Comparison of rates of hospitalization between single and dual virus detection in a Mexican cohort of children and adults with influenza-like illness

Abstract

Background. Molecular detection methods allow for the simultaneous detection of several infectious agents. This study assesses whether co-infection with 2 viruses as compared with 1 is associated with increased hospitalization in those with acute respiratory infections.Methods. We prospectively enrolled a cohort of pediatric and adult participants with influenza-like illness during 2010-2014 in Mexico. Clinical information and respiratory samples were collected at enrollment. Respiratory viruses were detected with multiplex polymerase chain reaction (PCR) and influenza-specific reverse transcription PCR assays. Participants were followed for 14 and 28 days after inclusion. Severity of disease, as measured by hospitalization with acute respiratory infections, was compared between single and dual viral infections.Results. Among 5662 participants in the study, either 1 (n = 3285) or 2 (n = 641) viruses were detected in 3926 participants. Rhinovirus (n = 1433), influenza (n = 888), and coronaviruses (n = 703) were the most frequently detected viruses (either alone or in co-infection). Bocavirus, respiratory syncytial virus (RSV), metapneumovirus, and rhinovirus cases were hospitalized more often than other viruses. Bocavirus+rhinovirus cases were hospitalized more often than those with rhinovirus alone (but not bocavirus alone). RSV cases were more likely to be hospitalized than cases with co-infections of RSV and parainfluenza virus or coronavirus. Metapneumovirus cases were hospitalized more often than those co-infected with metapneumovirus+coronavirus.Conclusions. In this study, detection of 2 viruses did not significantly increase hospitalizations compared with single virus infections. Larger studies will allow for distinguishing between sequential and simultaneous infection and for a better understanding of the role of each virus during the evolution of acute respiratory episodes.

Impact of the use of multiplex PCR on etiological diagnosis and treatment of acute respiratory infections in a private hospital of the north of the country

“…In a study carried out in our country in patients with influenza-like illness, the proportion of identified viruses was predominantly comprised of rhinovirus (36.5 %), followed by influenza virus (22.6 %), coronavirus (17.9 %) and RSV (14.2 %), although the samples appear to correspond to influenza seasons; of this sample, 47 % of subjects were hospitalized. 17 This reflects the wide circulation of respiratory viruses, which can determine moderate to severe conditions that require hospital management. In particular, RSV and influenza virus tend to cause more severe conditions.…”

“…In winter season, rhinoviruses predominate; however, in cases with community-acquired pneumonia or with respiratory infection that requires hospitalization, influenza virus, RSV and metapneumovirus predominate. 17,18 There is discrepancy on whether the presence of viral coinfections can cause a more severe course of infection. 17,18 Despite the fact that antimicrobial resistance is currently one of the main public health problems in the world, 11 irrational antibiotic prescription continues.…”

Impacto del uso de PCR múltiple en diagnóstico etiológico y tratamiento de infecciones respiratorias agudas en un hospital privado del norte del país

“…En un estudio realizado en nuestro país en pacientes con enfermedad semejante a influenza la proporción de virus identificados fue con predominio de rinovirus (36.5 %), seguido de influenza (22.6 %), coronavirus (17.9 %) y VSR (14.2 %), aunque las muestras parecen corresponder a temporadas de influenza; de esta muestra el 47 % fueron hospitalizados. 17 Lo anterior refleja la amplia circulación de virus respiratorios, que pueden condicionar cuadro moderados a graves que requieren manejo hospitalario. Particularmente, el VSR y el virus de la influenza suelen producir cuadros más graves.…”

“…En temporada invernal predominan los rinovirus, sin embargo, en los casos con neumonía comunitaria o con infección respiratoria que requiera hospitalización predominan el virus de la influenza, el VSR y el metapneumovirus. 17,18 Existe discrepancia sobre si la presencia de coinfecciones virales puede causar un curso más grave de la infección. 17,18 A pesar de que actualmente la resistencia a los antimicrobianos es uno de los principales problemas de salud pública en el mundo 11 , continúa su prescripción no razonada.…”

“…17,18 Existe discrepancia sobre si la presencia de coinfecciones virales puede causar un curso más grave de la infección. 17,18 A pesar de que actualmente la resistencia a los antimicrobianos es uno de los principales problemas de salud pública en el mundo 11 , continúa su prescripción no razonada. Se requiere darle el peso correcto a la asociación de estudios de laboratorio que detectan virus en pacientes con infecciones respiratorias moderadas a graves y poder aceptar que en el mayor porcentaje de esos casos no se requiere el uso de antimicrobianos.…”