Polymicrobial Acute Respiratory Infections in a Hospital-based Pediatric Population

Abstract

Background The clinical impact of polymicrobial respiratory infections remains uncertain. Previous reports are contradictory regarding an association with severe disease. Methods Three hundred and forty-six specimens from children with acute respiratory illness identified at the University of Iowa Hospitals and Clinics Clinical Microbiology Laboratory (CML) were evaluated by DFA, and/or viral culture by CML and later by molecular study for the presence of influenza, parainfluenza (HPIV), respiratory syncytial virus (HRSV), adenovirus (HAdV), human metapneumovirus (HMPV), rhinovirus (HRV), and human bocavirus (HBoV). Demographic and clinical data were abstracted from medical records. Results Multiple viruses were detected in 46 (21.7%) of 212 virus-positive specimens with the most frequent virus-virus combinations being HRV-HRSV (n=12), HRV-HBoV (n=6), and HRV-HPIV 3 (n=4). Risk factors for coinfection included: male gender (OR 1.70, 95% CI 0.83–3.46), 6 mos-1 yr age (OR 2.15, 95% CI 0.75–6.19), and history of immunosuppression (OR 2.05, 95% CI 0.99–4.23). Children with viral coinfections were less likely than children with single virus infections to be admitted to an intensive care unit (OR 0.32, 95% CI 1.12–9.17), however, this may be explained by undetected viral-bacterial coinfections. Conclusions HRV, HRSV, HBoV and polymicrobial infections were prevalent in this study. While the cross-sectional design could not easily examine polymicrobial infection and disease severity, prospective, population-based research regarding the clinical impact of such infections is warranted.

Evaluation of Viral Diagnostics on rEspiratory iNfections in ChildrEn

“…This likely reflects the greater sensitivity of the IS481 target, because there are more targets per organism than in an assay using species specific targets. 31 There are limitations to this study. First, the number of RT-PCR-positive pertussis samples is small, limiting the application of the results to the general population.…”

“…Furthermore, respiratory pathogens may also be detected in asymptomatic children, probably reflecting the natural virus colonization or asymptomatic infection in an individual in a certain period. 31,32 Laboratory factors may also influence the outcome of viral load. Nasopharyngeal aspirates, washes, swabs and brushes are usually considered suitable for RT-PCR analysis.…”

“…In our study, apneas occurred in seven out of 200 (3.5%) RSV single infections, comparable with data found in a recent review. 31 However, apneas occurred also in non RSVinfections (4/131, 3.1%). The clinical data and risk factors for children with apneas have been published elsewhere.…”

“…However, others report a higher disease severity in children with multiple respiratory infections [27][28][29] . And some investigators observed a less severe disease course in patients with multiple viral infections [30][31][32] . Although meta analyses may help to make more definitive conclusions, they are difficult to perform, since studies differ too much with respect to design and outcome parameters 20 .…”

“…Nowadays, immunoglobulins are studied in phase one and two clinical trials. Overview of new vaccine strategies and antivirals and their developmental stage are recently published 30,31 .…”