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Published on: August 2, 2024
Upper airway viruses and bacteria and clinical outcomes in children with cough
Kerry-Ann F O'Grady1, Keith Grimwood2, Theo P Sloots3,4
1Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, 4101, Australia.
Insights
In children with acute respiratory illness (ARI), the bacteria Moraxella catarrhalis was linked to persistent cough. Respiratory Syncytial Virus (RSV) A or B was associated with hospitalization in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Cough is a common symptom in pediatric acute respiratory illnesses (ARI).
- Previous studies have not comprehensively assessed upper airway microbes for predicting cough outcomes in children.
- This study investigates microbial predictors of hospitalization and persistent cough in children with ARI.
Purpose of the Study:
- To determine if upper airway microbes independently predict hospitalization and persistent cough at 28 days in children presenting with an ARI and cough.
- To identify specific viruses and bacteria associated with adverse cough outcomes in pediatric ARI.
Main Methods:
- A prospective cohort study of 817 children under 15 years old presenting with ARI and cough.
- Nasal swabs were collected for polymerase chain reaction (PCR) testing of 7 bacteria and 17 viruses.
- Logistic regression models analyzed predictors of hospitalization and persistent cough at 28 days.
Main Results:
- 14.2% of children were hospitalized, and 20.0% experienced persistent cough at 28 days.
- Respiratory Syncytial Virus (RSV) A or B detection was associated with increased hospitalization risk (aRR 1.8).
- Moraxella catarrhalis was the only significant microbial predictor of persistent cough (aRR 2.1).
Conclusions:
- Moraxella catarrhalis may play a role in the pathogenesis of persistent cough following pediatric ARI.
- Further research is warranted to explore the etiologic role of M. catarrhalis in chronic cough and its link to lung disease.
- Identifying specific microbial contributors can inform targeted interventions for pediatric respiratory illnesses.
Background:
Cough is symptomatic of a broad range of acute and chronic pediatric respiratory illnesses. No studies in children have tested for an extended panel of upper airway respiratory viruses and bacteria to identify whether they predict cough outcomes, irrespective of clinical diagnosis at the time of acute respiratory illness (ARI). We therefore determined whether upper airway microbes independently predicted hospitalization and persistent cough 28-days later in children presenting with an ARI, including cough as a symptom.
Methods:
A cohort study of children aged <15-years were followed for 28-days after presenting to a pediatric emergency department with an ARI where cough was also a symptom. Socio-demographic factors, presenting clinical features and a bilateral anterior nasal swab were collected at enrolment. Polymerase chain reaction assays tested for seven respiratory bacteria and 17 viruses. Predictors of hospitalization and persistent cough at day-28 were evaluated in logistic regression models.
Results:
Eight hundred and seventeen children were included in the analysis; median age 27.7-months. 116 (14.2%, 95%CI 11.8, 16.6) children were hospitalized and 163 (20.0%, 95%CI 17.2, 22.7) had persistent cough at day-28. Hospitalized children were more likely to have RSV A or B detected on nasal swab than those not admitted (adjusted relative risk (aRR) 1.8, 95%CI 1.0, 3.3). M. catarrhalis was the only microbial difference between children with and without cough persistence (aRR for those with cough at day 28: 2.1, 95%CI 1.3, 3.1).
Discussion:
An etiologic role for M. catarrhalis in the pathogenesis of persistent cough post-ARI is worth exploring, especially given the burden of chronic cough in children and its relationship with chronic lung disease. Pediatr Pulmonol. 2017;52:373-381. © 2016 Wiley Periodicals, Inc.
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