Abstract
Human coronaviruses (HCoVs) are associated with a variety of clinical presentations in children, but their role in disease remains uncertain. The objective of our prospective study was to investigate HCoVs associations with various clinical presentations in hospitalized children up to 6 years of age. Children hospitalized with acute bronchiolitis (AB), acute gastroenteritis (AGE), or febrile seizures (FS), and children admitted for elective surgical procedures (healthy controls) were included in the study. In patients with AB, AGE, and FS, a nasopharyngeal (NP) swab and blood sample were obtained upon admission and the follow-up visit 14 days later, whereas in children with AGE a stool sample was also acquired upon admission; in healthy controls a NP swab and stool sample were taken upon admission. Amplification of polymerase 1b gene was used to detect HCoVs in the specimens. HCoVs-positive specimens were also examined for the presence of several other viruses. HCoVs were most often detected in children with FS (19/192, 9.9%, 95% CI: 6–15%), followed by children with AGE (19/218, 8.7%, 95% CI: 5.3–13.3%) and AB (20/308, 6.5%, 95% CI: 4.0–9.8%). The presence of other viruses was a common finding, most frequent in the group of children with AB (19/20, 95%, 95% CI: 75.1–99.8%), followed by FS (10/19, 52.6%, 95% CI: 28.9–75.6%) and AGE (7/19, 36.8%, 95% CI: 16.3–61.6%). In healthy control children HCoVs were detected in 3/156 (1.9%, 95% CI: 0.4–5.5%) NP swabs and 1/150 (0.7%, 95% CI: 0.02–3.3%) stool samples. It seems that an etiological role of HCoVs is most likely in children with FS, considering that they had a higher proportion of positive HCoVs results than patients with AB and those with AGE, and had the highest viral load; however, the co-detection of other viruses was 52.6%.Trial Registration: ClinicalTrials.gov NCT00987519
Highlights
Human coronaviruses (HCoVs) consist of four species (HKU1, NL63, 229E, and OC43) and are associated with a wide variety of clinical presentations
Infections with 229E and OC43 have been implicated in the development of various chronic neurologic disorders, including multiple sclerosis [18]; OC43 was demonstrated in the cerebrospinal fluid of a child presumed to have acute disseminated encephalomyelitis [19]; and HKU1 has been associated with febrile seizures [12]
Our findings suggest that in children with acute bronchiolitis (AB) the presence of HCoVs in NP swabs is of minor importance and is most probably not causally related to AB because, among the three clinical groups, patients with AB had the lowest proportion of HCoV-positive NP swab results, very frequent “co-infection” with other respiratory viruses (95%), and very low viral load
Summary
Human coronaviruses (HCoVs) consist of four species (HKU1, NL63, 229E, and OC43) and are associated with a wide variety of clinical presentations. HCoVs typically cause mild upper respiratory tract infections, whereas in premature infants and children with chronic underlying diseases they may cause severe lower respiratory tract infections such as pneumonia and bronchiolitis [1,2,3,4]. The role of HCoVs in severe disease is unclear because they are frequently co-detected with other respiratory viruses, most often with respiratory syncytial virus (RSV) [4, 5]. Among four species of HCoVs, NL63 was found to be more frequently associated with croup than the other three species [6,7,8], whereas NL63 and HKU1 were associated with bronchiolitis and wheezing [6, 8,9,10,11,12,13,14]. Infections with 229E and OC43 have been implicated in the development of various chronic neurologic disorders, including multiple sclerosis [18]; OC43 was demonstrated in the cerebrospinal fluid of a child presumed to have acute disseminated encephalomyelitis [19]; and HKU1 has been associated with febrile seizures [12]
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