COMMENTARY

Same Old, Same Old Cold or Something More? Patterns of Pediatric URI

William T. Basco, Jr., MD, MS

Disclosures

July 01, 2016

Clinical Features, Virus Identification, and Sinusitis as a Complication of Upper Respiratory Tract Illness in Children Ages 4-7 Years

DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER
J Pediatr. 2016;171:133-139

Study Summary

Few large studies have followed children prospectively to determine the virology of upper respiratory tract infections (URIs) as well as the frequency of developing sinusitis as a complication. This study enrolled children aged 4-7 years at primary care practices in Wisconsin and followed them for 1 year. Nasal mucus samples were obtained at enrollment and again in February, April, September, and December of each year as part of planned sampling when the children were well. In addition, sampling was conducted by a study nurse if a child experienced URI symptoms for at least 24-48 hours and again on day 15 after onset of URI symptoms, when the child had presumably recovered from the acute URI. Parents completed symptom surveys after 48 hours and again on days 7, 10, and 15. An episode was considered to be complicated by sinusitis if the child had persistent symptoms for more than 10 days and was not improving; if the child had severe symptoms such as purulent nasal discharge plus an elevated temperature; or if the child exhibited worsening symptoms beyond the sixth day of illness. Virology was completed by polymerase chain reaction, which included assessments for respiratory syncytial virus, rhinovirus, para-influenza virus, influenza virus, adenovirus, coronavirus, enterovirus, human bocavirus, and human metapneumovirus.

The study enrolled 236 children, and 119 completed the 12 months of study. The mean age of the sample was 5.1 years, 46% were girls, 80% were white, 8% were black, 8% were Asian, and 7% were of Hispanic ethnicity. Most (83%) attended school or daycare.

Study children experienced an average of 1.3 URIs per year (range, 0-9). Almost one third (29%) did not experience a URI during the study, and 15% experienced at least four URIs. During 81% of the URI episodes, one or more viruses were detected. Rhinovirus accounted for 49% of all isolates. In addition, rhinovirus was present in approximately 25% of the well surveillance samples. During 12% of the URI episodes, multiple viruses were isolated, with the bulk of those having only two viruses. Other than rhinovirus, the only virus to be isolated from more than 10% of the URI samples was coronavirus, and none of the other detected viruses was present in more than 5% of the well surveillance samples.

For 21% of the children, the URI resulted in a missed school or daycare day. Approximately 11% of the parents missed work during URI episodes, and 24% of the URIs resulted in at least one medical visit. Criteria for sinusitis were met in 29 of the 327 URI episodes (8.9%). Approximately half of the sinusitis cases were due to persistent symptoms and the other half due to worsening symptoms. The authors concluded that most URI symptoms (72%) have either improved or resolved by day 10 and that sinusitis is the most common complication of URI in this age group.

Viewpoint

The definition of sinusitis in this study is a clinical one that has been used fairly consistently in other studies, allowing better comparison across studies, and the frequency of sinusitis identified in this study is in a similar range to that found in other studies. Having this information is helpful for clinicians to remember that we should consider whether we should make the diagnosis of sinusitis in more than 1 in 10 children in this age group with URI symptoms. It is also worth remembering the two important pathways to diagnosis—either persistent or worsening symptoms.

Abstract

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