Objective: To determine whether viral coinfection is a risk for severe
lower respiratory tract infection (LRTI). Working Hypothesis: Children
with viral coinfection had a higher risk for admission to the intensive
care unit (ICU) than those with a single virus infection. Study Design:
Retrospective, observational study for ten years. Patient-Subject
Selection: Children between 1-60 months of age hospitalized with LRTI.
Methodology: We defined severe LRTI as admission to the ICU for
high-flow nasal cannula oxygen/bilevel positive airway pressure/invasive
ventilation and assessed demographic and laboratory data with potential
risk factors from the patients’ medical records. Results: Of 2115
children hospitalized with LRTI, 562 had severe, and 1553 had mild
disease. Viral coinfection was present in 28.3% of all patients, and
those with viral coinfection were at a higher risk of severe LRTI than
those with a single virus infection (43.8% vs. 22.7%; aOR, 3.44; 95%
CI, 2.74-4.53). Respiratory syncytial virus (RSV) and rhinovirus (except
for between 25-60 months) coinfections were associated with severe LRTI
in all ages, whereas parainfluenza virus-3 (PIV3; 7-24 months) and
bocavirus (7-12 months) coinfections led to severe LRTI in early
childhood. Moreover, influenza-A coinfection caused severe LRTI in
children between 7-12 and 25-60 months. Other risk factors included
young age, prematurity, history of atopy, exposure to tobacco smoke,
underlying condition, neutrophilia, lymphopenia, and high CRP value.
Conclusion: Children with viral coinfection, particularly with
rhinovirus, RSV, influenza-A, PIV3, and bocavirus, may be followed
closely regarding the clinical changes.
Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: prospective observational study
