Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department

Abstract

Background: Rhinovirus is the most common cause of viral respiratory tract infections in children. Virologic predictors of lower respiratory tract infection (LRTI), such as viral load and the presence of another respiratory virus (coinfection), are not well characterized in pediatric outpatients.

Methods: Mid-nasal turbinate samples were collected from children presenting for care to the Seattle Children's Hospital emergency department (ED) or urgent care with a symptomatic respiratory infection between December 2011 and May 2013. A subset of samples was tested for rhinovirus viral load by real-time polymerase chain reaction. Clinical data were collected by chart reviews. Multivariate logistic regression was used to evaluate the relationship between viral load and coinfection and the risk for LRTI.

Results: Rhinovirus was the most frequent respiratory virus detected in children younger than 3 years. Of 445 patients with rhinovirus infection, 262 (58.9%) had LRTIs, 231 (51.9%) required hospital admission and 52 (22.5%) were hospitalized for 3 days or longer. Children with no comorbidities accounted for 142 (54%) of 262 rhinovirus LRTIs. Higher viral load was significantly associated with LRTI among illness episodes with rhinovirus alone (OR, 2.11; 95% confidence interval [CI], 1.24-3.58). Coinfection increased the risk of LRTI (OR, 1.83; 95% CI, 1.01-3.32).

Conclusions: Rhinovirus was the most common pathogen detected among symptomatic young children in a pediatric ED who had respiratory viral testing performed, with the majority requiring hospitalization. Higher rhinovirus viral load and coinfection increased disease severity. Virologic data may assist clinical decision making for children with rhinovirus infections in the pediatric ED.

Keywords: coinfection; disease severity; emergency department; rhinovirus; viral load.

Figure 1.

Flow diagram showing sample selection for VL testing and chart review. Of a total of 757 samples collected in patients younger than 3 years during the time period of the study, analysis was performed using clinical and virologic data from 445 HRV illness episodes.

Figure 2.

Frequencies of HRV/EntV, RSV, influenza A/B (Flu A/B), and hMPV detection in samples collected from children younger than 3 years presenting to the Seattle Children's Hospital ED or UC between December 14, 2011 to June 18, 2012, and February 27, 2013 to May 31, 2013.

Figure 3.

Percentages of patients with clinical and virologic characteristics in HRV only versus coinfection illness episodes (A) and low versus high VL illness episodes (B).

Figure 4.

Box plots showing the ages of children with HRV illness episodes with or without respiratory viral coinfection (A) (P = 0.027) and of children who were or were not hospitalized (B) (P = 0.002).

Figure 5.

Bar chart showing the percentages of LRTIs in children with HRV illness episodes with VLs indicated by CT values of >30, >25 to 30, >20 to 25, >15 to 20, or ≤15.