Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections

Abstract

Infection by rhinovirus (RV) and enterovirus (EV) in children ranges from asymptomatic infection to severe lower respiratory tract infection (LRTI). This cohort study evaluates the clinical impact of RV/EV species, alone or in codetection with other viruses, in young children with severe LRTI. Seventy-one patients aged less than 5 years and admitted to the Paediatric Intensive Care Unit (PICU) of a reference children’s hospital with RV or EV (RV/EV) LRTI were prospectively included from 1/2018 to 3/2020. A commercial PCR assay for multiple respiratory pathogens was performed in respiratory specimens. In 22/71, RV/EV + respiratory syncytial virus (RSV) was found, and 18/71 had RV/EV + multiple viral detections. Patients with single RV/EV detection required invasive mechanical ventilation (IMV) as frequently as those with RSV codetection, whereas none of those with multiple viral codetections required IMV. Species were determined in 60 samples, 58 being RV. No EV-A, EV-C, or EV-D68 were detected. RV-B and EV-B were only found in patients with other respiratory virus codetections. There were not any associations between RV/EV species and severity outcomes. To conclude, RV/EV detection alone was observed in young children with severe disease, while multiple viral codetections may result in reduced clinical severity. Differences in pathogenicity between RV and EV species could not be drawn.

The epidemiological features of respiratory tract infection using the multiplex panels detection during COVID-19 pandemic in Shandong province, China

“…The lower respiratory tract infection (LRTI) is mainly induced by virus, mycoplasma, chlamydia and bacteria, etc. In clinic, different pathogens may cause similar symptoms [7][8][9] . It's difficult to identify patient diseases because of the overlap or similar clinical presentations.…”

Concentrations of nitrogen compounds are related to severe rhinovirus infection in infants. A time‐series analysis from the reference area of a pediatric university hospital in Barcelona

“…RV infection (RVi) ranges from asymptomatic or mild symptomatic infection to being often the only etiological agent in patients requiring advanced life support in intensive care units. Viral and bacterial coinfections have been considered as factors associated with severe disease, but these results are not consistent between series 1,2 and the wide clinical spectrum of RVi has not been clearly explained by a unique element.…”

Impact of the bacterial nasopharyngeal microbiota on the severity of genus enterovirus lower respiratory tract infection in children: A case–control study

“…NPA samples were collected from all children according to the standard operating procedure established at the study site. 5 Nasopharyngeal secretions were aspirated using a catheter connected to a vacuum source. The mucus collected within the catheter was then eluted by the aspiration of 1.0 mL sterile phosphate-buffered saline Quality of sequencing data was assessed with the FASTQC toolkit.…”

“…Nonetheless, most of the published literature does not focus on specific viral coinfections as a factor of severity, and this could be different depending on the viral etiology 4 . In this sense, a recent study from our group that focused on the role of viral coinfection in the specific scenario of RV/EV infection showed that virus codetection appears not to be decisive to cause severe LRTI in young children in a PICU setting 5 …”

“…4 In this sense, a recent study from our group that focused on the role of viral coinfection in the specific scenario of RV/EV infection showed that virus codetection appears not to be decisive to cause severe LRTI in young children in a PICU setting. 5 Regarding bacterial coinfection, studies have shown that RV/EV infection in children is associated with increased detection of potential pathogenic bacteria in the respiratory tract (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis), causing increased risk of LRTI and asthma symptoms. 6 However, most of this research focused on bacterial-viral has been centered on single pathogenic organisms due to their microbiological culture-based nature.…”