Abstract
BackgroundBacteria and respiratory viruses co-occur in the nasopharynx, and their interactions may impact pathogenesis of invasive disease. Associations of viruses and bacteria in the nasopharynx may be affected by HIV.MethodsWe conducted a nested case-control study from a larger cohort study of banked nasopharyngeal swabs from families with and without HIV in West Bengal India, to look at the association of viruses and bacteria in the nasopharynx of parents and children when they are asymptomatic. Quantitative polymerase chain reaction for 4 bacteria and 21 respiratory viruses was run on 92 random nasopharyngeal swabs from children--49 from children living with HIV (CLH) and 43 from HIV uninfected children (HUC)-- and 77 swabs from their parents (44 parents of CLH and 33 parents of HUC).ResultsBacteria was found in 67% of children, viruses in 45%, and both in 27% of child samples. Staphylococcus aureus (53%) was the most common bacteria, followed by Streptococcus pneumoniae (pneumococcus) (37%) in children and parents (53, 20%). Regardless of HIV status, viruses were detected in higher numbers (44%) in children than their parents (30%) (p = 0.049), particularly rhinovirus (p = 0.02). Human rhinovirus was the most frequently found virus in both CLH and HUC. Children with adenovirus were at six times increased risk of also having pneumococcus (Odds ratio OR 6, 95% CI 1.12–31.9) regardless of HIV status. In addition, the presence of rhinovirus in children was associated with increased pneumococcal density (Regression coeff 4.5, 1.14–7.9). In CLH the presence of rhinovirus increased the risk of pneumococcal colonization by nearly sixteen times (OR 15.6, 1.66–146.4), and, pneumococcus and S. aureus dual colonization by nearly nine times (OR 8.7).ConclusionsChildren more frequently carried viruses regardless of HIV status. In CLH the presence of rhinovirus, the most frequently detected virus, significantly increased co-colonization with pneumococcus and S. aureus.
Highlights
The nasopharyngeal ecosystem composed of respiratory viruses and bacteria is dynamic [1, 2]
The association between pneumococcus and S. aureus is typically negative in healthy individuals, where if one is present the other usually is not, but in HIV infected individuals, in children living with HIV (CLH), this negative
Haemophilus influenzae type b conjugate vaccine (HibCV) was introduced in certain states in India but was not part of the program for CLH, and pneumococcal conjugate vaccines were not introduced in India until May 2017
Summary
The nasopharyngeal ecosystem composed of respiratory viruses and bacteria is dynamic [1, 2]. Underlying HIV infection may affect the density and balance of bacteria and viruses in the nasopharyngeal space. HIV infected individuals have a high burden of invasive disease from respiratory viruses, and bacteria that may colonize the nasopharynx [4, 5]. The association between pneumococcus and S. aureus is typically negative in healthy individuals, where if one is present the other usually is not, but in HIV infected individuals, in children living with HIV (CLH), this negative (2021) 13:8 interaction disappears, and CLH are more likely to have dual colonization [7,8,9,10]. Bacteria and respiratory viruses co-occur in the nasopharynx, and their interactions may impact pathogenesis of invasive disease. Associations of viruses and bacteria in the nasopharynx may be affected by HIV
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