The importance of gastrointestinal presentation for understanding respiratory virus infection in patients with acute respiratory illness: a cross-sectional study in Guangzhou

Abstract

Background: Respiratory virus infections often cause a wide spectrum of symptoms including gastrointestinal presentations (GP). The epidemiology of respiratory viruses in patients with GP needs to be better described.Methods: Throat swabs were collected and tested for 15 respiratory viruses from pediatric patients (≤14 years old) with acute respiratory illness in Guangzhou over a 3-year period. The features of respiratory virus infections were analyzed among those with GP.Results: Of 4,242 patients enrolled, 1,223 (28.8%) had GP. Among those, 647 (52.9%) were positive with one or more of the 15 tested respiratory viruses. The most frequently detected viruses were respiratory syncytial virus (RSV) (21.1%, 258), enterovirus (EV) (10.1%, 124), influenza A virus (infA) (7.8%, 95), adenovirus (ADV) (5%, 61), human metapneumovirus (HMPV) (4.1%, 50), and human bocavirus (HBoV) (3.5%, 43). More RSV (p = .001) and EV (P<0.001) infections were found in patients with GP than in patients without GP. 734 (60.0%) patients with GP presented with “Poor appetite”, 480 (39.2%) with “Vomiting”, 301 (24.6%) with “Diarrhea” and 73 (6.0%) with “Stomachache”. Significant differences in the virus positivity rate were found for RSV (p < .001), EV (p = .002) and PIV3 (p = .037). 90.6% (1,108/1,223) of patients with GP were under 5 years old. Among different age groups, significant differences in the virus positivity rate were found for infA (p = .005), influenza B virus (infB) (p = .006), RSV (p < .001), parainfluenza virus type 3 (PIV3) (p = .019), ADV (P<0.001), and HBoV (p = .009). RSV was mostly detected in patients under 2 years old (90.3%, 233/258) with frequency declining with age, while frequency of infA and infB increased with age. ADV, HBoV, and PIV3 reached their highest peaks in the age groups of 6-10 years old (11%), 7-12 months (8%) and 4–6 months (5.8%), respectively. In general, sample positivity rates in patients with GP increased when seasons changed. RSV, EV, infA, ADV, HMPV, and HBoV formed the bulk of the positive samples.Conclusions: In this study, the epidemiology of respiratory virus infections in patients with GP was analyzed. This information increases our understanding of respiratory virus infections and may help in clinical diagnosis of these viruses.