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Viral Coinfection of Children Hospitalized with Severe Acute Respiratory Infections during COVID-19 Pandemic
Célia Regina Malveste Ito1, André Luís Elias Moreira1, Paulo Alex Neves da Silva1
1Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil.
Insights
Respiratory virus coinfections, like human rhinovirus/SARS-CoV-2, increase severe respiratory illness in children. Certain coinfections, including RSV and hBoV, worsen disease severity in pediatric ICU patients.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- Severe acute respiratory infection (SARI) in children is primarily caused by respiratory viruses.
- Molecular diagnostics enable rapid, simultaneous detection of multiple viral pathogens, aiding in coinfection diagnosis.
Purpose of the Study:
- To investigate the prevalence and impact of viral coinfections in children with SARI admitted to the ICU.
- To identify common viral coinfection patterns and their association with disease severity.
Main Methods:
- A retrospective study of children admitted to the ICU with SARI between March 2020 and December 2021.
- Polymerase chain reaction (PCR) testing on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viruses.
Main Results:
- Out of 446 children, 160 had coinfections with two or more viruses.
- The most frequent coinfections were hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), and RSV/SARS-CoV-2 (12.69%).
- Coinfections with RSV and hBoV were associated with increased oxygen therapy use and higher mortality rates.
Conclusions:
- Coinfections with respiratory viruses like RSV and hBoV can exacerbate SARI severity in pediatric ICU patients.
- Children with SARS-CoV-2 coinfections may experience worsened clinical conditions, especially if comorbidities are present.
Abstract:
The main pathogens of severe respiratory infection in children are respiratory viruses, and the current molecular technology allows for a rapid and simultaneous detection of a wide spectrum of these viral pathogens, facilitating the diagnosis and evaluation of viral coinfection.
Methods:
This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study.
Results:
The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of (p > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively.
Conclusion:
Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities.
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