Single Versus Dual Respiratory Virus Infections in Hospitalized Infants

Aberle, Judith H.; Aberle, Stephan W.; Pracher, E; Hutter, Hans-Peter; Kundi, Michael; Popow‐Kraupp, Therese

doi:10.1097/01.inf.0000168741.59747.2d

Cited by 158 publications

(81 citation statements)

References 25 publications

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“…In comparison with children with a sole RSV infection, children with a RSV/RV co-infection had a significantly higher likelihood of bronchiolitis relapse, even after adjusting for many clinical factors and hospital length of stay. Taken together with other data from our group 6 and others, 7,24 our observations challenge the conventional wisdom that the infectious pathogen of severe bronchiolitis does not affect short-term outcomes.…”

Section: Discussionsupporting

confidence: 81%

“…Furthermore, the clinical significance of multiple pathogen infections remains unclear. 6,24,25 Indeed, the literature has shown that the clinical severity of RSV/RV bronchiolitis is less than, 7 no different than, 10,26 and greater than 6,24 bronchiolitis caused by RSV alone. For example, a single-center study in Greece of 118 children with severe bronchiolitis found that the viral etiologies were not associated with clinical severity score at hospital admission but children with RSV/RV co-infection were hospitalized later in the course of their diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Plausible explanation includes an enhanced RV replication due to impaired interferon-γ response and disrupted airway epithelium associated with RSV infection. 24,27,28 An alternative mechanism consistent with a protracted clinical course is an increase in the expression of the main RV receptor, intercellular adhesion molecule 1, on RSV-infected epithelium cells, increasing the likelihood of co-infection. 29–31 All of these mechanisms may promote the emergence of long-term damage to airway structures.…”

Section: Discussionmentioning

confidence: 99%

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Multicenter Study of Viral Etiology and Relapse in Hospitalized Children With Bronchiolitis

Hasegawa

Mansbach

Teach

et al. 2014

Pediatric Infectious Disease Journal

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Background It is unclear whether the infectious etiology of severe bronchiolitis affects short-term outcomes, such as post-hospitalization relapse. We tested the hypothesis that children hospitalized with rhinovirus (RV) bronchiolitis, either as a sole pathogen or in combination with respiratory syncytial virus (RSV), are at increased risk of relapse. Methods We performed a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis. During the winters of 2007 to 2010, researchers collected clinical data and nasopharyngeal aspirates from study participants; the aspirates were tested using real-time polymerase chain reaction. The primary outcome was bronchiolitis relapse (urgent bronchiolitis visit or scheduled visit at which additions to the bronchiolitis medications were made) during the 2 weeks after hospital discharge. Results Among 1836 enrolled children with 2-week follow-up data, the median age was 4 months and 60% were male. Overall, 48% had sole RSV infection, 8% had sole RV infection, and 13% had RSV/RV co-infection. Compared with children with sole RSV infection, and adjusting for 10 demographic and clinical characteristics and clustering of patients within hospitals, children with sole RV infection did not differ in their likelihood of relapse (OR, 0.99; 95%CI, 0.52–1.90; P=0.98), whereas those with RSV/RV co-infection were more likely to have relapse (OR, 1.54; 95%CI, 1.03–2.30; P=0.03). Conclusions In this prospective, multicenter, multiyear study of children hospitalized with bronchiolitis, we found that RSV/RV co-infection was independently associated with a higher likelihood of bronchiolitis relapse. Present data support the concept that the infectious etiology of severe bronchiolitis affects short-term outcomes.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multicenter Study of Viral Etiology and Relapse in Hospitalized Children With Bronchiolitis

Hasegawa

Mansbach

Teach

et al. 2014

Pediatric Infectious Disease Journal

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“…Respiratory viral coinfections have been identified in 1.8% - 49.2% of respiratory tract infections in previous studies [1214202728]. The variability in the reported coinfection frequency could be due to the methods of viral detection, the number of detectable viruses, the characteristics of enrolled patients, the frequencies of underlying disorders, the seasons when the studies were performed, and the inclusion or exclusion of URTI [1428].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, even as ADV infection occurs steadily all year round in Korea, the clinical impact of respiratory viral coinfection on childhood ADV infection has rarely been reported [19]. In addition, previous studies on ADV coinfections included only children younger than 1 or 3 years of age, or children with lower respiratory tract infections [182021]. This retrospective study was performed to investigate the clinical impact of respiratory viral coinfections in Korean children with ADV infection.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Mixed Respiratory Viral Infection in Children with Adenoviral Infection

et al. 2016

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BackgroundAlthough adenovirus (ADV) infection occurs steadily all year round in Korea and the identification of respiratory viral coinfections has been increasing following the introduction of multiplex real-time polymerase chain reaction tests, the clinical impact of viral coinfection in children with ADV infection has rarely been reported.Materials and MethodsMedical records of children diagnosed with ADV infection were retrospectively reviewed. The enrolled children were divided into two groups based on the identified respiratory viruses: ADV group and coinfection group. Clinical and laboratory parameters were compared between the two groups.ResultsIn total, 105 children (60 males and 45 females) with a median age of 29 months (range: 0-131 months) diagnosed with an ADV infection were enrolled. Fever (99.0%) was by far the most frequent symptom, followed by respiratory (82.9%), and gastrointestinal (22.9%) symptoms. Upper and lower respiratory tract infections were diagnosed in 56 (53.3%), and 32 (30.5%) children, respectively. Five (4.8%) children received oxygen therapy, and no child died due to ADV infection. Coinfection was diagnosed in 32 (30.5%) children, with rhinovirus (46.9%), and respiratory syncytial virus (21.9%) being the most frequent. The proportions of children younger than 24 months (P <0.001), with underlying medical conditions (P = 0.020), and diagnosed with lower respiratory tract infection (P = 0.011) were significantly higher in the coinfection group than in the ADV group. In a multivariate analysis, only the younger age was significantly associated with coinfection (P <0.001). Although more children in the coinfection group received oxygen therapy (P = 0.029), the duration of fever and hospitalization was not significantly different between the two groups.ConclusionRespiratory viral coinfection with ADV occurred more frequently in children younger than 24 months of age compared with children aged 24 months or older. Respiratory viral coinfection may increase the severity of ADV infection, however, appropriate therapy prevented prolonged hospitalization and poor prognosis due to coinfection.

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Prospective Multicenter Study of Viral Etiology and Hospital Length of Stay in Children With Severe Bronchiolitis

Mansbach

Piedra²,

Teach³

et al. 2012

Arch Pediatr Adolesc Med

315

140

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Objective: To determine whether hospital length of stay (LOS) for acute bronchiolitis is influenced by the infecting pathogen.Design: A prospective observational cohort study was performed during 3 consecutive years.Setting: Sixteen US hospitals participated in the study.Participants: Children younger than 2 years hospitalized with bronchiolitis were included.Main Exposure: The results of nasopharyngeal aspirate polymerase chain reaction pathogen testing served as the main exposure.Main Outcome Measure: Hospital LOS was determined.Results: Of 2207 participants, 72.0% had respiratory syncytial virus (RSV) and 25.6% had human rhinovirus (HRV); the incidence of each of the other viruses and bacteria was 7.8% or less. Multiple pathogen infections were present in 29.8% of the children. There were 1866 children (84.5%) with RSV and/or HRV. Among these 1866 children, the median age was 4 months and 59.5% were male. The median LOS was 2 days (interquartile range, 1-4 days). Compared with children who had only RSV, an LOS of 3 or more days was less likely among children with HRV alone (adjusted odds ratio [AOR], 0.36; 95% CI, 0.20-0.63; PϽ .001) and those with HRV plus non-RSV pathogens (AOR, 0.39; 95% CI, 0.23-0.66; PϽ.001) but more likely among children with RSV plus HRV (AOR, 1.33; 95% CI, 1.02-1.73; P=.04), controlling for 15 demographic and clinical factors. Conclusions:In this multicenter study of children hospitalized with bronchiolitis, RSV was the most common virus detected, but HRV was detected in one-quarter of the children. Since 1 in 3 children had multiple virus infections and HRV was associated with LOS, these data challenge the effectiveness of current RSV-based cohorting practices, the sporadic testing for HRV in bronchiolitis research, and current thinking that the infectious etiology of severe bronchiolitis does not affect shortterm outcomes.

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Single Versus Dual Respiratory Virus Infections in Hospitalized Infants

Cited by 158 publications

References 25 publications

Multicenter Study of Viral Etiology and Relapse in Hospitalized Children With Bronchiolitis

Multicenter Study of Viral Etiology and Relapse in Hospitalized Children With Bronchiolitis

Clinical Impact of Mixed Respiratory Viral Infection in Children with Adenoviral Infection

Prospective Multicenter Study of Viral Etiology and Hospital Length of Stay in Children With Severe Bronchiolitis

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