFB infection decreased and PIV infection increased after outbreak of epidemic.

Key words: Respiratory tract infections, COVID-19, Pathogen, Immunoglobulin M, Fluorescent antibody technique, indirect, Mycoplasma pneumoniae, Child

表1 2组患儿不同年份血清呼吸道病原体IgM呈阳性者中，病原体单一或混合感染分布情况比较[例数(%)]

组别(或入院年份)	例数	单一感染	混合感染
组别(或入院年份)	例数	单一感染	2种	3种	4种
研究组	319	259(81.2)	54(16.9)	6(1.9)	—
2020年	155	117(75.5)	33(21.3)	5(3.3)	—
2021年	164	142(86.6)	21(12.8)	1(0.6)	—
对照组(2019年)	520	334(64.2)	154(29.6)	29(5.6)	3(0.6)

表1 2组患儿不同年份血清呼吸道病原体IgM呈阳性者中，病原体单一或混合感染分布情况比较[例数(%)]

组别(或入院年份)	例数	单一感染	混合感染
组别(或入院年份)	例数	单一感染	2种	3种	4种
研究组	319	259(81.2)	54(16.9)	6(1.9)	—
2020年	155	117(75.5)	33(21.3)	5(3.3)	—
2021年	164	142(86.6)	21(12.8)	1(0.6)	—
对照组(2019年)	520	334(64.2)	154(29.6)	29(5.6)	3(0.6)

表2 2组患儿不同年份呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

组别(或入院年份)	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
研究组	771	0(0)	230(29.8)	0(0)	4(0.5)	4(0.5)	3(0.4)	35(4.5)	109(14.1)	319(41.4)
2020年	291	0(0)	126(43.3)	0(0)	3(1.0)	2(0.7)	2(0.7)	31(10.7)	34(11.7)	155(53.3)
2021年	480	0(0)	104(21.7)	0(0)	1(0.2)	2(0.4)	1(0.2)	4(0.8)	75(15.6)	164(34.2)
对照组(2019年)	805	2(0.3)	455(56.5)	3(0.4)	15(1.9)	20(2.5)	11(1.4)	183(22.7)	52(6.5)	520(64.6)
χ²值^a		—^b	114.17	—^b	5.98	10.15	4.27	109.36	25.31	85.30
P值^a		0.500	<0.001	0.250	0.019	0.001	0.039	<0.001	<0.001	<0.001

表2 2组患儿不同年份呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

组别(或入院年份)	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
研究组	771	0(0)	230(29.8)	0(0)	4(0.5)	4(0.5)	3(0.4)	35(4.5)	109(14.1)	319(41.4)
2020年	291	0(0)	126(43.3)	0(0)	3(1.0)	2(0.7)	2(0.7)	31(10.7)	34(11.7)	155(53.3)
2021年	480	0(0)	104(21.7)	0(0)	1(0.2)	2(0.4)	1(0.2)	4(0.8)	75(15.6)	164(34.2)
对照组(2019年)	805	2(0.3)	455(56.5)	3(0.4)	15(1.9)	20(2.5)	11(1.4)	183(22.7)	52(6.5)	520(64.6)
χ²值^a		—^b	114.17	—^b	5.98	10.15	4.27	109.36	25.31	85.30
P值^a		0.500	<0.001	0.250	0.019	0.001	0.039	<0.001	<0.001	<0.001

表3 研究组不同性别呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

性别	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
男性	420	108(25.7)	3(0.7)	3(0.7)	2(0.5)	15(3.6)	51(12.1)	152(36.2)
女性	351	122(34.8)	1(0.3)	1(0.3)	1(0.3)	20(5.7)	58(16.5)	167(47.6)
χ²值		7.47	—^a	—^a	—^a	2.00	3.02	10.22
P值		0.006	0.630	0.630	1.000	0.158	0.082	0.001

表3 研究组不同性别呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

性别	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
男性	420	108(25.7)	3(0.7)	3(0.7)	2(0.5)	15(3.6)	51(12.1)	152(36.2)
女性	351	122(34.8)	1(0.3)	1(0.3)	1(0.3)	20(5.7)	58(16.5)	167(47.6)
χ²值		7.47	—^a	—^a	—^a	2.00	3.02	10.22
P值		0.006	0.630	0.630	1.000	0.158	0.082	0.001

表4 对照组不同性别呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

性别	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
男性	450	1(0.2)	208(46.2)	3(0.7)	7(1.6)	9(2.0)	5(1.1)	92(20.4)	20(4.4)	250(55.6)
女性	355	1(0.3)	247(69.6)	0(0)	8(2.3)	11(3.1)	6(1.7)	91(25.6)	32(9.0)	270(76.1)
χ²值		—^a	44.05	—^a	0.53	0.99	—^a	3.04	6.86	36.47
P值		>0.999	<0.001	0.260	0.467	0.320	0.549	0.081	0.009	<0.001

表4 对照组不同性别呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

性别	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
男性	450	1(0.2)	208(46.2)	3(0.7)	7(1.6)	9(2.0)	5(1.1)	92(20.4)	20(4.4)	250(55.6)
女性	355	1(0.3)	247(69.6)	0(0)	8(2.3)	11(3.1)	6(1.7)	91(25.6)	32(9.0)	270(76.1)
χ²值		—^a	44.05	—^a	0.53	0.99	—^a	3.04	6.86	36.47
P值		>0.999	<0.001	0.260	0.467	0.320	0.549	0.081	0.009	<0.001

表5 研究组不同年龄段呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

年龄	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
0~1岁	101	8(7.9)	1(1.0)	0(0)	0(0)	3(3.0)	10(9.9)	18(17.8)
≥1~3岁	153	51(33.3)	1(0.7)	0(0)	0(0)	11(7.2)	26(17.0)	73(47.7)
≥3~7岁	388	141(36.3)	2(0.5)	3(0.8)	3(0.8)	16(4.1)	63(16.2)	185(47.7)
≥7~18岁	129	30(23.3)	0(0)	1(0.8)	0(0)	5(3.9)	10(7.8)	43(33.3)
χ²值		34.58	—^a	—^a	—^a	—^a	8.26	35.43
P值		<0.001	0.712	0.797	0.722	0.391	0.041	<0.001

表5 研究组不同年龄段呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

年龄	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
0~1岁	101	8(7.9)	1(1.0)	0(0)	0(0)	3(3.0)	10(9.9)	18(17.8)
≥1~3岁	153	51(33.3)	1(0.7)	0(0)	0(0)	11(7.2)	26(17.0)	73(47.7)
≥3~7岁	388	141(36.3)	2(0.5)	3(0.8)	3(0.8)	16(4.1)	63(16.2)	185(47.7)
≥7~18岁	129	30(23.3)	0(0)	1(0.8)	0(0)	5(3.9)	10(7.8)	43(33.3)
χ²值		34.58	—^a	—^a	—^a	—^a	8.26	35.43
P值		<0.001	0.712	0.797	0.722	0.391	0.041	<0.001

表6 对照组不同年龄段呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

年龄	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
0~1岁	105	0(0)	10(9.5)	0(0)	8(7.6)	4(3.8)	0(0)	8(7.6)	4(3.8)	25(23.8)
≥1~3岁	193	0(0)	114(59.1)	1(0.5)	4(2.1)	6(3.1)	1(0.5)	49(25.4)	9(4.7)	127(65.8)
≥3~7岁	368	0(0)	250(67.9)	0(0)	1(0.3)	7(1.9)	9(2.5)	102(27.7)	35(9.5)	279(75.8)
≥7~18岁	139	2(1.4)	81(58.3)	2(1.4)	2(1.4)	3(2.2)	1(0.7)	24(17.3)	4(2.9)	89(64.0)
χ²值		—^a	114.56	—^a	—^a	—^a	—^a	22.00	10.87	96.77
P值		0.047	<0.001	0.075	<0.001	0.569	0.190	<0.001	0.012	<0.001

表6 对照组不同年龄段呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

年龄	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
0~1岁	105	0(0)	10(9.5)	0(0)	8(7.6)	4(3.8)	0(0)	8(7.6)	4(3.8)	25(23.8)
≥1~3岁	193	0(0)	114(59.1)	1(0.5)	4(2.1)	6(3.1)	1(0.5)	49(25.4)	9(4.7)	127(65.8)
≥3~7岁	368	0(0)	250(67.9)	0(0)	1(0.3)	7(1.9)	9(2.5)	102(27.7)	35(9.5)	279(75.8)
≥7~18岁	139	2(1.4)	81(58.3)	2(1.4)	2(1.4)	3(2.2)	1(0.7)	24(17.3)	4(2.9)	89(64.0)
χ²值		—^a	114.56	—^a	—^a	—^a	—^a	22.00	10.87	96.77
P值		0.047	<0.001	0.075	<0.001	0.569	0.190	<0.001	0.012	<0.001

表7 不同季节研究组呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

季节	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
春季	147	33(22.5)	0(0)	1(0.7)	0(0)	1(0.7)	20(13.6)	52(35.4)
夏季	153	26(17.0)	0(0)	1(0.7)	1(0.7)	1(0.7)	25(16.3)	48(31.4)
秋季	249	86(34.5)	3(1.2)	0(0)	0(0)	12(4.8)	33(13.3)	108(43.4)
冬季	222	85(38.3)	1(0.5)	2(0.9)	2(0.9)	21(9.5)	31(14.0)	111(50.0)
χ²值		26.09	—^a	—^a	—^a	22.83	0.81	15.71
P值		<0.001	0.465	0.426	0.351	<0.001	0.847	0.001

表7 不同季节研究组呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

季节	例数	MP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
春季	147	33(22.5)	0(0)	1(0.7)	0(0)	1(0.7)	20(13.6)	52(35.4)
夏季	153	26(17.0)	0(0)	1(0.7)	1(0.7)	1(0.7)	25(16.3)	48(31.4)
秋季	249	86(34.5)	3(1.2)	0(0)	0(0)	12(4.8)	33(13.3)	108(43.4)
冬季	222	85(38.3)	1(0.5)	2(0.9)	2(0.9)	21(9.5)	31(14.0)	111(50.0)
χ²值		26.09	—^a	—^a	—^a	22.83	0.81	15.71
P值		<0.001	0.465	0.426	0.351	<0.001	0.847	0.001

表8 不同季节对照组呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

季节	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
春季	186	0(0)	123(66.1)	1(0.5)	7(3.8)	3(1.6)	2(1.1)	48(25.8)	11(5.9)	131(70.4)
夏季	189	0(0)	97(51.3)	0(0)	1(0.5)	4(2.1)	3(1.6)	36(19.1)	5(2.7)	110(58.2)
秋季	217	0(0)	130(59.9)	0(0)	0(0)	7(3.2)	2(0.9)	61(28.1)	13(6.0)	154(71.0)
冬季	213	2(0.9)	105(49.3)	2(0.9)	7(3.3)	6(2.8)	4(1.9)	38(17.8)	23(10.8)	125(58.7)
χ²值		—^a	14.60	—^a	—^a	—^a	—^a	8.94	11.36	13.25
P值		0.178	0.002	0.360	0.002	0.739	0.837	0.030	0.010	0.004

表8 不同季节对照组呼吸道感染患儿血清呼吸道病原体IgM阳性率比较[例数(%)]

季节	例数	LP1	MP	CP	RSV	腺病毒	INFA	INFB	PIV	总体阳性
春季	186	0(0)	123(66.1)	1(0.5)	7(3.8)	3(1.6)	2(1.1)	48(25.8)	11(5.9)	131(70.4)
夏季	189	0(0)	97(51.3)	0(0)	1(0.5)	4(2.1)	3(1.6)	36(19.1)	5(2.7)	110(58.2)
秋季	217	0(0)	130(59.9)	0(0)	0(0)	7(3.2)	2(0.9)	61(28.1)	13(6.0)	154(71.0)
冬季	213	2(0.9)	105(49.3)	2(0.9)	7(3.3)	6(2.8)	4(1.9)	38(17.8)	23(10.8)	125(58.7)
χ²值		—^a	14.60	—^a	—^a	—^a	—^a	8.94	11.36	13.25
P值		0.178	0.002	0.360	0.002	0.739	0.837	0.030	0.010	0.004

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