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. 2025 Sep 11;17(9):1236.
doi: 10.3390/v17091236.

Viral Burden of Respiratory Syncytial Virus and Viral Coinfections as Factors Regulating Paediatric Disease Severity

Velia Chiara Di Maio  1 , Rossana Scutari  2 , Martina Mastropaolo  2 , Luna Colagrossi  1 , Giulia Linardos  1 , Luana Coltella  1 , Stefania Ranno  1 , Eugenia Galeno  1 , Mara Pisani  3 , Anna Chiara Vittucci  3 , Sebastian Cristaldi  3 , Massimiliano Raponi  4 , Alberto Villani  3 , Cristina Russo  1 , Carlo Federico Perno  1   2
Affiliations

Viral Burden of Respiratory Syncytial Virus and Viral Coinfections as Factors Regulating Paediatric Disease Severity

Velia Chiara Di Maio et al. Viruses. .

Abstract

Background: Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infections (ARIs) in children. However, the clinical impact of RSV co-infection with other respiratory viruses remains unclear. This study investigates the frequency and clinical outcomes of RSV infections in a large paediatric cohort.

Methods: Paediatric patients with RSV-positive respiratory samples admitted to Bambino Gesù Children's Hospital between January 2022 and April 2024 were analysed.

Results: Within 17,259 respiratory samples from 9877 paediatric patients, 952 (9.6%) were RSV-positive. Among these, 637 patients with ARI were included. RSV affected the lower respiratory tract in 549 cases (86.2%) and the upper tract in 88 (13.8%) cases. RSV mono-infection was found in 286 (44.9%) patients, while 351 (55.1%) patients had co-infections. Mono-infections showed lower cycle-threshold (CT) than co-infections in both upper and lower tract (p-value:0.002 and 0.037, respectively). Pneumonia was associated with RSV co-infection (N = 48, 15.4%), whereas bronchiolitis was mostly seen in mono-infection (N = 196, 78.1%, p-value:0.002). Regression analysis showed an association between pneumonia and co-infection (AOR: 1.97 [1.06-3.64], p-value = 0.031), higher CT (AOR [95% CI]: 1.07 [1.02-1.11], p-value = 0.006) and older age (AOR [95% CI]: 1.48 [1.31-1.68], p-value < 0.001), whereas bronchiolitis was associated with mono-infection, younger age and lower CT.

Conclusions: This study highlights the role of RSV in paediatric disease and emphasises the importance of early diagnosis, personalised treatment and preventive strategies to improve outcomes and reduce the burden of disease.

Keywords: co-infection; disease burden; disease severity; paediatric patients; respiratory syncytial virus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of viral detections in positive respiratory samples with a SARS-CoV-2 test available in the overall population (A) and according to upper and lower respiratory tract infections (B).
Figure 2
Figure 2
Cycle threshold values of RSV A (A) and RSV B (B) according to upper and lower respiratory tract infections. CT: cycle threshold. Two-sided p-value was calculated by Mann–Whitney test.
Figure 3
Figure 3
Distribution of bronchiolitis and pneumonia according to RSV mono-infection and RSV viral co-infection. Two-sided p-value was calculated by Fisher exact test.
See this image and copyright information in PMC

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