Severity of Respiratory Syncytial Virus Lower Respiratory Tract Infection With Viral Coinfection in HIV-Uninfected Children

Natalie I Mazur, Louis Bont, Adam L Cohen, Cheryl Cohen, Anne von Gottberg, Michelle J Groome, Orienka Hellferscee, Kerstin Klipstein-Grobusch, Omphile Mekgoe, Fathima Naby, Jocelyn Moyes, Stefano Tempia, Florette K Treurnicht, Marietje Venter, Sibongile Walaza, Nicole Wolter, Shabir A Madhi,

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background. Molecular diagnostics enable sensitive detection of respiratory viruses, but their clinical significance remains unclear in pediatric lower respiratory tract infection (LRTI). We aimed to determine whether viral coinfections increased life-threatening disease in a large cohort. Methods. Molecular testing was performed for respiratory viruses in nasopharyngeal aspirates collected from children aged <5 years within 24 hours of hospital admission during sentinel surveillance for severe acute respiratory illness (SARI) hospitalization conducted in South Africa during February 2009-December 2013. The primary outcome was life-threatening disease, defined as mechanical ventilation, intensive care unit admission, or death. Results. Of 2322 HIV-uninfected children with respiratory syncytial virus (RSV)-associated LRTI, 1330 (57.3%) had RSV monoinfection, 38 (1.6%) had life-threatening disease, 575 (24.8%) had rhinovirus, 347 (14.9%) had adenovirus (ADV), and 30 (1.3%) had influenza virus. RSV and any other viral coinfection was not associated with severe disease (odds ratio [OR], 1.4; 95% confidence interval [CI], OR, 0.74; 95% CI, .39-1.4), ADV coinfection had increased odds of life-threatening disease (adjusted OR, 3.4; 95% CI, 1.6-7.2; P = .001), and influenza coinfection had increased odds of life-threatening disease and prolonged length of stay (adjusted OR, 2.1; 95% CI, 1.0-4.5; P = .05) compared with RSV monoinfection. Conclusions. RSV coinfection with any respiratory virus is not associated with more severe disease when compared to RSV alone in this study. However, increased life-threatening disease in RSV-ADV and RSV-influenza coinfection warrants further study.

Original languageEnglish
Pages (from-to)443-450
Number of pages8
JournalClinical Infectious Diseases
Volume64
Issue number4
DOIs
Publication statusPublished - 15 Feb 2017

Keywords

  • Child, Preschool
  • Coinfection
  • Critical Care
  • Female
  • Humans
  • Infant
  • Male
  • Molecular Diagnostic Techniques
  • Nasopharynx
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Tract Infections
  • South Africa
  • Survival Analysis
  • Virus Diseases
  • Viruses

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