Abstract
BackgroundLower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. In this study we determine the impact of respiratory viruses and how viral co-detections/infections can affect clinical LRTI severity in children in a hospital setting.MethodsPatients younger than 3 years of age admitted to a tertiary hospital in Brazil during the months of high prevalence of respiratory viruses had samples collected from nasopharyngeal aspiration. These samples were tested for 13 different respiratory viruses through real-time PCR (rt-PCR). Patients were followed during hospitalization, and clinical data and population characteristics were collected during that period and at discharge to evaluate severity markers, especially length of hospital stay and oxygen use. Univariate regression analyses identified potential risk factors and multivariate logistic regressions were used to determine the impact of specific viral detections as well as viral co-detections in relation to clinical outcomes.ResultsWe analyzed 260 episodes of LRTI with a viral detection rate of 85% (n = 222). Co-detection was observed in 65% of all virus-positive episodes. The most prevalent virus was Respiratory Syncytial Virus (RSV) (54%), followed by Human Metapneumovirus (hMPV) (32%) and Human Rhinovirus (HRV) (21%). In the multivariate models, infants with co-detection of HRV + RSV stayed 4.5 extra days (p = 0.004), when compared to infants without the co-detection. The same trends were observed for the outcome of days of supplemental oxygen use.ConclusionsAlthough RSV remains as the main cause of LRTI in infants our study indicates an increase in the length of hospital stay and oxygen use in infants with HRV detected by RT-PCR compared to those without HRV. Moreover, one can speculate that when HRV is detected simultaneously with RSV there is an additive effect that may be reflected in more severe clinical outcome. Also, our study identified a significant number of children infected by recently identified viruses, such as hMPV and Human Bocavirus (HBov), and this is a novel finding for poor communities from developing countries.
Highlights
Lower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities
respiratory syncytial virus (RSV) is well recognized as the main agent associated with severe LRTIs, recent data indicate that other viruses may play a significant role in these clinical outcomes
Of interest is the fact that wheezerelated Human rhinovirus (HRV) infection in the first year of life is associated with an increased risk for developing asthma later in life [8], and that this effect was greater than the observed in relation to RSV [9]
Summary
Lower respiratory tract infection (LRTI) is a major cause of pediatric morbidity and mortality, especially among non-affluent communities. Its impact among non-affluent populations has been scarcely evaluated In such locales, infants with respiratory syncytial virus (RSV)-associated LRTIs present a three times greater risk of a fatal event, when compared to their peers in developed countries [3]. Human rhinovirus (HRV) seems to be of particular interest, as the most prevalent virus in respiratory illnesses even in the first years of life [4,5], being associated with severe acute bronchiolitis, especially among children of atopic parents [6]. A recent study showed that, in a population of preterm infants, HRV was the most prevalent agent associated with severe bronchiolitis [7]. Of interest is the fact that wheezerelated HRV infection in the first year of life is associated with an increased risk for developing asthma later in life [8], and that this effect was greater than the observed in relation to RSV [9]
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