Abstract
ObjectiveWe aimed to assess the profile of respiratory viruses in young children hospitalized for acute lower respiratory tract infection (ALRI) and its association with disease severity, defined as need for pediatric intensive care unit (PICU) admission.DesignProspective observational cohort study.SettingA tertiary-care university hospital in Brazil.PatientsChildren younger than three years attending the pediatric emergency room with ALRI who were admitted to the hospital.InterventionsNone.Measurements and main resultsNasopharyngeal aspirates were collected from patients from June 1st, 2008 to May 31st, 2009within the first 48 hours of hospitalization. Nasopharyngeal aspirates were tested for 17humanrespiratory viruses by molecular and immunofluorescence based assays. Simple and multiple log-binomial regression models were constructed to assess associations of virus type with a need for PICU admission. Age, prematurity, the presence of an underlying disease and congenital heart disease were covariates. Nasopharyngeal aspirates were positive for at least one virus in 236 patients. Rhinoviruses were detected in 85.6% of samples, with a preponderance of rhinovirus C (RV-C) (61.9%). Respiratory syncytial virus was detected in 59.8% and human coronavirus (HCoV) in 11% of the samples. Co-detections of two to five viruses were found in 78% of the patients. The detection of HCoV alone (adjusted relative risk (RR) 2.18; 95% CI 1.15–4.15) or in co-infection with RV-C (adjusted RR 2.37; 95% CI 1.23–4.58) was independently associated with PICU admission.ConclusionsThe detection of HCoV alone or in co-infection with RV-C was independently associated with PICU admission in young children hospitalized for ALRI.
Highlights
Acute lower respiratory tract infections (ALRI) are responsible for the death of approximately 160,000 neonates and over 760,000 infants annually [1].Respiratory syncytial virus (RSV) and rhinovirus (RV) are the most frequent causes of acute respiratory infections in children [2,3,4]
The detection of human coronavirus (HCoV) alone or in co-infection with rhinovirus C (RV-C) was independently associated with pediatric intensive care unit (PICU) admission in young children hospitalized for ALRI
In children younger than two years old who presented to a pediatric emergency room (ER) with ALRI in Malaysia, RSV and RV were the most frequently detected viruses and, RSV was associated with a history of wheezing, virus detection was not associated with need for hospitalization [11]
Summary
Acute lower respiratory tract infections (ALRI) are responsible for the death of approximately 160,000 neonates and over 760,000 infants annually [1].Respiratory syncytial virus (RSV) and rhinovirus (RV) are the most frequent causes of acute respiratory infections in children [2,3,4]. In young children who presented to an outpatient clinic or ER in Japan with acute respiratory illness, RSV, RV, parainfluenza viruses (PIV) and human metapneumovirus (HMPV) were the most prevalent viruses. In children younger than two years old who presented to a pediatric ER with ALRI in Malaysia, RSV and RV were the most frequently detected viruses and, RSV was associated with a history of wheezing, virus detection was not associated with need for hospitalization [11]. In The Netherlands, the most frequent viruses detected in children presenting to the ER or outpatient clinic with ALRI were RSV, RV and human coronavirus (HCoV), and RSV detection correlated with longer duration of oxygen therapy [12]. There was no association between the virus species and hospital length of stay, and virus co-detections were not associated with disease outcome [12].In the present study, a comprehensive polymerase-chain-reaction(PCR) panel of primers and probes was used to detect respiratory viruses, enabling virus
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