Abstract
BackgroundViral respiratory tract infections are common during early childhood. How they impact cystic fibrosis lung disease history in young children is poorly known. The principal aim of our study was to determinate respiratory tract infections frequency in this cystic fibrosis young population. Secondary outcomes were nature of viral agents recovered and impact of such infections.MethodsWe conducted a prospective cohort study of 25 children affected by cystic fibrosis and aged less than 2 years. Nasal samplings were taken systematically monthly or bimonthly with additional samples taken during respiratory tract infections episodes. Ten pathogens were tested by a combination of five duplex RT-PCRs or PCRs: influenza A and B, respiratory syncytial virus (RSV), metapneumovirus (MPV), rhinovirus/enterovirus(RV/EV)), coronavirus (HKU1, NL63, 229E and OC43), parainfluenza virus (1–4), adenovirus and bocavirus (Respiratory Multi-Well System MWS r-gene®, BioMérieux, Marcy l’Étoile, France). Cycle thresholds (CTs) were reported for all positive samples and considered positive for values below 40. Quantitative variables were compared using a nonparametric statistical test (Wilcoxon signed rank for paired comparisons). Pearson’s correlation coefficient (r) was used to assess relationships between two variables. Statistical analyses were performed using SAS v9.4 (SAS Institute, Cary, NC, USA) or GraphPad Prism V6.00 (GraphPad Software, La Jolla, CA, USA). The significance level was set at 0.05.ResultsThe mean age at inclusion was 9.6 ± 6.7 months. The patients had 3.4 ± 1.7 respiratory tract infections episodes per child per year. Forty-four respiratory tract infections (69%) were associated with virus: rhinovirus and enterovirus (RV/EV) were implied in 61% of them and respiratory syncytial virus (RSV) in 14%. Only one patient required hospitalization for lower respiratory tract infections. 86% of the patients were treated by antibiotics for a mean of 13.8 ± 6.2 days. RSV infections (n = 6) were usually of mild severity.ConclusionsRespiratory tract infections in young children with cystic fibrosis were of mild severity, rarely requiring hospitalization. Unsurprisingly, RV/EV were the most frequent agents. RSV-related morbidity seems low in this population. This raises the question of the usefulness of RSV preventive medication in this young population.
Highlights
Viral respiratory tract infections are common during early childhood
There was no correlation between age at inclusion and the total number of Respiratory tract infection (RTI) (Pearson correlation, r = − 0.24, p = 0.2353) nor virus-positive RTIs
This frequency is in accordance with data reported by Collinson et al in the late 1990s (3.4 Upper RTI (URTI) per year in children under 6 years of age) using cultural or serological tools [18], but is half the 3.8 episodes identified using PCR over the 6 winter months reported by van Ewijk et al in a population of children with Cystic fibrosis (CF) who were a mean 3.5 years old [9]
Summary
Viral respiratory tract infections are common during early childhood How they impact cystic fibrosis lung disease history in young children is poorly known. There is a critical lack of data describing viral respiratory tract infections (RTIs) in young children with CF aged less than 2 years, when RTIs are frequent and potentially more severe at this early period of life. Some studies conducted in the late 1980s and 1990s have drawn a pessimistic scenario of viral RTIs in this vulnerable population that is no longer observed. In these seminal studies, clinical manifestations were described as severe, frequently requiring hospitalization and prolonged oxygen supply or mechanical ventilation [16,17,18]. Recent studies have shown that RSV epidemics may be associated with the occurrence of more pulmonary exacerbations [20], but RSV is rarely responsible for hospitalization because of respiratory events in CF patients [21, 22]
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