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Published on: September 22, 2023
Disease Severity and Viral Codetection in Acute Lower Respiratory Tract Infection
Maria Katherine Sierra-Echeverri1, Ofelia Maria Perez-Lopera1, Claudia Beltran-Arroyave1,2
1From the Department of Pediatrics, University of Antioquia.
Insights
Viral coinfections in children hospitalized with pneumonia are not linked to worse outcomes overall. However, in infants under one year, detecting multiple viruses is associated with more severe disease.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Virology
- Clinical Epidemiology
Background:
- The impact of multiple viral detections (coinfections) on respiratory infection severity in children is not well understood.
- Investigating coinfections is crucial for understanding disease progression and outcomes in pediatric respiratory illnesses.
Purpose of the Study:
- To determine the association between viral coinfections and disease severity in children under five hospitalized with suspected viral pneumonia.
- To identify risk factors for severe outcomes in pediatric viral pneumonia.
Main Methods:
- A case-control study was conducted with children hospitalized between September 2019 and June 2022.
- Cases met severity criteria (complicated pneumonia, ICU admission, ventilation, death), while controls did not.
- Multiplex polymerase chain reaction (PCR) was used for viral detection, and multivariate logistic regression analyzed associations.
Main Results:
- Of 561 patients, 39.8% had viral coinfections. Overall, coinfection was not significantly associated with increased severity (adjusted OR = 1.4).
- Younger age (<1 year) and prior bronchiolitis were independently associated with greater severity.
- In infants under one year, viral coinfection was significantly associated with increased severity (adjusted OR = 2.7).
Conclusions:
- Viral coinfections are not a significant predictor of severity in all children hospitalized with suspected viral pneumonia.
- However, coinfection is a critical factor associated with more severe disease specifically in infants under one year of age.
Background:
It is unclear whether codetections of viruses in respiratory infections are associated with worse outcomes. We aimed to establish the association between viral codetections and severity in children under 5 years of age hospitalized with suspected viral pneumonia.
Methods:
We designed a case-control study. The population comprised children hospitalized at a tertiary-level institution between September 2019 and June 2022 with clinical suspicion of pneumonia and detection of at least 1 respiratory virus by nested Multiplex polymerase chain reaction (FilmArray Respiratory Panel, Biomerieux). The cases were children between 1 and 60 months of age who met the severity criteria: complicated pneumonia, intrapulmonary complications, vasoactive requirement or ventilatory support or death. Controls were patients who did not meet these criteria. We performed multivariate analysis using binary logistic regression models to calculate adjusted ORs (ORa) for relevant variables and potential confounders.
Results:
We included 561 patients; 224 (39.9%) were infants, of whom 175 patients (31.2%) required intensive care and 1 died. Codetection was found in 223 children (39.8%). In the multivariate analysis, being younger than 1 year [ORa = 2.8; 95% confidence interval (CI): 1.8-4.5], and having a prior bronchiolitis (ORa = 3.6; 95% CI: 1.4-8.9), but not codetections (ORa = 1.4; 95% CI: 0.9-2.0), were independently associated with a greater severity. However, codetection was the only associated variable with worse severity in the subgroup of infants (ORa = 2.7, 95% CI: 1.1-6.8).
Conclusions:
The detection of 2 or more viruses in children <1 year of age with suspected viral pneumonia is associated with more severe disease.
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