To the Editors: We read with interest the article by Techasaensiri et al,1 which analyzed the effect of viral coinfection on the clinical and laboratory characteristics, and outcome of 129 patients with invasive pneumococcal disease. It is believed that viral infections in pneumococcal pneumonia appear to be associated with more severe clinical disease.2 Between December 2006 and December 2008, we performed a prospective study on hospitalized children at the Hospital Infantil Niño Jesus of Madrid, who had acute community-acquired pneumonia. Previously healthy, children aged 2 to 6 years were considered eligible for inclusion. Etiologic studies included blood culture; pneumococcal DNA detection in blood samples by real-time polymerase chain reaction (RT-PCR), as described by Tarrago et al3; and viral serologic conversion in paired serum samples. Three RT-nested PCR assays were performed in nasopharyngeal samples to detect a total of 16 respiratory viruses: influenza virus A, B, and C were detected using previously described primer sets only to amplify influenza viruses4; a second multiplex PCR was used to detect parainfluenza viruses 1 to 4, human coronaviruses 229E and OC43, enteroviruses, and rhinoviruses5; the presence of respiratory syncytial virus-A and B types, hMPV, HBoV, and adenoviruses was investigated by a third multiplex RT-nested PCR.6 Patients who needed thoracocentesis were admitted to the pediatric intensive care unit. The study of the pleural fluid included microbiologic cultures, Gram staining, antigen testing (Binax Now), and RT-PCR for Streptococcus pneumoniae. This study was approved by the ethical committee of our institution, and signed consent forms were obtained from informed parents. Pneumococcal pneumonia was diagnosed in 83 patients, on the basis of blood cultures (11), RT-PCR (71), or pleural liquid studies (16). Quantitative procalcitonin samples were obtained in 74 cases, and serology paired samples were done in 62 cases. Viral coinfections were found in 49 patients (59%): 25 patients with 1 virus, 18 patients with 2 viruses, and 6 patients with 3 viruses. The most common viruses identified were rhinovirus (28), respiratory syncytial virus (11), and adenovirus (11). As Techasaensiri et al reported, we did not find significant differences when comparing the clinical and laboratory characteristics of patients with positive versus negative viral tests (Table, Supplemental Digital Content 1, https://links.lww.com/INF/A672). Length of stay, pediatric intensive care unit admission, and development of pleural effusion were not influenced by the presence of viral coinfection. It is remarkable that none of the patients with respiratory syncytial virus developed pleural effusion. There were no deaths among our patients. In contrast to the study of Techasaensiri et al,1 we included only patients with pneumonia, preschool age, and without any known underlying medical condition. Our results indicate that viral coinfection in pneumococcal pneumonia had no influence on clinical manifestations, laboratory characteristics, and patient outcome. Javier Alvarez-Coca Gonzalez, MD, PhD Jorge Martinez Perez, MD Seccion de Pediatria, Hospital Infantil Niño Jesus David Tarrago Asensio, MD, PhD Inmaculada Casas Flecha, MD, PhD Centro Nacional de Microbiología, ISCIII Almudena Alonso Ojembarrena, MD Seccion de Pediatria, Hospital Infantil Niño Jesus Madrid, Spain Giovanni Fedele, MD, PhD Centro Nacional de Microbiología, ISCIII Madrid, Spain