Detection of Multiple Respiratory Viruses Associated With Mortality and Severity of Illness in Children*

Abstract

Objective Respiratory viral infection is a common source of morbidity and mortality in children. Co-infection with multiple viruses occurs frequently; however, the clinical significance of concomitant viral pathogens is unclear. We hypothesized that presence of more than one respiratory virus is associated with increased morbidity and mortality when compared to children with a single respiratory virus. Design Retrospective cohort study. Setting A tertiary care hospital. Patients All children at Duke Children’s Hospital over a two year period with isolation of a virus on an extended viral respiratory panel (EVRP) result. Demographic data, co-morbidities, and details of hospital encounter were recorded. Interventions None Measurements and Main Results 235 hospital encounters demonstrated positive EVRPs. Immunocompromised status (37%) and respiratory comorbidities (23%) were common. 28 patients (12%) tested positive for multiple viruses, with adenovirus (23/28) and respiratory syncytial virus (15/28) most prevalent in patients with multiple viruses. Viral co-detection was associated with increased use of non-invasive ventilation (p=0.02), extracorporeal membrane oxygenation (p=0.02), increased likelihood of moderate or severe illness (p=0.005) and increased mortality (p=0.01). Subgroup analysis demonstrated that this mortality association persisted for children with normal immune function (p=0.003) and children with no comorbidities (p=0.007). Conclusions Children with multiple respiratory viruses may be at increased risk of moderate or severe illness and mortality, with previously healthy children potentially being at greatest risk. Further studies are indicated to determine the significance and generalizability of this finding and to better understand the pathophysiology of viral co-infection.

Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology

“…A small cohort study reported that infants with severe bronchiolitis due to co-infections had higher odds to be admitted to the PICU than did those with a single virus; as in our study, the most dominant combination of the viruses was RSV and Rhinovirus (26). A single centre-study investigating the effect of viral coinfection in a two-year retrospective study, in which the diagnostic panel did not include Rhinovirus/enterovirus, reported that the most common co-infections were with adenovirus and RSV and found a significantly higher severity in patients with viral co-infections (7). However, no difference in the risk of invasive ventilation requirement and ICU LOS was observed.…”

“…Although there were minor annual fluctuations during the study period, the overall rate of detection of adenovirus, hMPV and other IQR (interquartile range), *median of days, † for patients who was endotracheally intubated. respiratory viruses was not as high as compared to published studies of non-PICU settings (7,(19)(20)(21)(22). The potential reasons could be related to our inclusion criteria, i.e.…”

“…Co-infection with multiple respiratory viruses is common in hospitalised children (6)(7)(8). Contrary to what one might predict, the severity of illness is not clearly greater with coinfection (6,7).…”

Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey

“…Median age of patients with influenza was 41 (11-75) months and median age of patients with the viruses other than influenza was 10 (3.5-28) months (p <0.001). The median PRISM score was 22 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)) and median PELOD score was 11 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) in patients with influenza. The median PRISM score was 9 (3-17) and median PELOD score was 10 (1-15) in patients with the viruses other than influenza (p <0.005).…”

“…15,22,23 In the present study, multiple viruses were detected in 13% of the patients. Although there are also contrary opinions, [24][25][26] detection of multiple viruses does not affect mortality and duration of stay in PICU. 22,27,28 Similarly, we showed that multiple viruses did not affect mortality.…”