Concurrent detection of other respiratory viruses in children shedding viable human respiratory syncytial virus

Abstract

Human respiratory syncytial virus (HRSV) is an important cause of respiratory disease. The majority of studies addressing the importance of virus co-infections to the HRSV-disease have been based on the detection of HRSV by RT-PCR, which may not distinguish current replication from prolonged shedding of remnant RNA from previous HRSV infections. To assess whether co-detections of other common respiratory viruses are associated with increased severity of HRSV illnesses from patients who were shedding viable-HRSV, nasopharyngeal aspirates from children younger than 5 years who sought medical care for respiratory infections in Ribeirão Preto (Brazil) were tested for HRSV by immunofluorescence, RT-PCR and virus isolation in cell culture. All samples with viable-HRSV were tested further by PCR for other respiratory viruses. HRSV-disease severity was assessed by a clinical score scale. A total of 266 samples from 247 children were collected and 111 (42%) were HRSV-positive. HRSV was isolated from 70 (63%), and 52 (74%) of them were positive for at least one additional virus. HRSV-positive diseases were more severe than HRSV-negative ones, but there was no difference in disease severity between patients with viable-HRSV and those HRSV-positives by RT-PCR. Co-detection of other viruses did not correlate with increased disease severity. HRSV isolation in cell culture does not seem to be superior to RT-PCR to distinguish infections associated with HRSV replication in studies of clinical impact of HRSV. A high rate of co-detection of other respiratory viruses was found in samples with viable-HRSV, but this was not associated with more severe HRSV infection.

Keywords: HRSV infection; HRSV isolation; respiratory virus co-infection; severity of HRSV disease.

Figure 1

HRSV seasonality in Ribeirão Preto, 2005. Of 266 NPAs, 111 (42%) were HRSV‐positive and were collected from February to November, with a seasonal increase from April to June (autumn). HRSV was isolated from 70 (63%) NPAs, collected from March to September, with peak activity from April to May. In addition to viable HRSV, other respiratory viruses were detected by PCR in 52 NPAs (74%) collected from March to September. The 18 (26%) NPAs positive only for viable HRSV by cell culture were collected from April to August.