Abstract
BackgroundThe relative incidence and clinical impact of individual respiratory viruses remains unclear among children presenting to the hospital emergency department with acute respiratory tract infection (ARTI).MethodsDuring two winter periods, respiratory virus real-time multiplex PCR results were evaluated from children (< 18 years) presenting to the emergency department of a tertiary referral hospital with ARTI that had been sampled within 48 hours of hospital presentation. In an attempt to identify virus-specific distinguishing clinical features, single virus infections were correlated with presenting signs and symptoms, clinical findings and outcomes using multivariate logistic regression.ResultsIn total, 274 children with ARTI were evaluated and most were aged < 3 years (236/274, 86%). PCR detected respiratory viruses in 224/274 (81.8%) children and included 162 (59%) single and 62 (23%) mixed virus infections. Respiratory syncytial virus (RSV) and human rhinovirus (HRV) single virus infections were common among children aged < 3 years, but proportional differences compared to older children were only significant for RSV (95% CI 1.3–15). Clinical differentiation between viral ARTIs was not possible due to common shared presenting signs and symptoms and the high frequency of mixed viral infections. We observed virus-associated outcome differences among children aged < 3 years. Oxygen treatment was associated with RSV (OR 3.6) and inversely correlated with FLU (OR 0.05). Treatment with steroids (OR 3.4) or bronchodilators (OR 3.4) was associated with HRV. Severe respiratory complications were associated with HRV (OR 3.5) and inversely correlated with RSV (OR 0.24).ConclusionsRespiratory viruses are frequently detected in young children presenting to the hospital emergency department with ARTI and require PCR diagnosis since presenting signs and symptoms are not discriminant for a type of virus. RSV and HRV bear a high burden of morbidity in the pediatric clinical setting.
Highlights
The relative incidence and clinical impact of individual respiratory viruses remains unclear among children presenting to the hospital emergency department with acute respiratory tract infection (ARTI)
Single virus infections were caused by Respiratory syncytial virus (RSV) (69 of 224, 31%), human rhinovirus (HRV) (53 of 224, 24%), FLU (16 of 224, 7%) and Other (24 of 224, 11%)
HRV and RSV single virus infections were common among children aged < 3 years, but proportional differences compared to older children were only significant for RSV
Summary
The relative incidence and clinical impact of individual respiratory viruses remains unclear among children presenting to the hospital emergency department with acute respiratory tract infection (ARTI). Recent molecular population-based studies show that viral ARTIs exceed 21% of pediatric emergency department visits during the seasonal influenza winter season and annual hospitalization rates exceed 1.5 per 100 children aged < 3 years [6,7,8]. These findings suggest a high burden of viral ARTI in young children. Recent clinical studies have included HRV molecular diagnostics, but interpretation of virusassociated correlations is hampered by age- and symptomrelated enrollment differences [9,10] or by sampling during the 2009 influenza pandemic [11,12]
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