Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection

Franz, Anna; Adams, Ortwin; Willems, Rhea; Bonzel, Linda; Neuhausen, Nicole; Schweizer-Krantz, Susanne; Rüggeberg, Jens U.; Willers, Reinhart; Henrich, Birgit; Schroten, Horst; Tenenbaum, Tobias

doi:10.1016/j.jcv.2010.05.007

Cited by 210 publications

(236 citation statements)

References 33 publications

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“…The HRV+RSV coinfection predominance could reflect the high frequency of these 2 infections in children with ARIs, which was also reported by others, 7,9,11,13,25 and the overlap in time periods when occurrence of respiratory infections caused by both viruses was high, from February to June. 27 We had shown previously that coinfection with HRV and another respiratory virus was not associated with disease severity.…”

Section: Discussionsupporting

confidence: 76%

“…12 Underlying risk conditions may also be involved in disease severity. 9,13 Again, the reports are contradicting; atopic family history has been associated with severe HRV infection, whereas exposure to smoking has not, 11 and the opposite has been reported in another study. 9 Furthermore, congenital heart disease was considered a risk factor in 1 study 3 but not in another.…”

Section: What This Study Addsmentioning

confidence: 91%

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Human Rhinovirus and Disease Severity in Children

Costa¹,

Queiróz²,

Silveira

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Human rhinovirus has been known as the common cold agent. Recently, studies have reported that this virus is responsible for severe infections of the lower respiratory tract in children. Reports of factors that increase disease severity have been contradictory. WHAT THIS STUDY ADDS:This study identifies some of the factors involved in disease severity in HRV infections in children. We expect that children at risk for developing severe disease could be identified sooner and appropriate measures could be taken. abstract OBJECTIVE: To evaluate retrospectively human rhinovirus (HRV) infections in children up to 5 years old and factors involved in disease severity.METHODS: Nasopharyngeal aspirates from 434 children presenting a broad range of respiratory infection symptoms and severity degrees were tested for presence of HRV and 8 other respiratory viruses. Presence of host risk factors was also assessed.RESULTS: HRV was detected in 181 (41.7%) samples, in 107 of them as the only agent and in 74 as coinfections, mostly with respiratory syncytial virus (RSV; 43.2%). Moderate to severe symptoms were observed in 28.9% (31/107) single infections and in 51.3% (38/74) coinfections (P = .004). Multivariate analyses showed association of coinfections with lower respiratory tract symptoms and some parameters of disease severity, such as hospitalization. In coinfections, RSV was the most important virus associated with severe disease. Prematurity, cardiomyopathies, and noninfectious respiratory diseases were comorbidities that also were associated with disease severity (P = .007).CONCLUSIONS: Our study showed that HRV was a common pathogen of respiratory disease in children and was also involved in severe cases, causing symptoms of the lower respiratory tract. Severe disease in HRV infections were caused mainly by presence of RSV in coinfections, prematurity, congenital heart disease, and noninfectious respiratory disease. Pediatrics 2014;133:e312-e321 AUTHORS:

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Section: Discussionsupporting

confidence: 76%

Section: What This Study Addsmentioning

confidence: 91%

Human Rhinovirus and Disease Severity in Children

Costa¹,

Queiróz²,

Silveira

et al. 2014

Pediatrics

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“…38,39 Finally, the qPCR method used in our study was not appropriate to adequately assess viral load, which has been found to be associated with severity of disease. 40 …”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Quantitative real-time polymerase chain reaction allows sensitive detection of respiratory viruses. The clinical significance of detection of specific viruses is not fully understood, however, and several viruses have been detected in the respiratory tract of asymptomatic children. WHAT THIS STUDY ADDS:Our results indicate that quantitative real-time polymerase chain reaction is limited at distinguishing acute infection from detection in asymptomatic children for rhinovirus, bocavirus, adenovirus, enterovirus, and coronavirus. abstract BACKGROUND: Acute respiratory illness (ARI) accounts for a large proportion of all visits to pediatric health facilities. Quantitative real-time polymerase chain reaction (qPCR) analyses allow sensitive detection of viral nucleic acids, but it is not clear to what extent specific viruses contribute to disease because many viruses have been detected in asymptomatic children. Better understanding of how to interpret viral findings is important to reduce unnecessary use of antibiotics. OBJECTIVE:To compare viral qPCR findings from children with ARI versus asymptomatic control subjects.METHODS: Nasopharyngeal aspirates were collected from children aged #5 years with ARI and from individually matched, asymptomatic, population-based control subjects during a noninfluenza season. Samples were analyzed by using qPCR for 16 viruses. RESULTS:Respiratory viruses were detected in 72.3% of the case patients (n 5 151) and 35.4% of the control subjects (n 5 74) (P 5 .001). Rhinovirus was the most common finding in both case patients and control subjects (47.9% and 21.5%, respectively), with a population-attributable proportion of 0.39 (95% confidence interval: 0.01 to 0.62). Metapneumovirus, parainfluenza viruses, and respiratory syncytial virus were highly overrepresented in case patients. Bocavirus was associated with ARI even after adjustment for coinfections with other viruses and was associated with severe disease. Enterovirus and coronavirus were equally common in case patients and control subjects.CONCLUSIONS: qPCR detection of respiratory syncytial virus, metapneumovirus, or parainfluenza viruses in children with ARI is likely to be causative of disease; detection of several other respiratory viruses must be interpreted with caution due to high detection rates in asymptomatic children. Although acute respiratory illness (ARI) in childrenaccountsfora large part ofall visits to pediatric health facilities and is a great economic burden on society, 1,2 our tools to diagnose the etiologic agents have until recently been limited. 3 Treatment with antibiotics induces development of antibiotic resistance in bacteria 4 and has a negligible effect on most ARIs, which generally are of viral origin. 5,6 Nevertheless, antibiotics are frequently prescribed due to lack of clinically valid diagnostic tests verifying a viral etiology. 7 Sensitive methods, such as quantitative real-time polymerase chain reaction (qPCR) analyses on nasopharyngeal samples, for a number of viru...

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“…Diagnosis of acute respiratory tract infection (ARI) and discrimination between bacterial and viral infection is not straight-forward. The diagnosis, clinical management, and understanding of the pathogenesis of a child presenting with symptoms of viral infection can be readily improved by using multiplex PCR to determine the presence or absence of a viral respiratory pathogen (3,4).…”

Section: Introductionmentioning

confidence: 99%