Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom

Abstract

Most studies exploring the role of upper airway viruses and bacteria in paediatric acute respiratory infections (ARI) focus on specific clinical diagnoses and/or do not account for virus-bacteria interactions. We aimed to describe the frequency and predictors of virus and bacteria codetection in children with ARI and cough, irrespective of clinical diagnosis. Bilateral nasal swabs, demographic, clinical and risk factor data were collected at enrollment in children aged <15 years presenting to an emergency department with an ARI and where cough was a symptom. Swabs were tested by polymerase chain reaction for 17 respiratory viruses and seven respiratory bacteria. Logistic regression was used to investigate associations between child characteristics and codetection of the organisms of interest. Between December 2011 and August 2014, swabs were collected from 817 (93.3%) of 876 enrolled children, median age 27.7 months (interquartile range 13.9-60.3 months). Overall, 740 (90.6%) of 817 specimens were positive for any organism. Both viruses and bacteria were detected in 423 specimens (51.8%). Factors associated with codetection were age (adjusted odds ratio (aOR) for age <12 months = 4.9, 95% confidence interval (CI) 3.0, 7.9; age 12 to <24 months = 6.0, 95% CI 3.7, 9.8; age 24 to <60 months = 2.4, 95% CI 1.5, 3.9), male gender (aOR 1.46; 95% CI 1.1, 2.0), child care attendance (aOR 2.0; 95% CI 1.4, 2.8) and winter enrollment (aOR 2.0; 95% CI 1.3, 3.0). Haemophilus influenzae dominated the virus-bacteria pairs. Virus-H. influenzae interactions in ARI should be investigated further, especially as the contribution of nontypeable H. influenzae to acute and chronic respiratory diseases is being increasingly recognized.

Upper airway viruses and bacteria in urban Aboriginal and Torres Strait Islander children in Brisbane, Australia: a cross-sectional study

“…In that study, RSV was weakly associated with children being hospitalised [14] and its higher prevalence amongst ED children compared to community children possibly reflects the severity of illness if infected rather than community prevalence. The seasonal distribution of organisms was also similar to that identified in the ED study [13], including a predominance of the autumn months for NTHi and RSV and that virus-bacteria codetection occurred predominantly in autumn and winter.…”

“…The prevalence of any organism in children in this study of 81% is similar to children aged <15 years presenting acutely to a tertiary paediatric emergency department (ED) in the same geographical location with ARIwC (91%), the majority of whom were non-Indigenous [13]. The prevalence of co-detection of viruses and bacteria in the ED study was 51.8% [13], higher than the 34.8% in this cohort.…”

“…The prevalence of co-detection of viruses and bacteria in the ED study was 51.8% [13], higher than the 34.8% in this cohort. However, children in the ED study were all symptomatic for ARIwC whilst the majority of children in this current study were asymptomatic.…”

Chronic cough postacute respiratory illness in children: a cohort study

“…Diary items included cough persistence and frequency, medication use and whether they sought further medical advice for the cough. A bilateral anterior nasal swab was collected and tested as previously reported 16. At day 28, if the child had not stopped coughing for a period of >3 consecutive days (criteria previously used to define clinical response in chronic cough studies20 21) during the follow-up period, he/she was reviewed by a paediatric pulmonologist within 2 weeks.…”

Streptococcus pneumoniae and chronic endobronchial infections in childhood

“…Pneumococcal pneumonia is a major cause of influenza‐related deaths and evidence is mounting of viral respiratory infections increasing bacterial loads . Following adjustment for age, season, and antibiotics positive associations remained between respiratory syncytial virus (RSV) and pneumococci, and between influenza and pneumococci, in children presenting to a pediatric emergency department with an acute respiratory illness . Furthermore, 28‐days after receiving the live attenuated influenza vaccine, 74 healthy children aged 2‐4 years had a transient six‐fold increase in NP pneumococcal density .…”