Clinical Disease Severity of Respiratory Viral Co-Infection versus Single Viral Infection: A Systematic Review and Meta-Analysis

Abstract

BackgroundResults from cohort studies evaluating the severity of respiratory viral co-infections are conflicting. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections.MethodsWe searched electronic databases and other sources for studies published up to January 28, 2013. We included observational studies on inpatients with respiratory illnesses comparing the clinical severity of viral co-infections to single viral infections as detected by molecular assays. The primary outcome reflecting clinical disease severity was length of hospital stay (LOS). A random-effects model was used to conduct the meta-analyses.ResultsTwenty-one studies involving 4,280 patients were included. The overall quality of evidence applying the GRADE approach ranged from moderate for oxygen requirements to low for all other outcomes. No significant differences in length of hospital stay (LOS) (mean difference (MD) −0.20 days, 95% CI −0.94, 0.53, p = 0.59), or mortality (RR 2.44, 95% CI 0.86, 6.91, p = 0.09) were documented in subjects with viral co-infections compared to those with a single viral infection. There was no evidence for differences in effects across age subgroups in post hoc analyses with the exception of the higher mortality in preschool children (RR 9.82, 95% CI 3.09, 31.20, p<0.001) with viral co-infection as compared to other age groups (I2 for subgroup analysis 64%, p = 0.04).ConclusionsNo differences in clinical disease severity between viral co-infections and single respiratory infections were documented. The suggested increased risk of mortality observed amongst children with viral co-infections requires further investigation.

Clinical severity of pediatric respiratory illness with enterovirus D68 compared with rhinovirus or other enterovirus genotypes

“…Invasive bacterial infection can lead to adverse outcomes, 10 and even viral coinfections may potentially affect patient outcomes; 11 however, both were rare events in our patient population. Despite the lack of evidence for invasive bacterial coinfection, about one-third of patients in both groups were given antibiotic treatment, in most cases because of the suspicion of bacterial pneumonia.…”

Etiología viral de infección respiratoria aguda en niños menores de 5 años en las provincias Comunera y García Rovira de Santander

“…No se halló alguna característica sociodemográfica o clínica particular ni mayor severidad de la IRA en los niños con co-infección; sin embargo, esto puede explicarse dado que el número limitado de aislamientos simultáneos no permite hacer comparaciones precisas entre niños con mono-infección y co-infección. A este respecto una reciente revisión sistemática y meta-análisis no encontró diferencias en severidad clínica entre las mono-infecciones y co-infecciones respiratorias virales, por lo cual el mayor riesgo de mortalidad observado en niños con co-infección viral aún requiere mayor investigación 11 .…”

Correlation between Infection with Multiple Respiratory Viruses and Length of Hospital Stay in Patients from Cheonan, Korea

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