[Etiology of lower respiratory infections in hospitalized infants]

As a contribution to knowledge about the etiology of lower respiratory tract infections (LRI) in infants, 235 patients aged one year or less admitted to a children's hospital at northern metropolitan area of Santiago, Chile along years 1987 throughout 1989 with radiologically confirmed diagnosis were studied. Infants were eligible only if their symptoms lasted for not more than five days and their hospital stay was less than two days. Controls consisted on 74 healthy infants. A search for presumptive etiology was done by means of usual bacteriological procedures (pharyngeal swabs and blood cultures), plus latex test for type b Haemophilus influenzae (Hib) and Streptococcus pneumoniae (SP) in concentrated urine specimens; indirect immunofluorescence (IF) for specific Chlamydia trachomatis (CT) IgM; serological tests, isolation and IF in pharyngeal aspirates for syncytial respiratory virus (SRV), influenza, parainfluenzae and adenoviruses were also used. Evidence of viral infection was detected from 135/235 (57.5%) of cases and 21/74 (28.3%) controls, SRV being the most common. From 18/119 and 2/119 studied patients Hib and SP antigens were respectively detected, but urinary antigens were also present in 6/24 controls, raising questions about this test's specificity. IF titers of 1:32 or higher for CT were found in 5/80 patients, all younger than 5 months. It was possible to perform the whole set of available methods in 80 patients, in 70% of which some evidence of a known etiologic agent was found. Serology alone gave etiological clues in only 30% of these cases and usual microbiological cultures of throat swabs and blood from none of them. No combinations of age, fever, respiratory rate, apnea, bronchial obstructive syndrome, white blood cell counts over 15,000 or of band forms over 500 per cu mm, erythrocyte sedimentation rates, reactive C protein and x-ray findings allowed differential diagnosis between presumptive bacterial or viral etiology, except in one case of an infant presenting with pleural effusion and positive antigenuria for Hib.