Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort

Abstract

Respiratory viruses play an important role in asthma exacerbation, and early exposure can be involved in recurrent bronchitis and the development of asthma. The exact mechanism is not fully clarified, and pathogen-to-host interaction studies are warranted to identify biomarkers of exacerbation in the early phase. Only a limited number of international exacerbation cohorts were studied. Here, we have established a local pediatric exacerbation study in Germany consisting of children with asthma or chronic, recurrent bronchitis and analyzed the viriome within the nasopharyngeal swab specimens derived from the entire cohort (n = 141). Interestingly, 41% of exacerbated children had a positive test result for human rhinovirus (HRV)/human enterovirus (HEV), and 14% were positive for respiratory syncytial virus (RSV). HRV was particularly prevalent in asthmatics (56%), wheezers (50%), and atopic (66%) patients. Lymphocytes were decreased in asthmatics and in HRV-infected subjects, and patients allergic to house dust mites were more susceptible to HRV infection. Our study thus confirms HRV infection as a strong ‘biomarker’ of exacerbated asthma. Further longitudinal studies will show the clinical progress of those children with a history of an RSV or HRV infection. Vaccination strategies and novel treatment guidelines against HRV are urgently needed to protect those high-risk children from a serious course of disease.

Bacterial lysate add-on therapy in adult and childhood asthma: a systematic review and meta-analysis

“…Respiratory tract infection is a major predisposing factor that contributes to asthma exacerbations. Statistically, up to 50% of asthma exacerbations are elicited by respiratory tract infections ( 50 ). Because of the imbalanced T1/T2 inflammatory responses observed in asthma, patients with asthma are predisposed toward respiratory tract infections, which causes symptom worsening, decline of pulmonary function, and poor disease control ( 51 ).…”

Prediction of Asthma Exacerbations in Children

“…Respiratory microbiota and specific bacteria-host interactions may also determine the risk of asthma exacerbations. Several Moraxella and Haemophilus members may enrich viral respiratory illnesses during the fall season, leading to subsequent exacerbations [139]. These episodes seem to have a regular peak after returning to school from their summer holidays, i.e., in September for the Northern hemisphere and in January for the Southern [135,[140][141][142].…”

Microarray-Based Analyses of Rhinovirus Species-Specific Antibody Responses in Exacerbated Pediatric Asthma in a German Pediatric Cohort

“…The definition of the group asthma, wheeze, and healthy controls, as well as atopy and steroid 'phenotypes', were described previously [29,31,32]. Briefly, the cohorts were stratified according to current diagnosis criteria for asthma, which were set for those who were between five to 17 years of age with respect to the history and lung function parameters (n = 49; 9.9 ± 3.3 years, 34 males).…”

“…In addition, asthmatics and wheezers who had a history of taking steroids or leukotriene receptor antagonist were classified as steroid-positive subjects. Patients with asthma and wheeze suffering from acute respiratory complains were defined as exacerbated patients (exacerbated asthmatics, exacerbated wheezers) [29,31,32].…”

“…Following these open and important questions, we recruited children and adolescents between 3 months and 17 years of age with recurrent obstructive bronchitis and/or asthma suffering from a respiratory exacerbation at a pediatric university hospital in western Germany (including healthy subjects as a control group) and addressed these issues in the biomaterials collected during exacerbation [29][30][31]. In a previous work, we already demonstrated that the majority of children and adolescents were positive for RV/enteroviruses in the nasopharyngeal swab specimens [32]. Measuring antibody levels rather than direct nucleic acid-based strategies for viral genomes could be a better indicator of exposure to virus infections, and the seroprevalence after RV infection is species-specific, as there are more serotypes that are described in the literature.…”