Abstract
BackgroundResults from cohort studies evaluating the severity of respiratory viral co-infections are conflicting. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections.MethodsWe searched electronic databases and other sources for studies published up to January 28, 2013. We included observational studies on inpatients with respiratory illnesses comparing the clinical severity of viral co-infections to single viral infections as detected by molecular assays. The primary outcome reflecting clinical disease severity was length of hospital stay (LOS). A random-effects model was used to conduct the meta-analyses.ResultsTwenty-one studies involving 4,280 patients were included. The overall quality of evidence applying the GRADE approach ranged from moderate for oxygen requirements to low for all other outcomes. No significant differences in length of hospital stay (LOS) (mean difference (MD) −0.20 days, 95% CI −0.94, 0.53, p = 0.59), or mortality (RR 2.44, 95% CI 0.86, 6.91, p = 0.09) were documented in subjects with viral co-infections compared to those with a single viral infection. There was no evidence for differences in effects across age subgroups in post hoc analyses with the exception of the higher mortality in preschool children (RR 9.82, 95% CI 3.09, 31.20, p<0.001) with viral co-infection as compared to other age groups (I2 for subgroup analysis 64%, p = 0.04).ConclusionsNo differences in clinical disease severity between viral co-infections and single respiratory infections were documented. The suggested increased risk of mortality observed amongst children with viral co-infections requires further investigation.
Highlights
Respiratory viral co-infections, defined as the detection of more than one viral pathogen in the same sample are detected in up to 30% of children with an acute respiratory tract infection (ARI) [1,2]
AM is a recipient of a Swiss National Science Foundation postdoctoral fellowship (PBGEP3-139828)
Dr Marek Smieja is a recipient of a Canadian Institutes of Health Research (CIHR) New Investigator Award
Summary
Respiratory viral co-infections, defined as the detection of more than one viral pathogen in the same sample are detected in up to 30% of children with an acute respiratory tract infection (ARI) [1,2]. A non-systematic and narrative review summarized eight cohort studies using either conventional techniques or molecular assays for detection of viruses [3]. The authors reported increased hospitalization rates among patients with viral co-infections compared to single respiratory viral infections (46.3% vs 21.7%, p,0.01) suggesting increased severity with viral co-infections. These findings were limited, by including heterogeneous patient-populations (adults and children, with or without underlying comorbid conditions) and by combining studies using conventional as well as molecular methods for viral detection and by a potentially biased selection of the included studies. We conducted a systematic review and meta-analysis to assess the clinical severity of viral co-infections as compared to single viral respiratory infections
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
