Bacterial coinfection in children hospitalized with respiratory syncytial virus infections
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M Korppi1, M Leinonen, M Koskela
1Department of Pediatrics, Kuopio University Central Hospital, Finland.
Insights
Respiratory syncytial virus (RSV) infections in children predispose them to secondary bacterial infections, particularly Streptococcus pneumoniae and Haemophilus influenzae. Prompt bacterial testing is crucial for managing RSV-related respiratory illnesses.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Microbiology
Background:
- Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections in children.
- Secondary bacterial infections frequently complicate viral respiratory illnesses.
- The interplay between RSV and bacterial pathogens requires further investigation.
Purpose of the Study:
- To prospectively investigate clinical and bacterial findings in children hospitalized with RSV infection.
- To compare bacterial coinfection rates in RSV-positive versus RSV-negative children during and after an RSV epidemic.
- To identify common bacterial pathogens associated with RSV-induced respiratory tract infections.
Main Methods:
- Prospective surveillance of 90 children with RSV infection over 12 months.
- Comparison with RSV-negative children hospitalized during peak RSV season (N=91) and post-epidemic (N=99).
- Bacterial infection assessment via antibody titers and pneumococcal antigen detection.
Main Results:
- Bacterial infection was found in 39% of children with RSV, versus 24% during the epidemic and 8% after.
- Streptococcus pneumoniae and Haemophilus influenzae were the most common bacterial coinfections.
- Pneumonia and acute otitis media were frequent in both RSV-positive and negative children during the epidemic.
Conclusions:
- RSV acts as a significant predisposing factor for secondary bacterial airway infections in children.
- Bacterial pathogens, especially Streptococcus pneumoniae and Haemophilus influenzae, are common in mixed RSV-bacterial infections.
- Active bacterial pathogen screening is recommended for children with lower respiratory tract syndromes, particularly those with confirmed RSV infection.
Abstract:
Clinical and bacterial findings were prospectively studied in 90 children hospitalized because of middle or lower respiratory tract infection caused by respiratory syncytial virus (RSV) during a surveillance period of 12 months. The results were compared with those of RSV-negative children hospitalized with identical indications during the 3 peak months of the RSV epidemic (N = 91) or for the 3 months after the outbreak (N = 99). A high frequency of pneumonia and acute otitis media were found in both RSV-positive and RSV-negative children during the epidemic, but not in control patients after the epidemic. Bacterial infection, based on a significant rise of antibody titer and/or on detection of pneumococcal antigen in serum or urine, was observed in 39% of the children with RSV infection. The respective figures were 24% in RSV-negative children hospitalized during the epidemic and 8% after the epidemic. Our observations stress the role of RSV as a predisposing agent for secondary bacterial infection in the airways of children. The most common bacteria involved in the mixed RSV-bacterial infections were Streptococcus pneumoniae and Haemophilus influenzae, the latter being found only in pneumonic patients. The presence or absence of pneumonia or acute otitis media was not significantly correlated with evidence of pneumococcal infection. We conclude that a bacterial pathogen should be actively sought when managing patients with lower respiratory tract syndromes, especially in those who have evidence of RSV infection.