Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections.

Daniel Penela-Sánchez,Desiree Henares,Pedro Brotons,María Cabrerizo,Carmen Muñoz-Almagro,Cristian Launes,Cristina Esteva,Silvia Ricart,Mariona-Fernández De-Sevilla,Georgina Armero,Iolanda Jordan,Jon González-De-Audicana

doi:10.3390/v13102059

Abstract

Infection by rhinovirus (RV) and enterovirus (EV) in children ranges from asymptomatic infection to severe lower respiratory tract infection (LRTI). This cohort study evaluates the clinical impact of RV/EV species, alone or in codetection with other viruses, in young children with severe LRTI. Seventy-one patients aged less than 5 years and admitted to the Paediatric Intensive Care Unit (PICU) of a reference children’s hospital with RV or EV (RV/EV) LRTI were prospectively included from 1/2018 to 3/2020. A commercial PCR assay for multiple respiratory pathogens was performed in respiratory specimens. In 22/71, RV/EV + respiratory syncytial virus (RSV) was found, and 18/71 had RV/EV + multiple viral detections. Patients with single RV/EV detection required invasive mechanical ventilation (IMV) as frequently as those with RSV codetection, whereas none of those with multiple viral codetections required IMV. Species were determined in 60 samples, 58 being RV. No EV-A, EV-C, or EV-D68 were detected. RV-B and EV-B were only found in patients with other respiratory virus codetections. There were not any associations between RV/EV species and severity outcomes. To conclude, RV/EV detection alone was observed in young children with severe disease, while multiple viral codetections may result in reduced clinical severity. Differences in pathogenicity between RV and EV species could not be drawn.

Highlights

Rhinoviruses (RV) and enteroviruses (EV) are among the main causative aetiologies of lower respiratory tract infection (LRTI) in children [1]
The aim of this study was to evaluate the clinical impact of viral coinfection in children admitted to a paediatric intensive care unit (PICU) with LRTI and RV or EV (RV/EV)
No differences were foundand between these three+ cohorts in sex, race, breast- than feeding status, or number of household contacts, but those patients with RV/EV detection and those with RV/EV + respiratory syncytial virus (RSV) codetection were younger than children with multiple viral codetection (p = 0.018)

Summary

Introduction

Rhinoviruses (RV) and enteroviruses (EV) are among the main causative aetiologies of lower respiratory tract infection (LRTI) in children [1]. They are RNA viruses belonging to the genus Enterovirus of the family Picornaviridae. Viral multiple detections are commonly observed in paediatric patients with LRTI, but there is no consensus on the relationship between viral coinfections and disease severity [2]. Most of the published literature does not focus on specific viral infections, and the role of coinfections in disease severity may be different depending on the viral aetiology [3]

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