scholarly journals Article Research Differentiation Between Typhoid and Typhus Fever Infection and Coinfection with Limited Resources in Iraq

2021 ◽  
Vol 8 (5) ◽  
pp. 213-217
Author(s):  
Fatma Abdalhamza Obed
Keyword(s):  
Enteric Fever ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Salmonella Typhi ◽  
Limited Resources ◽  
Widal Test ◽  
Rickettsial Infections ◽  
Male Patients ◽  
Typhus Fever ◽  
Test Slide

Enteric fever is caused by the Gram-negative bacilli Salmonella typhi and paratyphi, which have similar signs and symptoms to typhus and rickettsial illness. Both typhoid fever and rickettsia typhus, whether endemic or epidemic, have similar presentations, making it difficult to distinguish between the two diseases. As a result, co-infection of typhoid and typhus fever can be ignored if not recognized clinically. Serum was collected from 182 patients from the Suweib and fourth shurta areas who had a temperature of more than 38°C and two or more signs and symptoms of typhoid and typhus, such as headache lasting more than a week, rash, myalgia, arthralgia, and bleeding. Started with widal test slide method All result results confirmed by tube method Same samples investigated for typhus infection by weil-felix tests. Data entered to analyzed by SPSS program. the results were appeared of the 182 patients tested, 58 (18%) yielded results suggested that rickettsial infections or typhoid were the most likely because of their illnesses. patients’ age ranged from 8 to 75 years with mean age 29.10 years. The majority were female and mainly student (41.4%) and housewife (25.9%) by age and sex for the 58 patients for whom data were recorded. Age groups did not differ significantly (p > 0.5). The frequency of disease was 69% in female patients and 31% in male patients (p < 0.005). Finally, can Concluded Both widal and weil-felix test should done specially if no responses to typhoid treatment and depend on trial therapy by adding doxycycline in case that more sensitive and accurate tests are not available.

scholarly journals CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Poonam Meena ◽  
Satish Meena ◽  
Ashok Meena ◽  
Kailash Meena
Keyword(s):  
Typhoid Fever ◽  
Prospective Study ◽  
Enteric Fever ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Definitive Diagnosis ◽  
Clinical Profile ◽  
Widal Test ◽  
Clinical Signs And Symptoms

Background: The present study describes the clinical presentation of typhoid fever. Methods: The study was a hospital based prospective study. Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. Results: Commonest sign noticed was toxic look (88.00%) followed by coated tongue (79.00%) and splenomegaly (63.00%). Hepatomegaly was also noted in 35.00% of cases. Conclusion: Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission. Keywords: Enteric fever, Splenomegaly, Toxic look

scholarly journals Epidemiological Study of Salmonella typhi and Its Month-Wise Effect on Different Age Groups in Dehradun

2020 ◽  
pp. 256-260
Author(s):  
Sandhya Maurya ◽  
Chetna Kalra ◽  
Rupesh Kumar Mahto ◽  
Sandeep Singh ◽  
Narotam Sharma ◽  
...  
Keyword(s):  
Age Groups ◽  
Salmonella Typhi ◽  
Oral Route ◽  
Bacterial Disease ◽  
Widal Test ◽  
Igg Antibody ◽  
Contaminated Food ◽  
Waterborne Infection ◽  
Flagellar Antigen ◽  
Card Test

Introduction: Salmonella typhi is a bacterial disease caused by contaminated food and water, also known as foodborne and waterborne infection, it transmitted via faeco-oral route. Materials and Methods: A total of 204 clinical isolates were considered for its proposed study. IgM/IgG rapid card test (CTK Biotech) was used for the detection and Widal test (BEACON) was also performed for the same. Duration: March 2020 to November 2020. Results: A total of 204 blood samples were analyzed with clinically suspected cases of typhoid fever, out of which, some cases showed reactiveness and 50.98% showed negative for Salmonella typhi. Widal test showed reactive result for O Ag (Somatic Antigen) and H Ag (flagellar antigen) and 8.82% IgG and 42.64% (monthly) IgM antibody showed positive result. Conclusion: Typhoid IgM/IgG antibody rapid card test and Widal Antigen test, a simple and rapid method for the detection of Salmonella typhi bacterium in patient’s serum by serological techniques. Maximum number of positive cases were in the month of August, 2020 and September, 2020. The age group between 21-40 years were most infected by Salmonella typhi.

scholarly journals USE OF WIDAL TEST IN DIAGNOSIS OF TYPHOID FEVER IN NORTH INDIAN POPULATION BY ESTIMATING BASELINE TITER IN CONTROL GROUP

2017 ◽  
Vol 10 (7) ◽  
pp. 251
Author(s):  
Shetty Jeevan
Keyword(s):  
Typhoid Fever ◽  
Healthy Volunteers ◽  
Enteric Fever ◽  
Early Recognition ◽  
Test Group ◽  
Salmonella Typhi ◽  
Control Group ◽  
Age Group ◽  
Widal Test ◽  
Medical College

Objective: This study was undertaken to establish a cutoff significant titer for Widal test using healthy volunteers as control group. Utilizing the baseline titer obtained from the control group, a diagnosis of typhoid fever was made in the test group comprising outpatients and inpatients. Methods: Blood samples were collected from healthy volunteers and patients attending G.S Medical College and Hospital, Pilkhuwa, over a period of 6 months from September 2016 to March 2017. Antibodies to Salmonella typhi (TO, TH) and Paratyphi A (AH) and Paratyphi B (BH) are determined by this tube agglutination test. A total of 124 healthy controls and 303 patients having clinical suspicion of typhoid fever were subjected to Widal test. Results: In healthy control group, titer TO ≥20 was observed in 43 (34.7%), TO ≥40 in 48 (38.7%), TO≥80 in 25 (20.2%), and titer TO ≥160, TO ≥320 was observed in none of the control group. Titer TH ≥40 in 58 (46.8%), AH ≥40 in 7 (5.6%), and BH ≥40 in 13 (10.5%) were observed in the control group. Among the test group, 96 (31.7%) sera were positive out of 303 clinically suspected enteric fever by the Widal test. Among different age group studied, 34 (46.6%) patients belonged to the age group of 11-20 years which formed the highest followed by the age group of 21-30 years (33.3%). Conclusion: Based on the study, a cutoff titer of ≥160 for anti-O and anti-H antibodies and titer of ≥80 for anti-AH and anti-BH antibodies be considered as significant titer in diagnosis of enteric fever in this region. The baseline titer helps in early recognition and treatment of this serious health problem.

scholarly journals Antimicrobial Resistance in Typhoidal Salmonella: Surveillance for Enteric Fever in Asia Project, 2016–2019

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S276-S284 ◽  
Author(s):  
Farah N Qamar ◽  
Mohammad T Yousafzai ◽  
Irum F Dehraj ◽  
Sadia Shakoor ◽  
Seema Irfan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Enteric Fever ◽  
Treatment Options ◽  
Age Groups ◽  
Febrile Illness ◽  
Preventive Measure ◽  
Salmonella Typhi ◽  
Study Participants

Abstract Background Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. Methods From September 2016–September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. Results We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal. Conclusions Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine.

scholarly journals A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi.

2020 ◽  
Author(s):  
Saba Shahid ◽  
Marvi Mahesar ◽  
Nida Ghouri ◽  
Saba Noreen
Keyword(s):  
Enteric Fever ◽  
Clinical Course ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Systemic Infection ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Enteric fever is a systemic infection, which can be caused by Salmonella enterica; Typhi and Paratyphi A. Over time, Salmonella Typhi has developed resistance to antibiotics resulting in the emergence of extensively drug-resistant (XDR) enteric fever. WHO estimated 5274 cases of XDR Enteric fever in Karachi from November 2016 to December 2019. This study aims to determine clinical course, complications and outcomes of XDR enteric fever among the pediatric population coming to Indus HospitalMethods: A retrospective chart review of pediatric patients (aged one month to 15 years) seen in Indus Hospital between July 2017 to December 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about seasonality and distribution of cases, demographic details, signs and symptoms, clinical course, treatment, complications and outcomes of the cases treated for XDR Enteric feverResults: Six hundred and eighty children were included in the study. The median (IQR) age of the patients was 5 (2-8) years. More than half (n=391, 57.5%) of the patients were males. Most common clinical manifestations included fever, vomiting and diarrhea, noted in 680 (100%), 242 (35%) and 174 (25%) patients. Outcomes of 270 (39.7%) patients were recorded. Others were lost to follow up [351 (51.6%)], referred out [52 (7.6%)] or left against medical advice [7 (1%)]. 266 (39.1%) patients were cured, and four children (0.6%) expired. Seventy-eight patients (82%) and 15 patients (16.3%) got cured on Azithromycin and Meropenem alone while 157 on a combination of drugs.Conclusion: Our review indicated that children under five years of age were affected more with XDR Enteric fever. Meropenem and Azithromycin, either alone or in combination were the most effective antibiotics for treating XDR Enteric fever in children coming to Indus hospital

scholarly journals Comparative evaluation of rapid Salmonella Typhi IgM/IgG and Widal test for the diagnosis of enteric fever

2020 ◽  
Vol 14 (1) ◽  
pp. 18-25
Author(s):  
Farjana Akter ◽  
Mahmuda Yeasmin ◽  
Md Zahangir Alam ◽  
Md Rokibul Hasan ◽  
Fahmida Rahman ◽  
...  
Keyword(s):  
Blood Culture ◽  
Sensitivity And Specificity ◽  
Enteric Fever ◽  
Salmonella Typhi ◽  
Widal Test ◽  
Diagnostic Challenge ◽  
Medical College ◽  
Resource Limited ◽  
Test Kit ◽  
User Friendly

Background: Accurate and early diagnosis of enteric fever is a diagnostic challenge where facility for blood culture is not available. As a result, Widal test is still used widely in resource limited settings. Recently, user-friendly rapid immunochromatographic tests (ICT) have been introduced for quick diagnosis of enteric fever. So, we evaluated sensitivity and specificity of an immunochromatography based Salmonella Typhi IgM/IgG test kit and Widal test compared to blood culture for the diagnosis of enteric fever. Method: The study was conducted in the Department of Microbiology, Ibrahim Medical College (IMC) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from June 2017 to September 2017. Clinically suspected enteric fever cases were included. Blood culture, Widal and Salmonella Typhi IgM/IgG detecting ICT were employed for the diagnosis of enteric fever. Results: Out of 71 suspected cases of enteric fever, blood culture was positive in 36 cases (50.7%) while 42 (59.15%) and 35 (49.29%) cases were positive by Widal test and ICT respectively. Widal and ICT had sensitivity and specificity of 100% and 89.9% and 82.9% & 91.4% respectively. Conclusion: Findings of the study suggest that both Widal and immunochromatographic tests can be used interchangeably for rapid diagnosis of enteric fever. Ibrahim Med. Coll. J. 2020; 14(1): 18-25

scholarly journals A Reappraisal of Clinical Characteristics of Typhoid Fever

2012 ◽  
Vol 34 (3) ◽  
pp. 80-85 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Sanjana Zaman ◽  
Farhana Chaiti ◽  
Naveen Sheikh ◽  
Gopen Kumar Kundu
Keyword(s):  
Typhoid Fever ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Health Resources ◽  
Signs And Symptoms ◽  
Salmonella Typhi ◽  
Widal Test ◽  
Missed Diagnosis ◽  
The Mean

Background: Recent reports from developing countries show that the clinical presentation, diagnosis and treatment of typhoid have significantly altered often leading to missed diagnosis. The incidence of complications is also reported to be variable. The consequence of missed diagnosis is immense in terms of burden on limited health resources and patients’ suffering. Therefore, its clinical spectrum requires constant reappraisal to update our physicians with current knowledge. This study was carried out to determine the changes in clinical pattern of typhoid fever. Patients & Methods: A total of 106 children, aged up to 14 years, diagnosed primarily as typhoid fever, were included as study population. The diagnostic criteria were either positive blood culture for Salmonella typhi or Salmonella paratyphi or at least a four-fold rise in antibody titre on Widal test. The study included mode of clinical presentations, treatment received before admission, Widal test findings and culture and sensitivity to antibiotics. Results: The mean age of the patients was 5.2 years and males were a little than the females. The mean duration of illness was 11.2±3.3 days. Majority of the patients presented with classical signs and symptoms like step ladder pattern of fever (nearly 70%) coated tongue (69.8%), diarrhoea (49.1%), toxemia (68.9%), relative leucopenia (71.7%), hepatomegaly (55.7%), pain in the right hypochondrium (41.5%) and splennomegaly (18.9%). Very few cases had a typical manifestations. Over 85% of the patients had raised SGPT (>40 IU/L) and 13.8% had detectable jaundice (serum billirubin >3 mg/dl). Widal test demonstrated that about 45% of the patients’ ‘O’ antibody titer increased to 4-fold, 27.4% to 8-fold or more. In case of antibody ‘H’, 35.8% exhibited 4-fold and 39.7% 8-fold or more increase. Of the 103 cases, 68(66%) were positive for Salmonella typhi. Majority of the isolated organisms was sensitive to cefixime, ceftriaxone and gentamycin (83%, 84% and 82% respectively). The second line of sensitivity was obtained to amikacin (64.2%), meropenem (50%), ciprofloxacin (46.2%), imepenem (46.2%) and azithromycin (43.4%). The least sensitive drugs were amoxicillin (28.3%), cotrimoxazole (27.4%) and chloramphenicol (22.6%). Onethird (33.8%) of the patients had multidrug resistant (MDR) strains. However, No significant association was found between multi-drug resistant (MDR) strains and atypical clinical manifestations. Conclusion: Clinical presentation of most typhoid fever still conforms with the classic pattern. High fever, anorexia, coated tongue, diarrhoea, relative leucopenia and hepatosplenomegaly are still common manifestations of typhoid fever. So, majority of the patients could be treated blindly based on clinical diagnosis. However, treatment should be given with first line of drugs like cefexime or ceftriaxone. DOI: http://dx.doi.org/10.3357/bjch.v34i3.10357 BJCH 2010; 34(3): 80-85

scholarly journals A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug resistant (XDR) Salmonella Typhi isolates in children in Karachi.

2020 ◽  
Author(s):  
Saba Shahid ◽  
Marvi Mahesar ◽  
Nida Ghouri ◽  
Saba Noreen
Keyword(s):  
Enteric Fever ◽  
Clinical Course ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Systemic Infection ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Enteric fever is a systemic infection, which can be caused by Salmonella enterica; Typhi and Paratyphi A. Over a period of time Salmonella Typhi has developed resistance to many antibiotics which has resulted in emergence of extensively drug resistant (XDR) enteric fever. WHO estimated 5274 cases of XDR Enteric fever in Karachi from November 2016 to December 2019.This study aims to determine clinical course, complications and outcomes of XDR enteric fever among the pediatric population coming to Indus HospitalMethods: A retrospective chart review of pediatric patients (aged 1 month–15 years) seen in Indus Hospital between July 2017 to December 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about seasonality and distribution of cases, demographic details, signs and symptoms, clinical course, treatment, complications and final outcomes of the cases treated for XDR Enteric feverResults: Six hundred and eighty children were included in the study. The median (IQR) age of the patients was 5 (2-8) years. More than half (n=391, 57.5%) of the patients were males. Most common clinical manifestations included fever vomiting and diarrhea which were noted in 680 (100%), 242 (35%) and 174 patients (25%) Final outcomes of 270 (39.7%) patients have been recorded; 351 (51.6%) were lost to follow up, 52 (7.6%) were referred out and 7 (1%) left without medical advice. 266 (39.1%) patients were cured and 4 children (0.6%) expired. Seventy eight patients (82%) and 15 patients (16.3%) got cured on Azithromycin and Meropenum alone while 157 patients got cured on combination of drugs.Conclusion: Our review indicated that children under 5 years of age were affected more with XDR Enteric fever. Meropenum and Azithromycin, either alone or in combination were the most effective antibiotics for treating XDR Enteric fever in children coming to Indus hospital

scholarly journals TYPHOID FEVER

2007 ◽  
Vol 14 (04) ◽  
pp. 620-626
Author(s):  
MAQSOOD AHMAD ◽  
Badar Bashir ◽  
MUHAMMAD SAEED AKHTAR ◽  
Muhammad Irfan ◽  
MUHAMMAD AMER ADIL ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Salmonella Typhi ◽  
Blood Cultures ◽  
Efficacy And Safety ◽  
Widal Test ◽  
Male Patients ◽  
The Mean ◽  
Almost All ◽  
Study Setting ◽  
Symptoms And Signs

Objectives: To find out the efficacy and safety of Levofloxacinin patients suffering from typhoid fever. Design: Non-comparative and prospective study. Setting: Medical Units ofAllied & DHQ Hospital (PMC) Faisalabad. Period: From May 2002 to July 2004. Material & Methods: All suspectedfebrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose ofstudy till they were satisfactorily discharged. Results: This clinical study was conducted on 70 patients of Enteric Fever.Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58± 8.13while the mean age of females was 21.92± 4.73 years. Fever as a symptom was present in all 70(100%) of thepatients. Anorexia was there in 61(85.5%)patients and abdominal pain in 49(70%) patients. Twenty-seven (38.5%)patients had constipation along with other features. Diarrhea was present in 6 (8.5%) patients. Relative bradycardiawas present in 20(28.5%) patients. Hepatomegaly was there in 31(44.3%) and Splenomegaly in 24(34.3%). Elevatedliver enzymes were found in 29 (41.4%) of the patients and blood cultures positive for Salmonella typhi was seen in19(27.1%) patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18%of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of feverand other symptoms and signs. The side effects were seen in 17(24.2%) patients. Conclusions: In conclusionlevofloxacin is effective in treatment of typhoid fever and its use in this indication is safe.

scholarly journals 1465. Age-Dependent Interactions Among Clinical Characteristics, Viral Loads and Disease Severity in Young Children with Respiratory Syncytial Virus Infection (RSV) Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S734-S735
Author(s):  
Helena Brenes-Chacon ◽  
Cristina Garcia-Maurino ◽  
Melissa Moore-Clingenpeel ◽  
Sara Mertz ◽  
Fang Ye ◽  
...  
Keyword(s):  
Young Children ◽  
Disease Severity ◽  
Age Groups ◽  
Panel Member ◽  
Signs And Symptoms ◽  
Research Support ◽  
Review Panel ◽  
Viral Loads ◽  
Age Dependent ◽  
Rsv Infection

Abstract Background Differences in clinical presentation and viral loads according to age in young children with RSV, and their correlation with disease severity are poorly defined. The aim of this study was to define age-dependent the differences in demographic, clinical factors and viral loads between children &lt; 2 years of age with mild RSV infection evaluated as outpatients versus those hospitalized with severe RSV infection. Figure 1. Sign and Symptoms according to disease severity and age in infants with RSV infection. Most relevant signs and symptoms were stratified in outpatients (orange) vs inpatients (blue) by age in (A) &lt; 3 months, (B) between 3 and 6 months, and (C) &gt; 6 to 24 months of age. The Y axis represents the signs and symptoms in the two disease severity groups and the X axis the frequency of that specific symptom (%). Numbers next to bars represent the exact number of patients with that specific sign/symptom. Comparisons by Fisher exact test. Symbol (*) indicate significant 2-sided p values Figure 2. Viral load differences according to age in infants with RSV infection. The Y axis represents RSV loads in log10 copies/mL and the X axis differences in viral loads in outpatients (orange) and inpatients (blue) in the three age groups. Comparisons by Mann Whitney test. Methods Previously healthy children &lt; 2 years old with mild (outpatients) and severe (inpatients) RSV infection were enrolled and nasopharyngeal swabs were obtained for RSV typing and quantitation by real-time PCR. Patients were stratified by age (0-&lt; 3, 3-6, and &gt;6-24 months) and multivariable analyses were performed to identify clinical and viral factors associated with severe disease. Results From 2014-2018 we enrolled 534 children with RSV infection: 130 outpatients and 404 inpatients. Median duration of illness was 4 days for both groups, yet viral loads were higher in outpatients than inpatient in the three age groups (Fig 1). Wheezing was more frequent in outpatients of older age (&gt;3 months) than in inpatients (p&lt; 0.01), while fever was more common in inpatients that outpatients (p&lt; 0.01) and increased with age (Fig 2). Adjusted analyses confirmed that increased work of breathing and fever were consistently associated with hospitalization irrespective of age, while wheezing in infants &gt;3 months, and higher RSV loads in children &gt;6-24 months were independently associated with reduced disease severity. Conclusion Age had a significant impact defining the interactions among viral loads, specific clinical manifestations and disease severity in children with RSV infection. These observations highlight the importance of patient stratification when evaluating interventions against RSV. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Advisor or Review Panel member)Roche (Advisor or Review Panel member)

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