Severe Pediatric Rhinovirus Linked to RSV Coinfections

Steven Fox

January 14, 2014

Human rhinovirus (HRV) is a pathogen frequently associated with the common cold; however, recent studies have indicated that HRV may also cause severe lower respiratory infections in children. Now, investigators have found that severe HRV infections are associated with a limited number of factors, including coinfection with respiratory syncytial virus (RSV), prematurity, congenital heart disease, and noninfectious respiratory disease.

Lourenco Faria Costa, PhD, from Laboratory of Virology, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Brazil, and colleagues report the results of their study in an article published online January 13 in Pediatrics.

"Factors involved in increased disease severity in HRV infections are contradicting in the literature," the authors write. "Some reports have associated coinfection with a second respiratory virus with a more severe disease, whereas others have not."

To clarify those factors, the researchers conducted a retrospective study of 434 children younger than 5 years who presented with acute respiratory infections from 2001 to 2010 at hospitals and health clinics in Brazil. The children displayed a wide range of respiratory infection symptoms, as well as a broad spectrum of severity.

The researchers collected medical and demographic data on the children from questionnaires completed by attending physicians. The data included information on patients' age, day of symptom onset, clinical presentation, comorbidities, whether there was smoking in the household, and whether any atopic diseases were present.

The researchers tested nasopharyngeal aspirates from the children for HRV and 8 other respiratory viruses.

Testing detected HRV in 181 (41.7%) of the cultures. In 107 (59.1%) of the children, HRV was the only pathogen detected, whereas in 74 (40.9%) children, HRV shared coinfection with other pathogens. The most common coinfection was RSV, which was detected in 32 (43.2%) of the children with coinfections.

Compared with children with single-pathogen infections, those with coinfections were nearly twice as likely (51.3% vs 28.9%) to exhibit moderate to severe symptoms. Coinfections also were more likely to be linked with lower respiratory tract symptoms and with some indices of disease severity, including likelihood of hospitalization, the researchers say.

Other comorbidities associated with severe disease were premature birth, the presence of cardiomyopathy, and noninfectious respiratory diseases.

These findings have important implications for managing children with respiratory infections, the researchers write. "We expect that children at risk for developing severe disease could be identified sooner and appropriate measures could be taken," they conclude.

Supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Brazil), Conselho Nacional de Desenvolvimento Científico e Tecnológico (Brazil), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), and Pró-reitoria de Pesquisa e Pós-graduação of Universidade Federal de Uberlândia. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 13, 2014. Abstract

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