Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen

Abstract

BackgroundThe number of viral pathogens associated with pediatric acute respiratory tract infection (ARI) has grown since the introduction of reverse transcription real-time polymerase chain reaction (RT-PCR) assays. Multiple viruses are detected during a single ARI episode in approximately a quarter of all cases. The clinical relevance of these multiple detections is unclear, as is the role of the individual virus. We therefore investigated the correlation between clinical data and RT-PCR results in children with single- and multiple viral ARI.MethodsData from children with ARI were prospectively collected during two winter seasons. RT-PCR testing for 15 viruses was performed in 560 ARI episodes. In the patients with a single-viral etiology, clinical data, laboratory findings, patient management- and outcome data were compared between the different viruses. With this information, we compared data from children of whom RT-PCR data were negative, with children with single- and multiple viral positive results.ResultsThe viral detection rate was 457/560 (81.6%) of which 331/560 (59.1%) were single infections and 126/560 (22.5%) were multiple infections. In single viral infections, some statistically significant differences in demographics, clinical findings, disease severity and outcome were found between children with different viral etiologies. However, no clinically recognizable pattern was established to be virus-specific. In a multivariate analysis, the only variables that were correlated with longer hospital stay were the use of oxygen and nebulizer therapy, irrespective of the viral pathogen. Children with RT-PCR positive test results had a significant higher disease severity, fever, length of hospital stay, days of extra oxygen supply, and days of antibiotic treatment than children with a negative RT-PCR test result. For children with single- versus children with multiple positive RT-PCR test results, these differences were not significant.ConclusionsDisease (severity), management and outcome in pediatric ARI are not associated with a specific virus. Single- and multiple viral ARI do not significantly differ with regard to clinical outcome and patient management. For general pediatrics, RT-PCR assays should be restricted to pathogens for which therapy is available or otherwise may have clinical consequences. Further research with an extended panel of RT-PCR assays and a larger number of inclusions is necessary to further validate our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2118-6) contains supplementary material, which is available to authorized users.

Seasonality and clinical impact of human parainfluenza viruses

“…The rate of co‐detection was similar across HPIV strains and as others have shown, viral co‐detections did not impact severity of disease . However, due to limited sample size, we could not assess the impact of specific co‐infections.…”

Respiratory syncytial virus in Brazilian infants – Ten years, two cohorts

“…Studies have been trying to associate the viral type -RSV or other respiratory viruseswith a varying degree of severity in the clinical presentation of AVB. However, the results are still inconclusive [8,10,23]. Similar epidemiologic features (gender, breastfeeding, tobacco exposure, crowding and maternal education) could minimize the impact of these possible risk factors in the analysis of cohort comparison.…”

“…An effective vaccine is not available; current treatment is only supportive; preventive measures are limited to very expensive monoclonal antibodies [6]. AVB seems to be correlated with seasonality, gender, gestational birth age, birth weight, breastfeeding, tobacco exposure, crowding, maternal education and viral etiology [7][8][9][10]. In this study, epidemiologic risk factors, clinical features and viral identification in nasopharyngeal secretion by polymerase chain reaction (PCR) were evaluated and compared in two cohorts (2004 [11] and 2014) with 314 infants with AVB.…”

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

“…Both swabs were from children with ARIwC at the time of testing but the clinical significance of virus only detections is unknown. A recent study of respiratory viruses ( n  = 15) detected by PCR in 560 paediatric episodes of ARI reported 457 episodes were virus positive, of which 331 were single infections and 126 were multiple infections; testing was undertaken for only two bacteria ( C. pneumoniae and M. pneumoniae ) [18]. There was no difference in clinical severity and management between children with single infections and those with multiple infections.…”