Журнал «Здоровье ребенка» 4 (55) 2014

Asthma is one of the most common chronic respiratory diseases in children. Of particular importance in the development of asthma belongs viruses [16]. According to modern research [5, 15] to 85% of exacerbations of asthma and wheezing episodes in children etiologically associated with respiratory viruses. The main viruses that trigger asthma exacerbation include respiratory syncytial virus (RS-virus), rhinovirus, influenza viruses and parainfluenza, adenovirus and respiratory coronavirus [3].  In 2001-2006 range of respiratory viruses expanded through new human coronaviruses (NL63 and HKU-1), metapnevmovirus, bokavirus.

The ultimate role of viruses in the development of asthma continues to be studied

Research to identify metapnevmovirus, bokavirus, coronaviruses NL63 and HKU1 in young children with bronchial obstruction syndrome in Ukraine have been conducted.

Materials and methods. The study included 28 children aged 5 months to 6 years. The mean age of patients was 33.7 (95% CI 24.5 - 43.0) months. Of these boys - 20 (71.4%), girls - 8 (28.6%). With a diagnosis of acute asthma in the study included 12 (43%) children, with recurrent episodes of obstructive bronchitis - 16 (57%) children. The study was conducted during 2012. Detection and identification of respiratory viruses was performed in biomaterial smears from the nasal cavity by the method of multiplex PCR in real time.

Results and discussion. Respiratory viruses in clinical material were identified in 21 (75%) children. Respiratory viruses were identified year round. Often children with bronchial obstruction syndrome manifested bokavirus (39.3%). Metapnevmovirus was identified in 10.7% of children. Rhinovirus and RS virus were detected in 7.1% of children each. In 3.6% of cases identified parainfluenza virus types 1 and 3, 3.6% of registered co-infection (metapnevmovirus and parainfluenza virus type 1).

In the study of the frequency of detection of respiratory viruses, depending on the diagnosis, it was found that in both groups, identification of viruses was 75%. How in children with obstructive bronchitis and children with acute asthma often detected bokavirus. In patients with obstructive bronchitis bokavirus was 25%, whereas in children with asthma bokavirus was detected in 58.4% of cases. The detection rate bokavirus probably not significantly different between groups (p > 0.05), but clinically significant difference was still found. The relative risk RR = 2.3 (95% CI 0.9-6.2), acute asthma in children is 2.3 times more likely to have been associated with bokavirus infection compared with patients with obstructive bronchitis. Also in children with acute asthma were found metapnevmovirus and rhinoviruses in 8.3% of cases. In children with obstructive bronchitis range of respiratory viruses was much wider. Metapnevmovirus, RS-virus and parainfluenza viruses identified in 12.5% of children and rhinovirus co-infection were found in 6.25% of cases of obstructive bronchitis.

The clinical picture in both groups did not differ significantly and included clinical signs of respiratory infection, bronchial obstruction syndrome, mild signs of intoxication syndrome. When comparing the duration of obstructive syndrome demonstrated statistically significant differences. Thus, in patients with obstructive bronchitis it was 2.7 (95% CI 2.3-3.1) days, while in the group of children with acute asthma was 5.3 (95% CI 4.1-6.4) days (p < 0.0001).

Conclusions.

1. For the first time in Ukraine were identified new respiratory viruses (metapnevmovirus, bokavirus, coronaviruses NL63 and HKU1 in children during the first six years of life of patients with asthma and obstructive bronchitis.

2. Respiratory viruses play an important role as triggers bronchial obstruction syndrome and were found in 75% of affected children.

3. Bokavirus was identified in 39.3% of children. Exacerbation of asthma is 2.3 times more likely to be associated with bokavirus compared with patients with obstructive bronchitis RR = 2.3 (95% CI 0.9-6.2).

4. Metapnevmovirus was identified in 10.7% of patients. In 3.6% of cases was identified as part of co-infection.

5. The role of new viral pathogens in the development and course of asthma remains an urgent problem and requires further study.