Viral Etiology of Acute Respiratory Infections With Cough in Infancy: A Community-Based Birth Cohort Study

Nicolas Regamey, MD; Laurent Kaiser, MD; Hanna L. Roiha, MD; Christelle Deffernez, PhD; Claudia E. Kuehni, MD; Philipp Latzin, MD; Christoph Aebi, MD; Urs Frey, MD, PhD


Pediatr Infect Dis J. 2008;27(2):100-105. 

In This Article

Abstract and Introduction

Background: Acute respiratory infections (ARI) are a major cause of morbidity in infancy worldwide, with cough and wheeze being alarming symptoms to parents. We aimed to analyze in detail the viral aetiology of ARI with such symptoms in otherwise healthy infants, including rhinoviruses and recently discovered viruses such as human metapneumovirus (HMPV), coronavirus NL63 and HKU1, and human bocavirus (HBoV).
Methods: We prospectively followed 197 unselected infants during their first year of life and assessed clinical symptoms by weekly standardized interviews. At the first ARI with cough or wheeze, we analyzed nasal swabs by sensitive individual real time polymerase chain reaction assays targeting 16 different respiratory viruses.
Results: All 112 infants who had an ARI had cough, and 39 (35%) had wheeze. One or more respiratory viruses were found in 88 of 112 (79%) cases. Fifteen (17%) dual and 3 (3%) triple infections were recorded. Rhino- (23% of all viruses) and coronaviruses (18%) were most common, followed by parainfluenza viruses (17%), respiratory syncytial virus (RSV) (16%), HMPV (13%), and HBoV (5%). Together rhinoviruses, coronaviruses, HMPV, and HBoV accounted for 60% (65 of 109) of viruses. Although symptom scores and need for general practitioner (GP) consultations were highest in infants infected with RSV, they were similar in infants infected with other viruses. Viral shedding at 3 weeks occurred in 20% of cases.
Conclusions: Rhinoviruses, coronaviruses, HMPV, and HBoV are common pathogens associated with respiratory symptoms in otherwise healthy infants. They should be considered in the differential diagnosis of the aetiology of ARI in this age group.

Acute viral respiratory illnesses are a major cause of morbidity in infants and young children. Although most often self-limited and confined to the upper respiratory tract, they lead to a substantial number of upper or lower respiratory tract complications. Wheezing disorders, bronchiolitis, or pneumonia with possible subsequent hospitalizations may occur, especially in infants. In addition, some viral respiratory tract infections acquired early in life might lead to asthma or other chronic lung dysfunction.[1]

The role of respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus (IV), and adenovirus in causing acute respiratory infections (ARI) in infants and children is widely accepted.[2] However, in addition to these viruses, other viruses have been recently identified as causative agents of respiratory illnesses in infants and children. Rhinoviruses and coronaviruses, often referred to as the common-cold agents, have turned into the focus of attention because they can cause lower respiratory tract disease in addition to their known role as upper respiratory tract pathogens.[3,4] Recently, human metapneumovirus (HMPV), human coronavirus (HCoV) NL63 and HKU1, and human bocavirus (HBoV) have been identified in respiratory samples from children with acute respiratory diseases,[5,6,7,8] but the relative contribution of these viruses to respiratory symptoms early in life has not been well described.

We aimed to analyze in detail the pattern of viruses associated with respiratory symptoms in unselected, otherwise healthy infants. Therefore, we studied prospectively the first ARI with cough or wheeze, 2 significant symptoms that often alarm parents and lead to medical consultations and drug prescriptions, in a birth cohort of healthy infants during their first year of life. We analyzed respiratory samples at the onset of symptoms for a large number of respiratory viruses, including rhinoviruses and the newly recognized HMPV, HCoV-NL63, HCoV-HKU1, and HBoV. We studied the contribution of each virus to type, severity, and duration of symptoms and assessed the persistence of viruses in respiratory samples 3 weeks after the onset of symptoms.


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