Viral and Atypical Bacterial Detection in Acute Respiratory Infection in Children Under Five Years

Abstract

BackgroundAcute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil.MethodsClinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA.Findings407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia.InterpretationThis study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively.

Respiratory Viral Test Results in Children

“…Our current study revealed that single rhinovirus (23.0%) and rhinovirus+RSV co-infection (7.6%) were more common in children <2 y. As in our current study, the literature reveals that most rhinoviruses are commonly detected as a single infection (25). The most common co-infections with rhinovirus include the parainfluenza virus and RSV (26).…”

Viral and bacterial infection among hospitalized-suspected influenza A/H5N1 patients in Indonesia, 2008-2009

“…This finding correlates with previous studies that illustrate the common viral-bacterial agents that cause ARI. 7,21,24 Co-infection of influenza A virus and bacterial such as Streptococcus pneumoniae is commonly recognized since secondary infection by Streptococcus pneumoniae were thought to be the cause of death during the 1918 Spanish Flu pandemic. Additionally, secondary bacterial pneumonia and acerbation of underlying conditions during epidemic years are also associate to hospitalization and deaths.…”

Treatment of Respiratory Syncytial Virus Infection: Past, Present and Future

“…The use of antibiotics is often associated with adverse reactions and community acquired bacterial resistance (Brook, 1998). On the other hand, severe bronchiolitis is commonly associated with bacterial co-infection (Bezerra et al, 2011). For these reasons, it is currently advised that antibiotics are used cautiously when treating bronchiolitis.…”