Respiratory syncytial virus and seasonal influenza cause similar illnesses in children with sickle cell disease

Abstract

Background Respiratory syncytial virus (RSV) is a cause of acute chest syndrome (ACS) in sickle cell disease (SCD), but its clinical course and acute complications have not been well characterized. We compared RSV to seasonal influenza infections in children with SCD. Procedure We defined cases as laboratory-confirmed RSV or seasonal influenza infection in inpatients and outpatients <18 years of age with SCD from 1 September 1993 to 30 June 2011. We used Fisher’s exact test to compare proportions, Student’s t-test or Wilcoxon rank-sum test to compare continuous variables, and logistic regression to evaluate associations. Results We identified 64 children with RSV and 91 with seasonal influenza. Clinical symptoms, including fever, cough, and rhinorrhea were similar for RSV and influenza, as were complications, including ACS and treatments for SCD. In a multivariable logistic regression model, older age (OR 1.2 per year, 95% CI [1.02–1.5], P = 0.04), increased white blood cell count at presentation (OR 1.1 per 1,000/µl increase, 95% CI [1.03–1.3], P = 0.008), and a history of asthma (OR 7, 95% [CI 1.3–37], P = 0.03) were independently associated with increased risk of ACS in children with RSV. The hospitalization rate for children with SCD and RSV (40 per 1,000 <5 years and 63 per 1,000 <2 years) greatly exceeds the general population (3 in 1,000 <5 years). Conclusions We conclude that RSV infection is often associated with ACS and similar in severity to influenza infection in febrile children with SCD.

Sickle-cell disease in febrile children living in a rural village of Madagascar and association with malaria and respiratory infections

“…Conversely, RSV A or B belonging to the family Paramyxoviridae, was significantly associated with a high risk of infection in SCT patients compared to the normal population whereas no virus was detected in SCD patients. RSV A and B are a major cause of lower respiratory tract infection during infancy and childhood and were associated with acute chest syndrome similar in severity to influenza infection in febrile children with SCD [30]. The reason why RSV A and B were not detected in our study using a sensitive molecular tool is unknown but it may be linked either to the small number of identified SCD patients, or the possible death of those children.…”

The prevalence of abnormal leukocyte count, and its predisposing factors, in patients with sickle cell disease in Saudi Arabia

“…This finding is consistent with several studies. 24 , 25 Eisenbrown et al 25 reported that a higher WBC level in SCD patients with a cough should prompt a chest X-ray.…”

Clinical Manifestations of Sickle Cell Anemia: Infants and Children

“…Children with SCD are frequently hospitalized with viral infections, including infl uenza and respiratory syncytial virus (Bundy et al 2010 ;Sadreameli et al 2014 ). These infections may cause increased morbidity in some children with SCD as they are often implicated in triggering VOC or acute chest syndrome.…”