Background: Human coronaviruses (HCoVs) cause respiratory tract infections during childhood manifesting as common colds, bronchiolitis, croup and pneumonia. In temperate geographies, HCoV activity peaks between December and March. The epidemiology and manifestations of HCoV infections have not been previously reported from Ecuador. Methods: Children <5 years who presented with ≥2 symptoms consistent with an acute respiratory tract infection were eligible for enrollment. After obtaining informed consent, demographic data and details regarding the acute illness were recorded. Secretions collected with a nasopharyngeal swab underwent diagnostic testing using multiplex polymerase chain reaction. Results: A total of 850 subjects were enrolled. A total of 677 (80%) tested positive for at least 1 pathogen, including 49 (7.2%) who tested positive for ≥1 HCoV type. HCoV-NL63 was the most frequent type detected (39%), followed by HCoV-OC43 (27%), 229E (22%) and HKU1 (12%). Nearly all subjects who tested positive for HCoV had nasal congestion or secretions (47/49; 96%). The most frequent syndromic diagnosis was common cold (41%), followed by bronchiolitis (27%). We found no association between the infecting HCoV type and subject’s syndromic diagnosis (P > 0.05) or anatomic location of infection (upper vs. lower respiratory tract; P > 0.05). The 2018–2019 peak HCoV activity occurred from October to November; the 2019–2020 peak occurred from January to February. Conclusions: HCoVs were detected in ~7% of outpatient Ecuadorean children <5 years of age with symptoms of acute respiratory tract infection. The most frequently detected HCoV types, and the period of peak HCoV activity differed for the 2018–2019 and 2019–2020 seasons.

Background Implementation of respiratory virus prevention measures requires detailed understanding of regional epidemiology; however, data from many tropical countries are sparse. We describe etiologies of ambulatory pediatric acute respiratory tract infections (ARTI) in Ecuador immediately preceding the onset of the SARS‐CoV‐2 pandemic. Methods Children < 5 years presenting to a designated study site with an ARTI were eligible. Informed consent was obtained. Demographic and clinical data were recorded. A nasopharyngeal swab was collected, processed, and analyzed using multiplex polymerase chain reaction (PCR) for common respiratory pathogens. Rhinovirus/enterovirus positive samples were further characterized by genomic sequencing. Results A total of 820 subjects were enrolled in the study between July 2018 and March 2020. A total of 655 (80%) samples identified at least one pathogen. Rhinoviruses (44%) were most common, followed by enteroviruses (17%), parainfluenza viruses (17%), respiratory syncytial virus (RSV) (15%), and influenza viruses (13%). Enterovirus D68 was the most common enterovirus detected and was among the leading causes of bronchiolitis. Seasonal RSV and influenza virus activity were different along the coast compared with the highlands. Conclusions Ongoing regional surveillance studies are necessary to optimize available and emerging pathogen‐specific preventative measures.

Human immunodeficiency virus and co-infection by cytomegalovirus (CMV) is a life threatening association with increased risk of complications and high impact in morbidity and mortality due to immunosenescence, disproportionate inflammatory response and increased viral replication of HIV if not treatment is started [1]. Multisystemic compromise can even produce retinal, gastrointestinal, hematological, pulmonary and central nervous compromise by CMV. The purpose of this review is to provide a diagnostic and therapeutic approach based on current literature and pharmacotherapeutics.

A 31-year-old man presenting a dyspnoea, persistent fever, haemoptysis, a Leishmaniasis cutaneous record and recent close contact with a person diagnosed with influenza virus (H1N1). During admission to the emergency department, the patient rapidly progressed to respiratory failure requiring invasive mechanical ventilation and antibiotics because of suspected bacterial pneumonia. During his stay at the intensive care unit, he progressively developed bycytopenia, splenomegaly and reticulonodular lung opacities. Moreover, the bone marrow biopsy evidenced hemophagocytosis of lymphocytes and detection of H1N1 by Reverse Transcription Polymerase Chain Reaction (RT-PCR). Hence, the case of hemophagocytic syndrome secondary to influenza virus H1N1, which was rapidly resolved after initiation of antiviral therapy, is presented hereof.