Clinical and laboratory profiles of hospitalized children with acute respiratory virus infection

Abstract

Purpose: Despite the availability of molecular methods, identification of the causative virus in children with acute respiratory infections (ARIs) has proven difficult as the same viruses are often detected in asymptomatic children.

Methods: Multiplex reverse transcription polymerase chain reaction assays were performed to detect 15 common respiratory viruses in children under 15 years of age who were hospitalized with ARI between January 2013 and December 2015. Viral epidemiology and clinical profiles of single virus infections were evaluated.

Results: Of 3,505 patients, viruses were identified in 2,424 (69.1%), with the assay revealing a single virus in 1,747 cases (49.8%). While major pathogens in single virus-positive cases differed according to age, human rhinovirus (hRV) was common in patients of all ages. Respiratory syncytial virus (RSV), influenza virus (IF), and human metapneumovirus (hMPV) were found to be seasonal pathogens, appearing from fall through winter and spring, whereas hRV and adenovirus (AdV) were detected in every season. Patients with ARIs caused by RSV and hRV were frequently afebrile and more commonly had wheezing compared with patients with other viral ARIs. Neutrophil-dominant inflammation was observed in ARIs caused by IF, AdV, and hRV, whereas lymphocyte-dominant inflammation was observed with RSV A, parainfluenza virus, and hMPV. Monocytosis was common with RSV and AdV, whereas eosinophilia was observed with hRV.

Conclusion: In combination with viral identification, recognition of virus-specific clinical and laboratory patterns will expand our understanding of the epidemiology of viral ARIs and help us to establish more efficient therapeutic and preventive strategies.

Keywords: Child; Clinical profile; Epidemiology; Multiplex RT-PCR; Respiratory virus.

Fig. 1. Frequency of single and multiple virus detection. IFA, influenza A virus; IFB, influenza B virus; RSV A, respiratory syncytial virus A; RSV B, respiratory syncytial virus B; PIV, parainfluenza virus; hCV, human coronavirus; hRV, human rhinovirus; hEV, human enterovirus; AdV, adenovirus; hBV, human bocavirus; hMPV, human metapneumovirus.

Fig. 2. Distribution of respiratory virus infection among different pediatric age groups. IFA, influenza A virus; IFB, influenza B virus; RSV A, respiratory syncytial virus A; RSV B, respiratory syncytial virus B; PIV, parainfluenza virus; hCV, human coronavirus; hRV, human rhinovirus; hEV, human enterovirus; AdV, adenovirus; hBV, human bocavirus; hMPV, human metapneumovirus.

Fig. 3. Seasonal distribution of respiratory virus infection in children. IFA, influenza A virus; IFB, influenza B virus; RSV A, respiratory syncytial virus A; RSV B, respiratory syncytial virus B; PIV, parainfluenza virus; hRV, human rhinovirus; hEV, human enterovirus; AdV, adenovirus; hMPV, human metapneumovirus; hBV, human bocavirus; hCV, coronavirus.