Study of Aetiology of Acute Respiratory Tract Infection in Adult Outpatients in Bangladesh Institute of Tropical and Infectious Diseases (BITID) in Chattogram, Bangladesh by Filmarray Respiratory Panel Assay in Nasopharyngeal Swab

Author(s): Dr. Istiak Ahmad, Prof. Dr. Md Shakeel Ahmed, Prof. Dr. Md Mamunur Rashid, Dr. Md Zakir Hossain, Dr. Ratan Kumar Nath, Dr. Saifuddin Mahmud, Dr. Tabassum Ferdousi, Dr. Farzin Akhter, Dr. Mohammad Rifat Kamal, Zahirul Islam.

Background:

According to World Health Organization (WHO) respiratory infection account for 6% of total global disease burden. In Bangladesh acute respiratory tract infection (ARTI) are one of the leading causes of heath care visit for both adult and children. ARTI can be caused by a heterogeneous group of viruses and bacteria that produce similar clinical presentations. Although viruses are the major pathogen that causes upper respiratory tract infections and acute bronchitis, the extensive use of antibiotics among patients with ARTI threatens to erode the efficacy of these medications.

Objectives:

This study aims to identify and describe the etiological agents associated with acute respiratory tract infections (ARTIs) by FilmArray respiratory panel assay in nasopharyngeal swab in adults attending in outpatients of Bangladesh Institute of Tropical and Infectious Diseases Hospial, Chattogram, Bangladesh and their associated risk factors such as clinical symptoms, signs, sociodemographic characteristics and reduce inappropriate antibiotic use in viral infections.

Methods:

This cross-sectional observational study was conducted in Bangladesh Institute of Tropical and Infectious Diseases (BITID), Chattogram, Bangladesh from 1st July 2023 to 31st December 2023. A total of 100 patients with ARTI who attended in outpatient department of the Bangladesh Institute of Tropical and Infectious Diseases (BITID), Chattogram, Bangladesh were enrolled in this study. Nasopharyngeal swabs for FilmArray respiratory panel assay obtained from all patients. Data were collected over a period of 6 months and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 25.

Results:

In this study, most of the patients 50 (50.0%) lies between 18 years to 30 years. Mean ± SD of the patients was 21.2 ± 7.3 years. Most of the patients 67 (67.00%) were male and 33 (33.00%) were female. Common symptoms were cough 87 (87.0%), fever 81(81.0%), runny nose 66 (66.0%), muscle ache 43 (43.0%) and lethargy 45 (45.0%). Most of the patients 72 (72.0%) had a high temperature, respiratory rate was increased in 7 (7.0%), high blood pressure was recorded in 8 (8.0%) patients. Result of FilmArray was positive in 69 (69.0%) patients, among them 47 (68.1%) patients were male and 22 (31.9%) patients were female. Viruses are the major pathogen, among 69 positive cases 67 (97.1%) were viral infections and only 2 (2.9%) were bacterial infections and 17 (24.6%) were mixed infection. About 11 types of viruses were identified according to the result of FilmArray. Among them most of the viruses were Influenza B (26), Influenza A H3 (15), Human Rhinovirus/Enterovirus (11), Influenza A H1-2009 (6), SARS CoV2 (5), Adenovirus (5), RSV (3),Influenza A (2), Human Metapneumovirus (2),Parainfluenza virus 3 (1) and Coronavirus NL63 (1) . Only 2 types of bacteria were identified which were Chlamydia pneumoniae (1) and Bordetella pertussis (1). Among total 100 patients, 58 (58.0%) patients used antibiotic, among antibiotic receiver 34 (58.62%) patients were male and 24 (41.37%) patients were female and 42 (42.0%) patients did not use antibiotic. Among positive 69 patients, 43 (62.3%) patients used antibiotic, among antibiotic receiver 26 (60.46%) patients were male and 17 (39.54%) patients were female. Azithromycin was the commonly used antibiotic 26 (26%) and Ciprofloxacin was used by 9 (9%) patients among antibiotic user.

Conclusion:

By implementing FilmArray respiratory panel assay in acute respiratory tract infections microorganism can be precisely diagnosed and inappropriate use of antibiotics can be reduced.