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Prospective evaluation for respiratory pathogens in children with sickle cell disease and acute respiratory illness
Ashok Srinivasan1, Winfred C Wang, Aditya Gaur
1Department of Bone Marrow Transplantation and Cellular Therapy (BMTCT), St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Human rhinovirus (HRV) was the most common respiratory virus in children with sickle cell disease. HRV infection did not increase the risk of acute chest syndrome (ACS) in these children.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Respiratory Virology
Background:
- Infections in children with sickle cell disease (SCD) are a significant concern.
- The role of specific respiratory viruses like human rhinovirus (HRV) in SCD complications remains understudied.
Purpose of the Study:
- To investigate the prevalence and clinical significance of common respiratory viruses in children with SCD experiencing acute respiratory illness.
- To determine the association between viral detection and the development of acute chest syndrome (ACS).
Main Methods:
- Prospective collection of nasopharyngeal wash specimens from 60 children with SCD and acute respiratory illness.
- Multiplexed PCR testing for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis.
- Evaluation of clinical characteristics and viral distribution in patients with and without ACS.
Main Results:
- A respiratory virus was detected in 78% of patients; HRV was the most common (62%).
- All nine patients (15%) who developed ACS had a viral infection, but no specific virus was significantly associated with ACS.
- Co-infections were common (30%) but not more frequent in patients with ACS.
Conclusions:
- HRV is the predominant respiratory virus in children with SCD presenting with acute respiratory illness.
- Current findings suggest HRV is not associated with increased morbidity or ACS in this population.
- Further research with larger cohorts and asymptomatic controls is warranted to fully elucidate the role of emerging respiratory viruses in SCD complications.
Background:
Human rhinovirus (HRV), human coronavirus (hCoV), human bocavirus (hBoV), and human metapneumovirus (hMPV) infections in children with sickle cell disease have not been well studied.
Procedure:
Nasopharyngeal wash specimens were prospectively collected from 60 children with sickle cell disease and acute respiratory illness, over a 1-year period. Samples were tested with multiplexed-PCR, using an automated system for nine respiratory viruses, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Bordetella pertussis. Clinical characteristics and distribution of respiratory viruses in patients with and without acute chest syndrome (ACS) were evaluated.
Results:
A respiratory virus was detected in 47 (78%) patients. Nine (15%) patients had ACS; a respiratory virus was detected in all of them. The demographic characteristics of patients with and without ACS were similar. HRV was the most common virus, detected in 29 of 47 (62%) patients. Logistic regression showed no association between ACS and detection of HRV, hCoV, hBoV, hMPV, and other respiratory pathogens. Co-infection with at least one additional respiratory virus was seen in 14 (30%) infected patients, and was not significantly higher in patients with ACS (P = 0.10). Co-infections with more than two respiratory viruses were seen in seven patients, all in patients without ACS. Bacterial pathogens were not detected.
Conclusion:
HRV was the most common virus detected in children with sickle cell disease and acute respiratory illness, and was not associated with increased morbidity. Larger prospective studies with asymptomatic controls are needed to study the association of these emerging respiratory viruses with ACS in children with sickle cell disease.
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