Diagnostic value of respiratory virus detection in symptomatic children using real-time PCR

Abstract

Background: Acute respiratory tract infections are an important public health problem. Sensitive and rapid diagnostic techniques have been developed and are used in daily clinical practice. Here we evaluate the clinical relevance of detecting 20 common respiratory pathogens by molecular methods in a general pediatric clinic.

Methods: Nasopharynx samples of children < 18 years of age with respiratory symptoms referred to a general pediatric clinic were tested for the presence of 19 viruses and Mycoplasma pneumoniae, using real-time polymerase chain reaction.

Results: Of 177 patients included in this retrospective study, 73% were positive for at least one virus. Respiratory syncytial virus (36.6%) and human rhinovirus (24%) were most frequently detected. Patients in whom a respiratory virus or Mycoplasma pneumoniae was detected, were younger (6 versus 24 months; p < 0.001) and more often hospitalized (116 versus 34; p = 0.001) than patients in whom no respiratory pathogen was detected. Also they were more likely to present with feeding problems, dyspnea, rhinorrhea and wheezing (all p < 0.05) than patients without a respiratory pathogen.In the majority of cases, clinicians did not change their antibiotic management after detecting a viral respiratory pathogen. No difference in mean Ct value was found between patients with one respiratory pathogen and those with >1 respiratory pathogen (30.5 versus 31.2; p = 0.573).

Conclusion: Routine testing of common respiratory pathogens could lead to a better understanding of their role in disease in children with respiratory symptoms.

Figure 1

Seasonality of respiratory pathogens. Abbreviations: HAdV: human adenovirus, HBoV: human bocavirus, HCoV: human coronaviruses (HKU1, NL63, OC43 and 229E), HEV: human enterovirus, HMPV: human metapneumovirus, FLUAV: influenza A virus, FLUBV: influenza B virus, KIPyV: KI polyomavirus, MP: Mycoplasma pneumoniae, HPIV 1–4: human parainfluenza viruses, HPeV: human parechovirus, HRV: human rhinovirus, RSV: respiratory syncytial virus and WUPyV: WU polyomavirus.

Figure 2

Mean Ct values of the various respiratory pathogens. Abbreviations: Ct value: Cycle threshold value, HAdV: human adenovirus, HBoV: human bocavirus, HKU1, NL63, OC43 and 229E: human coronaviruses, HEV: human enterovirus, HMPV: human metapneumovirus, FLUBV: influenza B virus, KIPyV: KI polyomavirus, MP: Mycoplasma pneumoniae, HPIV 1–4: human parainfluenza viruses 1–4, HPeV: human parechovirus, HRV: human rhinovirus, RSV: respiratory syncytial virus and WUPyV: WU polyomavirus. Horizontal bars represent group means.