Viral causes of severe acute respiratory infection in hospitalized children and association with outcomes: A two-year prospective surveillance study in Suriname

Abstract

Background Viruses are the most frequent cause of severe acute respiratory infection (SARI) in children. It is currently unknown whether presence of a virus, the number of viruses, or type of virus, are associated with clinical outcomes of pediatric SARI in developing countries. Methods Between 2012 and 2014 nasopharyngeal swabs and demographic and clinical variables were prospectively collected for surveillance of viral causes of SARI in Surinamese children within 48 hours after hospitalization. These swabs were tested for 18 respiratory viruses using a multiplex polymerase chain reaction (PCR) panel to identify the specific viral causes of SARI, unknown to the treating physicians. In post hoc analyses we evaluated if the PCR results, and demographic and clinical characteristics, were associated with course of disease, duration of respiratory support, and length of stay (LOS). Results Of a total of 316 analyzed children, 290 (92%) had one or more viruses. Rhinovirus/enterovirus (43%) and respiratory syncytial virus (34%) were most prevalent. Course of disease was mild in 234 (74%), moderate in 68 (22%), and severe in 14 (4%) children. Neither presence of a single virus, multiple viruses, or the type of virus, were different between groups. Prematurity and lower weight-for-age-z-score were independent predictors of a severe course of disease, longer duration of respiratory support, and longer LOS. Conclusions Viruses are common causes of pediatric SARI in Suriname, yet not necessarily associated with clinical outcomes. In developing countries, demographic and clinical variables can help to identify children at-risk for worse outcome, while PCR testing may be reserved to identify specific viruses, such as influenza, in specific patient groups or during outbreaks.

Epidemiology of Respiratory Pathogens in Children with Severe Acute Respiratory Infection and Impact of the Multiplex PCR Film Array Respiratory Panel: A 2-Year Study

“…Nevertheless, ADV and CoV were only detected in 4.1% and 3.7% of cases, respectively. ese results are comparable to those reported by several studies [19,24]. It was noticeable that HRV was the most detected respiratory pathogen in studies conducted in our country and other ones [1,4,9,18,19,20,24,29].…”

“…In this study, male dominance in children with SARI was found (58.1%), confirming the results of previous studies [4,19,23,24]. According to McClelland and Smith [25], this dominance can be explained by an interaction between gender-specific immune responses and immune responses to specific microbes.…”

“…Among the 534 patients enrolled in this study, the overall prevalence of respiratory pathogens was 72.5% (n � 387) and the proportion of co-infections was 23.3%. Our positivity rate is within the range found in the literature, which varied between 51.4% and 92% [12,19]. Multiple viruses or coinfection bacteria and virus were found in 15-33.5% [6,12,20].…”

“…Our study confirmed this vulnerability showing that 76.5% (406/534) of children admitted with SARI were less than one year old. Similar findings have been noted by studies conducted in China [1,4,18] and in the Netherlands [19]. In contrast to this finding, few studies such as that conducted by Lei et al [20] have reported that SARI were more common in patients aged one to three years (52%).…”

Requirement of respiratory support in acute bronchiolitis in infants is linked to endothelial and neutrophil activation

“…Nasopharyngeal swabs sample handling and analysis were done as described before. 19 In short, extraction of genetic material was performed with the QIAamp MinElute Virus Spin Kit (Qiagen) and detection of viruses was performed with the Respifinder SMART 22 multiplex PCR kit (Pathofinder BV) on a Lightcycler 480 (Hoffmann La Roche), according to the manufacturers' instructions. Blood samples were collected in serum microtainers using venipuncture, capillary collection, or blood collection during the insertion of a venous cannula.…”