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Viral Loads and Disease Severity in Children with Rhinovirus-Associated Illnesses
Maria I Sanchez-Codez1, Katherine Moyer2, Isabel Benavente-Fernández3,4,5
1Division of Pediatric Infectious Diseases, Puerta del Mar University Hospital, Av. Ana de Viya, 21, 11009 Cádiz, Spain.
Insights
Rhinoviruses (RVs) can cause severe illness in children, even when not the primary diagnosis. Compatible symptoms significantly increased hospitalization, prolonged stays, oxygen need, and PICU admission, despite similar RV viral loads.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Clinical Microbiology
Background:
- Rhinovirus (RV) infections are common in children, but their role in non-classic syndromes is unclear.
- Understanding RV's impact beyond typical respiratory illnesses is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the clinical significance of rhinovirus detection in children presenting with diverse clinical syndromes.
- To compare outcomes between children with RV-compatible symptoms and those with incidental RV detection.
Main Methods:
- Retrospective analysis of 2473 children PCR+ for RV from 2011-2013.
- Univariate and multivariable logistic regression to assess associations with clinical characteristics and outcomes.
- Comparison of RV viral loads and bacterial co-infections between groups.
Main Results:
- 96% of RV+ children had compatible symptoms; 4% had incidental detection.
- Comparable RV viral loads between groups, but higher in single RV infections vs. co-infections in symptomatic children.
- Bacterial co-infections were more frequent in incidentally detected RV (7.6%) than in compatible symptom groups (1.9%).
Conclusions:
- Compatible symptoms significantly increased odds of hospitalization (OR 4.8), prolonged stays (OR 1.9), oxygen need (OR 12), and PICU admission (OR 4.13).
- Disease severity is worse in children with compatible symptoms, irrespective of comparable RV viral loads.
- Rhinovirus detection warrants clinical consideration even in non-classic presentations due to potential severity.
Abstract:
The role of rhinoviruses (RVs) in children with clinical syndromes not classically associated with RV infections is not well understood. We analyzed a cohort of children ≤21 years old who were PCR+ for RV at a large Pediatric Hospital from 2011 to 2013. Using univariate and multivariable logistic regression, we analyzed the associations between demographic, clinical characteristics, microbiology data, and clinical outcomes in children with compatible symptoms and incidental RV detection. Of the 2473 children (inpatients and outpatients) with an RV+ PCR, 2382 (96%) had compatible symptoms, and 91 (4%) did not. The overall median age was 14 months and 78% had underlying comorbidities. No differences in RV viral loads were found according to the presence of compatible symptoms, while in children with classic RV symptoms, RV viral loads were higher in single RV infections versus RV viral co-infections. Bacterial co-infections were more common in RV incidental detection (7.6%) than in children with compatible symptoms (1.9%, p < 0.001). The presence of compatible symptoms independently increased the odds ratio (OR, 95% CI) of hospitalization 4.8 (3.1-7.4), prolonged hospital stays 1.9 (1.1-3.1), need for oxygen 12 (5.8-25.0) and pediatric intensive care unit (PICU) admission 4.13 (2.0-8.2). Thus, despite comparable RV loads, disease severity was significantly worse in children with compatible symptoms.
