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Observational Study
. 2016 Apr:171:133-9.e1.
doi: 10.1016/j.jpeds.2015.12.034. Epub 2016 Jan 16.

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

Gregory P DeMuri  1 , James E Gern  1 , Stacey C Moyer  1 , Mary J Lindstrom  2 , Susan V Lynch  3 , Ellen R Wald  1
Affiliations
Observational Study

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

Gregory P DeMuri et al. J Pediatr. 2016 Apr.

Abstract

Objective: To determine the rate of sinusitis complicating upper respiratory tract illnesses (URIs) in children. We prospectively identified the clinical, virologic, and epidemiologic characteristics of URIs in a population of 4- to 7-year-old children followed for 1 year.

Study design: This was an observational cohort study in 2 primary care pediatric practices in Madison, Wisconsin. Nasal samples were obtained during 4 asymptomatic surveillance visits and during symptomatic URIs. A polymerase chain reaction-based assay for 9 respiratory viruses was performed on nasal samples. A diagnosis of sinusitis was based on published criteria.

Results: Two hundred thirty-six children ages 48-96 months were enrolled. A total of 327 URIs were characterized. The mean number of URIs per child was 1.3 (range 0-9) per year. Viruses were detected in 81% of URIs; rhinovirus (RV) was most common. Seventy-two percent of URIs were resolved clinically by the 10th day. RV-A and RV-C were detected more frequently at URI visits; RV-B was detected at the same rate for both asymptomatic surveillance visits and URI visits. Sinusitis was diagnosed in 8.8% of symptomatic URIs. Viruses were detected frequently (33%) in samples from asymptomatic children.

Conclusions: Sinusitis occurred in 8.8% of symptomatic URIs in our study. The virus most frequently detected with URIs in children was RV; RV-A and RV-C detection but not RV-B detection were associated with illness. Viruses, especially RV, are detected frequently in asymptomatic children. Most URIs have improved or resolved by the 10th day after onset. Children experienced a mean of 1.3 URIs per year, which was lower than expected.

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Figures

Figure 3
Figure 3
Respiratory viruses detected in nasal specimens from 725 asymptomatic surveillance visits and 327 URI visits from 236 study subjects. The detection rates shown include samples with both single and multiple viruses detected. ORs and 95% CIs (shown in parentheses) for the difference in detection of each virus between URI and surveillance specimens: ADV 3.6 (1.4-9.3), hBoV 1.3 (0.5-3.1), CoV 3.4 (2.1-5.7), EV 3.6 (1.2-11.1), FLU 7.0 (2.8-17.8), hMPV 4.9 (2.1-11.5), PIV 8.7 (3.5-21.5), RSV 8.4 (3.1-22.8), and RV 3.0 (2.3-3.9). There were 242 viruses detected in surveillance visits and 266 viruses in URI visits. ∗P < .001 for an OR different than 1.
Figure 4
Figure 4
RV species detected in nasal specimens (n = 179) in 725 surveillance (n = 725) vs 327 URI visits (n = 327). ORs for the comparison between surveillance and URI visits for each species: RV-A 2.0 (1.4-2.8,∗P < .001), RV-B 0.9 (0.5-1.7, P = Not Significant), RV-C 3.5 (2.3-5.1, ∗∗P < .001).
Figure 5
Figure 5
Detection of virus by month in 725 surveillance samples and 327 URI samples collected over three respiratory seasons from 236 subjects. A, ADV, hBoV, CoV, EV, FLU, hMPV, PIV, and RSV. B, RV (different scale). Because the number of samples per month varied, the data are presented as the percent of samples (surveillance + URI) in which a particular virus was detected.
Figure 1
Figure 1
Number of URIs per subject in a 1-year period (n = 119).
Figure 2
Figure 2
Number of URIs (n = 327) by month in 236 children.
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