Childhood ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies During Infancy and

ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies during Infancy and
Childhood
Herta Wulff, Patricia Kidd and Herbert A. Wenner
Pediatrics 1964;33;30-44
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://www.pediatrics.org
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright © 1964 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.
Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

ETIOLOGY OF RESPIRATORY INFECTIONS
Further Studies during Infancy and Childhood
Herta Wulif, Ph.D., Patricia Kidd, and Herbert A. Wenner, M.D.

Ihixon Memorial Laboratory, Department of Pediatrics, University of Kansas
School of Medicine, Kansas City 3, Kansas
INTRODUCTION MATERIALS AND METHODS

I N RECENT YEARS viruses have been asso- Nosocomial
ciated VitIl a large fraction of respiratory
The study includes 114 infants and chil-
illnesses of infancy and childhood. The
dren entering the hospital or Clinics of the
clinical expressions associated with such in-
University of Kansas Medical Center be-
fections vary greatly. Parainfluenza virus,
t\veen November 20, 1961, and May 10,
types 1 and 2, and influenza 22 3 and pos-
1962 (Fig. 1). These patients were grouped
sibly ECHO type 11 among others have
as follows: pneumonia, 47; bronchiolitis, 21;
been linked with “croup,” and sometimes
laryngotracheobronchitis (LTB), 11; influ-
with pneumonia. C Respiratory syncytial
enza, 3; upper respiratory infection (URI),
( RS) virus may be found during upper res-
18; and other, 14 (Fig. 2). The signs used
piratory tract infections, or at worst with
for grouping patients into major clinical
bronchiolitis and pneumonia. . .
categories have been described elsewhere.l

In our previous studiesl0, an association
Each entry was made without knowledge
as rigid as those of others was not found
of viral or bacterial flora. When overlapping
between RS and parainfluenza type 1 virus
signs were present entry was based on those
and bronchiolitis or pneumonia. None of
predominating at the first examination.
25 infants with bronchiolitis could be linked
Pneumonia developed in 11 additional chil-
with RS virus, and of 39 with pneumonia
dren; from signs obtained at the first ex-
only a small fraction (13%) developed spe-
amination 8 had been classified as LTB or
cific antibodies. Clinical observations, and
bronchiolitis (see notes on entries, Fig. 2).
data from the laboratory suggested that of
The 14 patients entered as “other” were
those developing pneumonia a fraction were
sampled on entry because they were sus-
of bacterial origin.
pected as having primary respiratory ill-
In this study specific viruses were re-
nesses or because corresponding signs de-
covered from half the study population.
Among these the majority included RS and veloped in hospital. Final diagnoses in these
influenza B viruses, each independently as- patients ranged from staphylococcal septi-
cemia to diffuse “collagen” disease.
sociated with outbreaks of respiratory ill-
ness. On the other half respiratory illnesses
Monthly Admissions
could not be associated with 14 viruses.
Available evidence suggested that some Entries are arranged graphically in Fig-
were very likely caused by bacteria. ure 1.
(Submitted Ma 3, 1963; accepted for publication August 15.)

Aided by grants from the National Foundation and the United States Public Health Service Research
Grant, No. CA 06006-02, from the National Cancer Institute; also supported in part by a Public Health
Service Research Career Program Award 5-KC-A1-13,976 from the National Institute of Allergy and
Infectious Diseases.
Dr. Wulif is Research Fellow, Section for Virus Research.
ADDRESS: (H.A.\V.) Rainbow Boulevard at 39th St., Kansas Cit 3, Kansas.
PEDIAnucs, January 1964

30

ARTICLES 31
fusion broth containing penicillin (800 units),

streptomycin (800 mi.) and amphotericin B
(1 mp.). Swabs were swirled in diluent and
excess fluid obtained by rolling them against
the wall of the collecting bottle. Antibiotics
were added to urine samples in quantities
( per ml) mentioned above. Specimens vere
inoculated usually within 10 minutes after
collection.
Three tissue culture systems were used:
Fic. 1. The patients and viruses recovered during (a) primary monkey kidney, (b) primary
the studs period. Each block represents a patient; human amnion, and (c) HEP-2, an estab-
time of entry is based on date nearest onset of lished cell line.13 Procedures used in culti-
illness. For years 1961-1962. vation of these cells on glass surfaces have
been described. Each specimen was inocu-
Age and Race lated into 4 to 6 tubes of each culture sys-
Seventy-five per cent were infants. tem (0.1 ml/culture). Cell cultures were
Among 29 children, 1 1 ranged from 5 to 14 racked in a drum and rotated mechanically
years, 9 of the 11 came to the Out-Patient at 37#{176}C. Cultures were examined every
Clinic with an influenza-like illness. All other day for specific cytopathic effect
others were admitted to hospital. (CPE). Twice during the incubation period,
Negroes comprised 40% of the study on the fifth day and before passage, one
group; the rest were Caucasians. The frac-
tion of Negroes in the clinical categories
were “other,” 29%; URI, 24%; LTB, 73%;
bronchiolitis, 38%; and pneumonia, 45%.
Specimens
Samplings included nose and throat swabs

(all patients), urine (52 patients), and feces
(6 patients). Usually samples were obtained
a few hours after admission to hospital (ex-
Ui
cept for those developing infection in hos-
pital). Paired sera were available for 74 z
children.
Bacteriology
Each nose and throat swab was plated

on rabbit’s blood agar (BAP); after plating
swabs were swirled in Pike’s medium.12
Bacteria grown in Pike’s medium were re-
plated on BAP. Bacteria present on all
plates were identified on the basis of colony
NDJ FMAMJ ND) FMAMJ
morphology, Gram’s strain, bile soiubility MONTH
(pneumococci), and sensitivity to bacitracin FIG. 2. Seasonal (listribution according to clinical
(hemolytic streptococci). category. As noted earlier in the text, 11 patients
tiuring their illness developed radiographic cvi-
Virology (ience of pneumonia. By our criteria these individ-
uals were not entered in the panel marked for
Virus isolation: Nose and throat swabs
pneumonia patients; they are, however, noted by
were placed immediately in 4 ml of veal in- symbol (solid circle). See Fig. 1 for legend.

32 RESPIRATORY INFECTIONS
tube, representing each specimen and tissue Some viruses were typed by ilemadsorp-
culture type was tested at 4#{176}C
for hemad- tion-inilibition. Cultures were inoculated
sorption (HAd) of guinea pig erythrocytes. with 1 : 10 or 1 : 100 dilution of virus, and
Fluid harvests from positive cultures incubated 3 to 4 days at 37#{176}C.After dis-
(CPE + or HAd + ) were often frozen carding fluid overlays, cell sheets were
( 70#{176}C)prior to passage
- to form a virus washed twice with phosphate buffered sa-
stock. Virus stocks were dispensed into line; tilen 0.2 ml of pretreated antiserum
ampoules, glass-sealed, and stored at (absorbed with guinea pig erythrocytes)
-70#{176}C. Some strains later identified as RS added to all except control cultures. Thirty
virus were very unstable stored at -70#{176}C minutes later 0.2 ml of 0.4% suspension of
even with added chicken serum (20%, macti- guinea pig erythrocytes was delivered to
vated) or gelatin (0.5%). Unstables viruses each culture. After incubation for 20 mm-
procured from CPE + cultures were main- utes at 4#{176}Ctile cultures were read for
tamed in continuous passage until condi- presence or absence of HAd.
tions providing for stability were estab-
lished. Subsequently such vinises retained Antibody Determinations
infectivity to titer for at least 2 months when By serum neutralization : Procedures have
mixed vith an equal volume of glycerin, been described.10 Human sera inactivated
stored in a dry-ice box. at 56#{176}Cfor 30 minutes were diluted in
Negative cultures were observed for 2 to fourfold steps and tested for serum dilution
3 weeks; eacil s’as subcultured if nonspe- endpoints neutralizing about 100 ID50 of
cific CPE interfered with readings. Cultures each of the 11 viruses entered in the study.
were frozen ( - 70#{176}C) and thawed; then Paired sera were always included in the
fluid overlays were harvested for passage same test. Antibody measurements were
(0.2 ml) into fresh tissue cultures. Each made by serum neutralization for all except
negative sample was subcultured 3 times; influenza C and adenoviruses. By hemag-
at tile end of the tilird passage the cell glutination inhibition: Antibodies against
“sheet’ was cilecked for HAd with guinea influenza C were measured by this method.
pig erythrocytes. Nonspecific inhibitors were removed using
methods described pre’iousl.1#{176} By corn plc-

Type Determinations
ment-fixation: Tile metllod used for measur-
Type-specific antisera for influenza, para- ing antibodies for adenoviruses has been
influenza, reo-, adeno-, and enteroviruses described also.’#{176}
were procured from monkeys and rabbits.bO
Antiserum for respiratory syncytial virus RESU LTS
(strain 87) was prepared in monkeys.
Bacterial Flora
Following passage, and formation of virus
stocks, infectivity endpoint (TCID50) of Satisfactory cultures of the nasopharynx
each isolate was determined using the tissue were obtained from 80 of 100 infants and
culture system yielding CPE. One hundred cilildrefl (excluding 14 children entered in
TCIDI) of stock virus was mixed with an tile “other” category). The analysis is based
equal volume of 1:8 dilution of antiserum. Oil the frequency of recovering pneumo-
Virus-serum mixtures were incubated for cocci (Str. /)neumoniae) and influenza bacilli
1 hour at 37#{176}C;immediately thereafter they (H. influenzae); Group A hemolytic strepto-
were placed in an ice-water bath. Each mix- cocci were recovered only from the oro-
ture was inoculated into 3 or 4 cultures; pilarynx of 3 children.
each culture received 0.2 ml. Tests were A portion of the data is summarized in
scored after 3 to 4 days incubation when Table I. Pneumococci were recovered from
coiltrol cultures indicated CPE and 40 to half, influenza bacilli from a third, and one,
100 ID0 of virus in the test. the other or both bacteria, from two-thirds

ARTICLES 33
TABLE I
RECovERY OF Str. jnteuinoiiiae AND H. influenzae FROM THE N&soviijiyxx
No. of Persons Frequency (%)
Clinical Category “P.V.’+

Either one
in Group Cultured “PN” “hi. Influ” . flu”
or Both
URI 21* 8 50 25 25 50
LTB 11 11 64 36 27 73
Bronchiiolitis 21 20 40 20 10 50
Pneumonia 47 41 46 46 12 76
Totals 100 80 48 36 15 69
* Includes 3 patients with influenza-like illness. Abbreviations: URI, infection limited largely to the PlIilrYIIx
LTB, laryngotracheobronchitis; “PN,” Sir. pneuinoniae; “H. miEn,” Hemophilus influenza, smooth l)hIase.
The data were subgrouped and scored for virus-positive and virus-negative individuals. The fraction of virus
Ilegative individuals in the categories were for LTB, 45%; bronchiohitis, 40%; and pneumonia, 51%. Rates ob-
tained by such subgrouping were not significantly different.
of the patients. The total rates obtained subdivided according to type of pneumonia
for clinical groupings were not only similar ( from radiographic evidence) and whether
to one another, but did not differ signifi- or not they yielded virus (Table II). No
cantly from total over-all rates. Subgroup- differences in rates between the classes were
ing for age differences disclosed that older found for lobar pneumonia. But for the
infants (12 to 24 months) with LTB yielded larger group with bronchopneumonia pneu-
pneumococci and those of corresponding mococci were recovered with greatest fre-
age with pneumonia yielded influenza ba- quency ( 3:1) from patients not yielding
cilli about twice the expected rate. Further virus. Other data on age-specific rates for
subgrouping by clinical category according patients with lobar pneumonia, however,
to the presence or absence of virus showed showed that older children yielded pneu-
among the latter a slightly larger associa- mococci more often (100%) than young in-
tion of pneumococci among patients with fants (17%). Rates for influenza bacilli were
bronchiolitis and pneumonia. The numbers consistently 2 to 3 times higher among older
are small, and the differences statistically children than among infants.
insignificant. Forty-one virus-positive persons, all ex-
Fifty-eight patients presenting with or de- cept 4 with lower respiratory tract infec-
veloping pneumonia during illness were lions were subgrouped according to their
TABLE II
REcovERY OF Sir. pneuinoniae AND hi. influenzae FROM THE NAsoI’IIJtNx OF PERSONS WITH
No. of Persons Frequency (%)

Kind of Pneumonia (‘lass - PV+ Iither one
In Group (‘u/lured “PN” “ii. influ” II. infii” or Both
Lobar Virus + 5 5 40 40 0 8()

Virus 0 12 11 45 46 9 82
Bronchopneunionia Virus + 24 21 43 14 60
Virus 0 17 14 79 43 21 100
See Table I for abbreviations. Eleven infants, noted symbolically in Figure 2, developed Pneumollia; they are
included in this table.

viruses. Rates for influenza bacilli were positive group; however, in this group
twice and pneumococci half the expected leukocytosis in younger infants and children
values among patients yielding influenza B exceeded (2: 1) those found in correspond-
and adenoviruses. Since RS and influenza B ing members of the virus-positive group.
comprised the majority of the virus isolates, The data are summarized in Table III.
patients yielding these viruses were sub- The 2: 1 ratio of leukocytosis for virus-
grouped by age, the presence or absence of negative and virus-positive patients varied
pneumonia, and compared with the fraction for several clinical categories. Among 18
from whom no virus was recovered. Pneu- patients with bronchiolitis the ratio was 3:1;
mococci and influenza bacilli were found among 11 patients with LTB the ratio was
more often with virus-associated pneumonia 1 : 1; and among 46 patients with pneumonia
than not; however, only rates for H. in- the ratio was 2: 1. Rates also varied for the
fi uenzae exceeded the mean values noted in kind of virus recovered. Approximately a
Table I. third of patients yielding RS and influenza
B viruses presented leukocytosis. Only 1 of
Leukocytosis
7 patients yielding RS virus in the presence
Patients presenting counts of 15,000 or of pneumonia had leukocytosis. In contrast
more cells per cu mm, chiefly polymorpho- 5 of 8 patients with pneumonia yielding
nuclear leukocytes, were deemed to have either adeno-, reo-, or paramnfluenza types
leukocytosis. Approximately half (49%) had 2 and 3 viruses presented with leukocytosis,
leukocytosis. Counts ranged from 15,000 to occasionally quite marked (e.g., 40,800).
54,600, with a mean value of 16,640 ±
7,000. Virus-negative patients developed Accessory Clinical Data
leukocytosis about twice as often as virus- Significant differences were not found
positive patients. Virus-positive infants either in the magnitude or duration of
more than a year of age presented more febrile responses based on the presence or
often (3: 1) with leukocytosis than either absence of virus within several clinical cate-
younger infants or older children. Rates gories. Since a large fraction (73%) of the
among virus-negative infants of the same patients received antimicrobial therapy only
age corresponded with those of the virus- a crude analysis was made to compare the
TABLE III
TIlE LEUKOCYTE RESPONSES FOR ThOSE IELDING AND NOT \IELDING VIRUSES: ACCORDING TO AGE AND
SEVERAL CLINICAl. CATEGORIES
Jirus + hrus 0
Category Class > WI/C , > WI/C

No. of ?5o. of
Persons No % Persons No.
%
Age <12 mo. 27 6 22 21 11 52

12-23 nio. 11 8 73 16 13 81
>24mo. 14 4 29 13 7 54
Clinical URI 4 0 0 6 5 83
LTB 6 3 50 5 3 60
Bronc’litis 13 3 23 8 4 50
Pneumonia 21 7 33 25 19 76
See Table I for abbreviations. >WBC, >15,000leukocytes cu mm. Of interest was coniparison of bacte-
rial recovery rates with the leukocyte response by age. Just as leukocytosis was more pronounced among older
infants so was the frequency of encountering H. infiuenzae. The ratios were 4:7:1 in the order of age entered above.

ARTICLES 35
TABLE IV
S.IPIINGS Thi AT ‘IELDED Sp’IFI ED \IRUSES
Jirus
Parainfluen:a
.\O. (if
Samples Ill- lolal
( iii per)
I/s /ih1e1h(5 I/co .ldeno Mump.r “N,,
B
1 2 3
Nasopharyngeal (N) 114 10 5 1 1 1 18

Oropharyngeal (0) I 14 2 3 1 1 3 2 2 14
N+O . . 6 7 3 4 3 2 25
Urine+O I 52 I I
Urine+N+() . I I
Feces 6 1 1
Totals 286 18 15 365 5 5 I ‘2 60
Influ, influenza virus; “X,” unidentified viruses. These agents, one obtained in I)ecensber from a 5-year-old
lioy with bronehopneumonia, and the other in April front a 10-month-old ioy with bronchiolitis could not be
recovered from the original samples. These agents produced CPE like RS, and were lost during storage at - 70#{176}C.
Mump virus was isolated once from the oropharynx and urine of a 9-month-old infant. This virus and a strain
of adenovirus were the only agents recovered from 32 urine samples. A strain of reovirus, type 1 was detected only
in feces; feces were not obtained from 4 other patiehlts yielding reovirus in pharyngeal samples.
febrile course of patients in any group. The RS and influenza B comprised 55%, para-
febrile course was seldom prolonged; a influenza 23%, and adeno- and reoviruses
crude average was 2.2 days for all patients each about 8% of the virus isolates. Except-
with fever; the range varied from 1.8 days ing one strain of reovirus all were detected
( pneumonia) to 3 days (upper respiratory in either nose or throat.
infections). RS and influenza B viruses involved more
patients than any other serotype. Influ-
Viruses
enza B virus, first recovered early in Janu-
RECOVERY RATES. Fifty-eight patients ary, kept reappearing until mid-March. RS
yielded 60 viruses; 56 yielded one and 2 virus detected first in mid-February in-
yielded 2 viruses (see Table IV and Fig. 1). volved at least 18 infants and children dur-
TABLE V
I)ISTJI1BITIoN OF \IJttSES A((ORDING TO (‘h.INIcAI CATEGORI ES
RS Influenza B Parainftucnza, Types Reo .ldeno Slumps So Virus

. .vo. j
(linical
Category
.
Per-
Sons
-- -i
----
-- I
-_________
--
I S
----
---- Recovered
xo. % .\-o. % y0 c % xo.

y0 %
0 % x. No. %
“Other” I I 8 3 5 0 . . 0 . I 8 0 . I 8 0 . Ii 50
(RI 0’ 10 6 30 0 .. 0 .. 0 .. l5 0 .I .5 10 50
Ll’B ft I 10 0 . . 0 . . I 10 0 . 0 . S 33
Bronchiolitu, IS ii I 7 1 7 is is o . . 0 . . 0 . . 7 47
Pneumonia 58t I 0 S 9 4 4 1 4 4 7 0 . . 30 5
A1Icategories 114 18 16 15 13 3 3 6 .5 5 4 5 4 5 4 1 1 56 49
S Includes S children entered in Figure with influenza.

t Includes 11 patients listed in other categories who subsequently were found to have pneumonia.
I Yielded RS and reovirus type I.
I One yielded influenza B and reovirus type I.
Percentages total 99; agents not identified are not included in the table.

BRO NC H OL IllS
to yield virus, they also failed to convert not
5 only against prevailing viruses, but also
several others (Fig. 6) entered in the study.
0
ACE RELATIONSHIPS. Forty-two of the 58
patients yielding viruses were less than 2
years of age. Fifteen of 18 RS and 13 of 14
PNEUMONIA
parainfluenza viruses were recovered from
0
infants mostly under a year of age. A similar
z distribution was obtained for reo-, and
4
adenoviruses, oftentimes, however, in older
2
infants than among those just mentioned.
0
In contrast, 10 of 15 influenza B vinises
SI
were recovered from children (> 2 to 14
years of age). The data are summarized in
Figure 3.
<3 3:24 Seventy-nine of the 95 infants had infec-
4-6 25-36 4-6 25-36
7-12 >37 7-IS >37 tion of the lower respiratory tract. Thirty-
AGE IN MONTHS
five of the 79 yielded viruses. Thirteen, or
Fic. 3. Distribution by age of patients in clinical 14 (including an unidentified virus), were
categories. The kinds of virus recovered are ‘n- RS virus; of these all except 2 were asso-
tered. See Fig. 1 for legend.
ciated with bronchitis or pneumonia. Para-
ing the ellSuillg 3 months. Reovirus (type 1) influenza, adeno-, and reoviruses (20 strains)
was encountered ciliefly during the peak were encountered almost always (85%)
prevalence of influenza. Parainfluenza type among infants with LTB, bronchiolitis, or
2 was recovered only during early winter pneumonia. Influenza B was associated with
ITloiltils. ParaillfluellZa types 1 and 3 were URI in older children; this virus was re-
encountered oiil’ at sporadic intervals. covered also from 4 of 5 infants, and one
CLINICAL RELATIONSHIPS. Data depicted child ill of bronchiolitis or pneumonia. Five
ill Figure 2 and tabulated in Table V ilhis- of 10 children with lower respiratory in-
trate a random distribution of virus sero- fection yielded virus: 2 with influenza B,
ty)es \Vithill the arbitrary clinical cate- and one each with RS, parainfluenza, type
gories. Approximately half the patients in 1, or an unidentified virus.
each category yielded viruses. Of the 30
Seroconvers ion
viruses recovered from 58 patients with
pneumonia 11 (37%) were RS, 5 (17%) were Twenty-seven of 36 patients from whom
influenza B, and 4 (13%) were adenoviruses; virus was recovered developed specific
the 10 remaining comprised parainfluenza, antibodies (Table VI); a fraction (e.g., RS,
reovirus, and one unidentified agent. Among 3 of 11 persons) had maximal or near maxi-
the 16 viruses recovered from 32 persons mal levels of specific antibody in the first
(left, upper 2 panels, Fig. 2) presenting serum sample. Four infants failed to de-
mainly with signs of URI, 9 (56%) were in- velop antibodies to the serotype (e.g., para-
fluenza B, 3 (19%) were RS, and the 4 re- influenza, type 2).
maining were either parainfluenza, reo-, Among 36 patients from whom virus was
adeno-, or mumps virus. Although the fre- not recovered seroconversion was obtained
dj11e11cy distributions for serotypes vary (e.g., for 4 viruses; rates were highest for RS
predominance of RS, adeno-, and parain- (17%) lowest for influenza B (6%), with inter-
fluenza, type 2 with infections of the lower mediate values for adeno- and parainflu-
respiratory tract) the general pattern was enza, type 3 viruses. Data charted in Fig-
tile same in the several categories. But ap- ure 4 illustrate that seroconversion may
proximately half the patients not only failed occur while failing to recover viruses. Dur-

ARTICLES 37
ing the peak prevalence of RS and influenza 80

U-,
B viruses conversion rates exceeded isola- hr
LU
tion rates by a factor of two. LU
01
>
FOR Moiu THAN ONE VIRUS. Eleven of z
15 patients yielding virus and 4 others
from W11OIT1 virus was not recovered de- 40
veloped antibodies to two or more viruses 2:

(Table VII). All 11 patients yielding viruses
developed antibodies to the serotype. Het-
erologous conversions to RS and influenza B
viruses were obtained more often than U)
zw
-
others. However, 7 converted to parainflu-

<-I
enza; of these 5 converted to type 1. Among -
0>
virus-positive patients 5 converted to one,
3 to two, and possibly 3 to three viruses 4
other than those recovered during their ill- 3
ness. Similar findings apply to 4 virus-nega- 2
LU
tive individuals.
Heterotypic antibody responses were 0
analyzed using data illustrated in Table
VIII. The serologic data relate to infants, FIG. 4. The seasonal character of influenza B and
RS virus infections. Entries in the lower panel rep-
sillce their antibody responses were more
resent about one-half the patients from whom sat-
likely primary and not yet complicated by isfactory paired sera were available. Conversion
re-infection from singular serotypes. Al- rates in the upper panel relate to the fraction (0-
though heterologous responses were not tcred in the lower panel (solid lines) awl an addi-
always associable with specific viruses , such tiOITh1l group (broken lines) who converted, but
failed (see text for intervals between collection of
viruses were often recovered from convert-
sera) to yield virus on admission to the hospital.
ers, even during (a) an existent seropositive
status for another virus, or (b) seroconver-
5iOIl to such viruses. Moreover, infants
already seropositive for a singular serotype not obtained for influenza A, Coxsackie
occasionally harbored virus in the oro- A21 and ECHO 28 viruses. These data are
pharynx. summarized graphically in Figure 5.
Among 13 infants converting either to CLINICAL CATEGORIES. Patients with pneu-
parainfluenza types 1 or 3 virus, 4 con- inonia converted more often than others to
verted to heterotype and 2 yielded the virus RS, influenza B, parainfluenza, type 1, and
serotype. Among 4 infants seropositive for adenoviruses. The conversion rate for RS
type 1, 2 converted to type 3 and 1 yielded (32%) was at least twice that of any
type 3 virus. Among seropositive infants other virus. Patients with bronchiolitis con-
homologous viruses were recovered less verted chiefly to RS (29%), and a
often than heterotypic viruses to which anti- substantial fraction (6 to 18%) coil-
bodies had developed. These data indicated verted to paramnfluenza and influenza B
a general specificity of antibody response. viruses. Patients with LTB converted \Vitll
AGE-SPECIFIC RATES. Very young infants equal frequency to 6 serotypes. While in
were recruited by RS (72%), parainfluenza general conversions obtained among pa-
(14 to 20%), and adenoviruses (17%); 16% of tients with predominantly upper respiratory
these infants converted to influenza B virus. infections were fewer, these as well as those
Sero-conversion to influenza C. HGP, and in “others” converted mainly to RS and in-
reovirus took place largely during late influenza B virus. The data are summarized
fancy and childhood. Seroconversion was in Table IX.

RESPIRATORY INFECTIONS
FOR BOTH AGE AND CLINICAL EXPRESSION. ing March and April, 1962; RS virus was
Seroconversions for parainfluenza viruses recovered from one and antibodies to RS
occurred more often (2: 1) before than after developed in another. The fourth patient
1 year of age. dll(l (leveloped principally in contracted pneumonia 9 days after admis-
association \Vith lower respiratory tract in- SiOil for iron-deficiency anemia; iSolatioll of
fections. Among 37 infants with pneumonia parainfluenza, ty)e 3 virus atteil(le(l de-
and bronchiolitis the rates were: RS, 33%; velopment of specific antibodies. Patients
parainfluenza type 1, 17%; parainfluenza in hospital are at risk of infection from
type 3, 11%; and influenza B virus, 11%. Five viruses (and other microbes) unrelated to
infants with LTB each converted to a single those, if any, harbored on admittance.
serotype (Table IX). RS virus recruited Data presented earlier indicated that re-
about equally among infants and young cently acquired heterologous antibodies
children, the principal but not dominant were found more often in patients where
clinical expression being pneumonia and a delay of a month or more transpired be-
bronchiolitis. Older children as noted were tween serum samples (Table VII). The in-
recruited by influenza B virus. Among 11 tervals, for many spanned the seasonal
children with pneumonia seroconversion oc- prevalence of influenza B and RS virus.
curred only for influenza B, RS, and adeno- Very likely during this period antibodies
viruses. were engendered to these and other viruses.
Simultaneous infection with 2 viruses was
Nosocomial and Other Considerations noted in 2 infants (one age 17 months with
Three infants and a young child de- pneumonia; the other age 1 year with LTB;
veloped respiratory illnesses within 5 to 14 see Fig. 3). In one of these, antibodies had
days following entry to hospital. Two of 3 already developed or was engendered for
developed upper respiratory infections dur- these viruses, and additively within the
TABLE VI
CoNv:JLsIoN RATES (%) AMONG PATIENTS IELD1NG SPECIFIED \‘IRUSES
Seroposilire (1st serum) Conrcrters

.Vo.
(‘lass Persons
in (lass RS
Influ
B 1
Parainftuenza
- --- 3
Reo Adeno RS
Irif
B
Ia
1
Parainfluenza
e
Reo .4deno
No virus 36 47 31 8 43 17 47 17 6 0 0 9 0 11
115 Ii 36 18 0 3.5 18 64 73 0 7 0 0 0 0
Influenza Ii 10 80 10 () 10 30 60 44 90 10 0 0 0
Parainfluenza, type I 0 0 0 0 30 50 30 0 50 50 0 50 0 0
Parainfluenza, type 4 0 0 0 50 3 75 0 .50 0 0
Parainfluenza, type 3 4 0 3 0 0 .50 0 0 0 100 0 5t
Reo 0 0 0 0 0 0 0 100 0 0 0 0 100 0
Adeno 4 I) 0 0 0 .50 Q5 5 50 0 0 0 0 50
All virus-positive 36’ 36 1$ II 44 36 .50 41 3-1 17 6 17 9 8
‘Flie totals, seropositir e f-converters lo not always 100%, because seceral patients yielding viruses failed to develop measuratle anti-
111)(IieS h,y the methods used. See ‘rable IX for paCents (-onverting to more than one virus.
* Includes one of the infants shedding I viruses. S’era from I persons yielding the unknown agents, and one yielding mumps virus are not
entered.
t An infant yielding parainfluenza type S converted to the homologous, but not the prototype. This patient also converted to adenovirui
(<I:8to 1:64).

ARTICLES 39
TABLE VII
SEROCONVF:IOSION OBTAINED TO Two OR MORE \IRUSES
interval troconrersion f-r

(days)
Kind of Virus No. of Ae
Beta-c-en Pa;ainfluenzu
Recovered Persons (mean)
1st and 2nd
Patient’s
RS
lifts _______________ Reo -Ideeto
In.flu Rhino
B 3
$erum
Virus C 1!GP
115 3 7mo 8, 33, 90 +++
Influenza II 3 7yr 5, 67, 139 +++ +,-.-

+
Parainfluenza, I lOmo 186 + + + +

type 1
Parainfluenza, I 6mo 51 + + + + +
type I
Parainfluenza, 1 6mo 97 + + + +
type 3
Reovirus,’ 1 17 nil) 9 + + + +
type I
Adenoviruses 1 lOmo 165 + + + t
type I
No virus 4 I3mo 98, 99, -‘ +, +.

recovere-l 138, 183
No. converting to the Heterotype 9/il 411 5/14 0,14 314 I, 14 1, 14 1 13 1/15
* Patient yielded influenza B virus from the nasopahrynx.
t Seropositive, first serum; no increase in titer. Symbols: + signs indicate a positive serologic response, four-fold increase. Each + repre-
sents a person, and is related linearly to the interval between first and second serum sample. Open areas indicate a negative serologic response.
Sera were obtained on the day of admission and again at intervals thereafter: 34 were obtained within I weeks, II within 1 month, and 7 within
I month., after onset of illness. For II patients the intervals between first and second serum samples ranged from 60 to 186 days.
fortnight he acquired antibodies for in- sion. Fifty-six patients of similar ages and
fluenza C virus (Table VII). Still others de- presenting with similar illnesses failed to
veloped multiple antibodies within a week; yield virus; nevertheless a fraction (30%)
for these infection must have been acquired converted to 4 viruses (Table VI) entered
outside the hospital. Finally, patients do not in the study. Thus, specific viruses were
often arrive at hospital at the onset of ill- associated with infections (see below for
ness. Some may have acquired antibodies mitigating circumstances) involving the res-
from a current primary infection but were, piratory tract of at least half the study
without recovery of virus, inseparable from population.
the already antigenically experienced mdi- A satisfactory correlation was obtained
vidual. between viruses recovered and develop-
ment of specific antibodies. Four virus-
COMMENT positive infants failed to convert (largely
Another attempt11 has been made in this paramnfluenza type 2 virus), and 11 virus-
study to assess the relationship of several negative patients collectively converted to
viruses with infections of the respiratory RS, adeno-, parainfluenza type 3 and in-
tract. Fifty-eight of 114 infants and children fluenza B viruses. Fifteen patients, all in-
presenting with several clinical expressions fants, except one experienced dual infec-
of infection yielded viruses; among the frac- tions either simultalleously as evidenced by
tion providing satisfactory serum samples recovery of 2 viruses, or in rapid succession
the majority (58%) experienced seroconver- as evidenced by rapid development of het-

of the viruses. These viruses were prevalent

in the community during the Winter and
Spring of 1962. Two-thirds of the patients
yielding RS virus developed pneumonia; a
corresponding fraction yielding influenza B
virus had illness referable principally to the
upper respiratory tract. Both viruses were
found also, however, with infections of
greater or lesser severity. Adeno-, reo-, and
00 parainfluenza viruses were associated also
INFLUENZA C
80 ECHO 28 with LTB, bronchiolitis, and pneumonia. An
60 NO MEASURABLE
hr 40 accounting of the virus serotypes encoun-
#{149} ANTIBODIES
Ui
0. 20 tered among these patients is given in Fig-
00 ure 6.
80 Infants are prime targets for most of the
60 viruses entered in the study. The primary
40
infection provides immunity, complete or
20
partial. Infection intervenes (Fig. 5) very
00
probably even before maternal antibodies
80
60 disappear. Young infants during outbreaks
40 have sharper clinical expressions of dis-
20 ease (bronchiolitis) than young children,
although many of the latter develop pneu-
4-6 3-24 >37 4-6 I324 >37 4-6 3-24 >37 monia, apparently another manifestation of
AGE IN MONTHS infection from RS virus. But in our earlier
Fic. 5. Serological contour maps for 14 viruses. The studiesbo,1 we failed to find an association
solid contours depict conversions; the stippled between RS virus and bronchiolitis or pneu-
contours the fraction already seropositive on admis-
monia. Infection was largely at the sub-
sion to hospital. Our strain, designated RS-related,
has serological distinctions from the prototype RS clinical level. Although the clinical expres-
virus. Data derived from 74 paired sera. sion, and epidemicity may have been modu-
lated by passive immunity, this explanation
erologous antibodies . Heterologous anti- is unsatisfactory. Nor is there any evidence
body rises could not be related to a sharing of increased virulence; while our RS strain
of antigens between viruses. is not identical* with the prototype (Long)
The long intervals lapsing after the pri-
mary illness and collection of some sera FREQUENC’
PERCENT
represent obstacles in relating the clinical o NO VIRUS ISOLATED 49

URS 16
expression to the antibody response. Inter- 0 INFLUENZA TYPE B I3

o PARA INFLUENZA TYPE I 3
pretations are difficult, particularly for pa- 0 - 2 S
- - _3 4
tients from whom virus was not recovered. #{149}REOVIRUS TYPE I 4
JII
O ADENOVIRUS 4
Since during infancy many of these viruses I MUMPS I

51 NOT IDENTIFIED I
recruit rapidly, and in successive waves, it

is quite possible that antibodies developing
from infections were unrelated to the illness Fic. 6. Proportionate association of several viruses
that brought the patient to hospital. More- with respiratory infection involving 1 14 infants and
over, even with optimal samples, the asso- children.
ciation of virus (and antibody development)

* RS viruses recovered from these patients are
with disease may not be definable with not serologically identical with the prototype Long.
complete assurance. The differences will be reported in a separate
RS and influenza B viruses comprise 55% study.

ARTICLES 41
TABLE VIII
TIlE SpEcIFIcITY OF TIlE SEIwL0GIc RESPONSES: DATA FOIL INFANTS AND TWo ViRus PAnts
Rates
No. of
Virus Paired Serologic Class Sero-Response Recovery of Virus
Sera
RS Influenza B RS influenza B
Pair I . RS/Irtfluenza B Virus Pairs
RS 37 1st serum RS+, converting to B 20 3 (15%) 2 (10%) 3 (100%)

Collversion to RS and B 17 3 (18%) 7 (41%) 0
Influenza B 21 1st serum B+, conserting to RS 6 (46%) 13 3 (50%) 0

Conversion to B and RS S (38%) 8 0 4 (50%)
Parainfluenza
Pair . Parainfluenza Type I/Type 3
Type 1 Type 3 Type 1 Type 3
Para 1 10 1st SFUH1 Type 1 +, converting to T3 4 (50%) 0 1 (50%)

Conversion to Types 1 and 3 6 (33%) 1 (17%) 1 (50%)
Para 3 7 1st serum Type 3+, converting to Ti 0 0 0 1 (5%)

Coisversiors to Types 3 and 1 (9%) 7 1 (50%) (9%)
This table illustrates but ‘2 of 6 virus pairs, and additionally included RS/parainfluenza, type I ; illflUenza B/
l)arItiflfluenza, ty)e 1, influenza B/reovirus type 1; and influenza C/reovirus type 1. These data highlight the fre-
quencies of both honsotypic and heterotypic antibodies (seropositives and converters) and the viruses associated
with specific seroconversion. Thus, using entries for RS in the first row, among ‘O RS seropositive persons S con-
verted to and yielded influenza B virus. In row i, among 17 RS seroconverters 3 also converted to influenza B;
while 7 yielded ItS, none yielded influenza B virus.
the clinical manifestations associated with fections than in preceding years. Our data,
it resemble those described for RS in other like those of others, indicate that RS and
9 parainfluenza viruses (types 1 and 2) may
Viruses like RS, influenza C, and several be associated with croup, bronchiolitis, and
parainfluenza viruses recruit steadily and pneumonia; however, a similar association
rapidly during infancy; by early childhood of parainfluenza type 3, reo- and adeno-
all have experienced past infection. Others ruT8 with the clinical complexes re-
such as influenza A and B viruses may re- mains, in our opinion, uncertain.
cruit with even greater rapidity, but gen- Finally, there is another fraction of pa-
erally periodically, although they may tients ( 30%) entirely dissociated from
linger in the community.14 Still others like those viruses entered in the study. The clini-
parainfluenza type 2 recruit less rapidly and cal evidence indicated that many of these
certainly more slowly; others like ECHO were associated with pathogenic bacteria,
28 and Coxsackie A21 have not involved although it is not known that they were the
infants and children of this area for at least primary invaders. Lower respiratory tract
5 years. Antibodies for selected viruses in infections were associated with leukocytosis
several study populations are compared in twice as often in the virus-negative as the
Table X. virus-positive groups. Patients with LTB
Our recovery of viruses is in good agree- had leukocytosis with equal frequency in
ment with reports of others, particularly both groups. In the virus-positive group
for RS 15 RS virus was associated leukocytosis accompanied infections yield-
more often with lower respiratory tract in- ing adeno-, reo- or parainfluenza types 2

TABLE IX
Tii E CLINiCAL (‘ATEGoJuEs: RATES OF S>:1tocoN VERSION
1requeniie.s’ (%) for Inelu’eited I iru.c

.‘so, .\‘() (‘(Ill-
(‘Iinieal I’ersnii.s’ / .
(Ir(Il/l/!I1(’Il (I - /of!ucit-.ia ks [leo
version.
(‘alegory in (‘lass -#{149} -- Ii, jie I 1(/(00
11/11111) 1(1 .1iij
JJ(;J) P7rus
1 .? - i? (‘ Long
Pneumonia
Bronc’litis
__;;;__
17 il 6 i
h 6 l 0
3’2
‘29
‘29
‘23
3
0
11
0
3
0
4’2
35
LTB 5 0 ‘20 ‘2() 0 ‘2() 0 ‘20 ‘20 0 ‘20 0 60
URI 15 0 0 8 0 33 0 13 8 7 0 0 40
Other 6 O (1 (1 0 33 0 33 ‘25 0 0 0 50
Totals 74 8 3 10 1 ‘21 ‘2 ‘27 23 3 6 ‘2 4’2
Conversions ss-ere not ol)taine(1 for influellza A2, E(’Il() 28, co (‘oxsackie A21 viruses. The cous-ersjoii rates for
iiiiy virus isolated iii the several c11111(’al categories ranged from 50 to 100% (‘Fable VIII).
S Strain “87” is hot serologit’ally ideuti-al with the l)rotot’pe strain (Long). Only a fraction of tile sera relnailled
for tests st’ith straiii “87. “ ‘l’here ssas !)53- agreeisieiit between strains with ItS poSitive scm.
and 3 viruses. On the other hand, H. in- flora of these and tile virus-positive group.
fluenzae and Str. pneumoniae were often Our results suggest that essentially similar
encountered with equal frequency in virus- clinical expressions of respiratory infections
positive and virus-negative patients. The may be obtained from several viruses, some
only significant difference was the predomi- pathogenic bacteria, or both. Such infec-
nance of pneumococci in the nasopharynx tions, although differing presumably in
(in association with leukocytosis) among in- pathologic detail, are not singularly corre-
fants with bronchopneumonia. Although lated with specific anatomical sites of in-
leukocytosis developed in virus-negative jury. Many of these infectious agents are
patients with lobar pneumonia, no signifi- associated with infections of the upper as
cant differences were found in the bacterial well as the lower respiratory tract. Although
‘FABLE X
SEItoIoGI’AI (‘011 I’OSITION OF SF:sF:1tA1 STUDY PoPuIATIoNS

i958-6
Kind of Virus
No.of -- -- ------------------________________ -________
Age Group
(yr)
Persons
Years
I
2
---
Parainfluon:a
3
115
.4
Influenza
B
--__________
C
abc a be abc abc abc abc abc
‘t ropositire
6 mo-I years 19 4I41 75 I864l444I3l59 65800 71540 146619

1-3 years 18 10 6 II 10 0 100 100 50 90 30 100 80 100 0 6 II 33 40 100 33
Over 3 years 80 18 9 10 60 11 95 89 89 94 33 89 75 71 100 68 17 89 61 100 89
(‘inrerters
6 mo-I ye-irs 1) 11 41 3 1 0 38 1 II - 15 7 19 0 4 0 4 0 15 14 1 1(1

1-3>’ears 18 10 6 5 10 0 6 0 0 8 10 33 0 0 0 0 10 17 15 0 0
Over 3 ye irs 80 1 9 4 6 0 1 0 0 7 II 11 1 11 (1 5 II 67 II 0 0
(a) 19.58-59; (h) 199-60; (e) 161-61. ee references 10 and 11. Entrei un(ler kind of virus are percentage values.

ARTICLES 43
epidemiologic data indicate that these vi- tamed of concurrent bacterial infection in a
ruses have an impact on the pathogenesis fraction of patients yielding viruses.
of lower respiratory tract infections, as yet
we are not completely convinced that all REFERENCES
die viruses recovered or those eliciting anti-
1. Chanock, H. M. : Association of new type of
bodies in the study are the primary patho- cytopathic myxovirus with infantile croup.
gens responsible for LTB, bronchiolitis, and J. Exp. Med., 104:555, 1956.
pneumonia. At best we have been able to 2. Beale, A. J., et a!.: Isolation of cytopathic
link about 50% of the infections in our pa- agents from respiratory tract in acute tra-
cheobronchitis. Brit. Med. J., 1:302, 1958.
tients with specific viruses; another fraction
3. Vargosko, A. J., et a!.: Association of type 2
( 30%) may be associated with bacterial hemadsorption (parainfluenza 1) virus and
pathogens. Finally, we believe there is hid- Asian influenza A virus with infectious
den among both groups a fraction in which croup. New Engl. J. Med., 261:1, 1959.
both viruses and bacteria may influence the 4. Philipson, L. : Aetiology of non-diphtheritic
croup. II. Virologic investigations. Acta
course of infection.
Pediat., 47:4, 1958.
5. Kurova, M., and Isheda, N. : Newborn virus
SUMMARY
pneumonitis (type Sendai). II. The isolation
Sixty viruses were recovered from 58 of of a new virus possessing hemagglutinin
114 infants and children ill of respiratory activity. Yokahama MCCI. Bull. 4:217, 1953.
6. Parrott, R. H., et al.: Clinical features of in-
infections. Two outbreaks, one caused by
fection with hemadsorption viruses. New
RS and the other by influenza B viruses, Engl. J. Med., 260:731, 1959.
occurred during the study period. RS and 7. Beem, s-I. : Association of the chimpanzee
influenza B viruses totaled 55% of the virus corvza agent with acute respiratory dis-
yield. Other viruses recovered were para- ease in children. New Engi. J. Med., 263:
522, 1960.
influenza types 1, 2 and 3 (14 strains), reo-
8. Chanock, R. NI., et al.: Respiratory syncytial
virus, type 1 (5 strains), adenovirus (5
virus. I. Virus recovery and other observa-
strains), and mumps (1 strain). Two viruses tions during 1960 outbreak of bronchiolitis,
were lost and remain unidentified. pneumonia, and minor respiratory diseases
Good correlation was obtained between in children. J.A.M.A., 176:647, 1961.
viruses and development of specific anti- 9. McClelland, L., et al.: Studies of acute respira-
torY illnesses caused l)% respirator syncytial
body. A small fraction of infants had dual
virus. 2. Epidemiology and assessment of
virus infections; heterotypic antibody re- importance. New Engl. J. Med., 264:1169,
sponses were observed in 20% of the pa- 1961.
tients. These were considered to represent 10. \Venner, Fl. A., et al: The epidemiology of
acute respirators’ diseases. II. Risk of infec-
in part successive infections with specific
tion among infants and family associates
viruses.
from viruses accompanying respiratory ill-
Fourteen of 18 RS viruses, 6 influenza, nesses. PEDIATRICS, 28:886, 1961.
and all except one of the parainfluenza vi- 11. Wenner, H. A., et al.: The etiology of respira-
ruses (type 3) were associated with laryngo- tory illnesses occurring in infancy and child-
hood. PEDIATRICS, 31:4, 1963.
tracheobronchitis, bronchiolitis, and pneu-
12. Pike, R. M. : An enrichment broth for isolating
monia. None was associated with any single
hemolvtic streptococci from throat swabs.
clinical category. RS was associated more Proc. Soc. Exp. Biol. Med., 57:186, 1944.
often with pneumOllia than bronchiolitis; 13. Toolan, II. V. : Transplantable human neo-
influenza B was associated less often with p1isms m:iintained in cortisone-treated lab-
these than with upper respiratory infection. orator animals: lIS. # 1; 1-1. Ep. # 1;
I-I. Ep. #2; II. Ep. #3; and H. Emb. Rh.
Analysis of virus-positive and virus-nega-
#1. Cancer Res., 14:660, 1954.
tive subgroups for bacterial “pathogens”
14. Jordon, W. S., Jr., et al.: A study of illness
and leukocytosis indicated that pneumonia in a group of Cleveland families. XVI. The
of virus-negative infants was very likely epidemiology of influenza, 1948-1953. Amer.
bacterial in origin. Evidence was also ob- J. Hyg., 68:169, 1958.

15. VivelI, 0., et al.: Serologische und klinische 17. Chany, C., et a!.: Severe and fatal pneumonia
Untersuchungen #{252}ber
Viruserkrankungen des in infants and young children associated
Respirationstraktes. IV. Epidemiologische with adenovirus infection. Amer. J. Hyg.,
Beobachtungen bei Respirationstrakterkran- 67:367, 1958.
kungen der Jahre 1957-1961. Z. f. Kinderh., 18. Jen Kuie-Fang, et a!.: The role of adenovirus
86:553, 1962. in the etiology of infantile pneumonia and
16. Dienhardt, F., et al: The isolation of adeno- pneumonia complicating measles. Chin.
virus type 1 from a fatal case of viral “pneu- Med. J., 81:141, 1962.
monitis.” Arch. mt. Med. 102:816, 1958.
PROTEIN METABOLISM, INFLUENCE OF scriptions in which the trend of thought is at

GROWTH HORMONE, ANABOLIC STEROIDS times difficult to follow and some irrelevant
AND Nu-nirrioN IN HEALTH AND DISEASE. material is included.
An International Symposium, edited by The strong points of the publication from tile
pediatrician’s viewpoint are the assembling in
F. Gross, Berlin: Germany, Springer-
one volume of much relatively recent material
Verlag, 1962, 521 pp.
not easy to find elsewhere, a comprehensive
Even among scholarly pediatricians, few list of references, a valuable and concise chap-
except those with particular dedication to en- ter, “Metabolic Effects of Growth Hormone in
docrinology will be motivated to read through Man,” by M. S. Raben, et al., an excellent
a major portion of this book. Most of the analysis of human growth by J. M. Tanner,
presentations concern mode of action or re- “Evaluation of Growth and Maturity in Chil-
sults of laboratory or clinical trials with ana- dren,” and a chapter by A. Prader and R. Illig
bolic steroids. Discussions after each of the on use of anabolic agents (including anabolic
formal presentations provide some interesting steroids and growth hormone) in disorders of
data and opinions, but in many instances these growth.
discussions appear to be nearly verbatim tran-
SAMUEL J. For%Lorc, M.D.

ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies during Infancy and
Childhood
Herta Wulff, Patricia Kidd and Herbert A. Wenner
Pediatrics 1964;33;30-44
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org
Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in
its entirety can be found online at:
http://www.pediatrics.org/misc/Permissions.shtml
Reprints Information about ordering reprints can be found online:
http://www.pediatrics.org/misc/reprints.shtml

Childhood ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies During Infancy and

Încărcat de

Informații document

Descriere originală:

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Childhood ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies During Infancy and

Încărcat de

Drepturi de autor:

Formate disponibile

ETIOLOGY OF RESPIRATORY INFECTIONS: Further Studies during Infancy and

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

Herta Wulif, Ph.D., Patricia Kidd, and Herbert A. Wenner, M.D.

INTRODUCTION MATERIALS AND METHODS

categories have been described elsewhere.l

(Submitted Ma 3, 1963; accepted for publication August 15.)

PEDIAnucs, January 1964

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

fusion broth containing penicillin (800 units),

Samplings included nose and throat swabs

Each nose and throat swab was plated

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

methods described pre’iousl.1#{176} By corn plc-

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

RECovERY OF Str. jnteuinoiiiae AND H. influenzae FROM THE N&soviijiyxx

No. of Persons Frequency (%)

Clinical Category “P.V.’+

No. of Persons Frequency (%)

Lobar Virus + 5 5 40 40 0 8()

included in this table.

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

Category Class > WI/C , > WI/C

Age <12 mo. 27 6 22 21 11 52

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

S.IPIINGS Thi AT ‘IELDED Sp’IFI ED \IRUSES

Nasopharyngeal (N) 114 10 5 1 1 1 18

Totals 286 18 15 365 5 5 I ‘2 60

I)ISTJI1BITIoN OF \IJttSES A((ORDING TO (‘h.INIcAI CATEGORI ES

RS Influenza B Parainftucnza, Types Reo .ldeno Slumps So Virus

xo. % .\-o. % y0 c % xo.

S Includes S children entered in Figure with influenza.

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

ing the peak prevalence of RS and influenza 80

veloped antibodies to two or more viruses 2:

others. However, 7 converted to parainflu-

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

CoNv:JLsIoN RATES (%) AMONG PATIENTS IELD1NG SPECIFIED \‘IRUSES

Seroposilire (1st serum) Conrcrters

Parainfluenza, type 4 0 0 0 50 3 75 0 .50 0 0

Parainfluenza, type 3 4 0 3 0 0 .50 0 0 0 100 0 5t

Reo 0 0 0 0 0 0 0 100 0 0 0 0 100 0

All virus-positive 36’ 36 1$ II 44 36 .50 41 3-1 17 6 17 9 8

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

SEROCONVF:IOSION OBTAINED TO Two OR MORE \IRUSES

interval troconrersion f-r

115 3 7mo 8, 33, 90 +++

Influenza II 3 7yr 5, 67, 139 +++ +,-.-

Parainfluenza, I lOmo 186 + + + +

Adenoviruses 1 lOmo 165 + + + t

No virus 4 I3mo 98, 99, -‘ +, +.

* Patient yielded influenza B virus from the nasopahrynx.

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011

of the viruses. These viruses were prevalent

represent obstacles in relating the clinical o NO VIRUS ISOLATED 49

expression to the antibody response. Inter- 0 INFLUENZA TYPE B I3

pretations are difficult, particularly for pa- 0 - 2 S

tients from whom virus was not recovered. #{149}REOVIRUS TYPE I 4

Since during infancy many of these viruses I MUMPS I

recruit rapidly, and in successive waves, it

ciation of virus (and antibody development)

Downloaded from www.pediatrics.org. Provided by Indonesia:AAP Sponsored on March 15, 2011