Factors Associated with Severe Acute Respiratory Infections Due to Rhinovirus/Enterovirus Complex in Children and Their Comparison with Those of Respiratory Syncytial Virus

Background: Acute respiratory tract infections (ARTIs) are one of the main causes of morbidity and mortality in children under the age of five worldwide. Objectives: The objective of this research was to describe the main characteristics of hospitalized patients with ARTI caused by the rhinovirus/enterovirus (RV/EV) complex and the risk factors associated with severe infection. Methods: This was a retrospective descriptive study in patients from one month to 18-years-old who had been hospitalized for ARTI between October 2015 and December 2019 at Fundación Cardioinfantil in Bogotá, Colombia, and had had an RT-PCR viral panel during their hospitalization. Rhinovirus/enterovirus infection was characterized to identify factors associated with disease severity as compared to respiratory syncytial virus (RSV). A multivariate analysis was performed, controlling for confounding factors, to identify groups at risk of developing associated acute respiratory distress syndrome (ARDS). Results: During the study period, 645 RT-PCRs were performed, with the two main etiological agents identified being RV/EV (n = 224) and RSV (n = 68). The median age of patients with the RV/EV complex was 27 months (IQR: 8 - 70), and seven months for those with RSV (IQR: 2 - 11). Severe RV/EV complex infections required more transfers to intensive care (47% vs. 11%), showed more viral coinfection (OR: 2.13, 95% CI: 1.42 - 4.64), and had less bacterial coinfection (OR: 0.55, 95% CI: 0.31 - 0.98) than RSV infections. The RV/EV group had a higher risk of developing ARDS (OR: 3.6, 95% CI: 1.07 - 12:18), especially in premature infants (P: 0.05; exp(B), 2.99; 95% CI = 1.01 - 8.82), those with heart disease (P: 0.047; exp(B), 2.99; 95% CI = 1.01 - 8.82), and those with inborn errors of metabolism (P: 0.032; exp(B), 5 - 01; 95% CI = 1.15 - 21.81). A total of 13 patients from both study groups died (4.5%), with no differences found between the groups (RV/EV 54% vs. RSV 46%; P = 0.3). Conclusions: Respiratory infection due to RV/EV in children can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with the development of ARDS, especially in risk groups such as those with prematurity, heart disease, or inborn errors of metabolism.

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Hyperimmune globulins in prevention and treatment of respiratory syncytial virus infections.

Clinical Microbiology Reviews ◽

10.1128/cmr.8.1.22 ◽

1995 ◽

Vol 8 (1) ◽

pp. 22-33 ◽

Cited By ~ 62

Author(s):

V G Hemming ◽

G A Prince ◽

J R Groothuis ◽

G R Siber

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Syncytial Virus ◽

High Risk ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Lower Respiratory Tract Infections ◽

Syncytial Virus ◽

Tract Infections

Respiratory syncytial virus (RSV) is an important community and nosocomial respiratory pathogen for infants and young children. RSV causes especially severe disease in the prematurely born or those with chronic cardiopulmonary diseases. Elderly persons and those with T-cell deficiencies, such as bone marrow transplant recipients, are also at high risk for serious lower respiratory tract infections. To date, prevention of RSV infections by vaccination has proven elusive and no preventive drugs exist. Studies in animals and humans have shown that the lower respiratory tract can be protected from RSV infection by sufficient circulating RSV neutralizing antibody levels. Recently, an RSV hyperimmune immune globulin (RSVIG) was developed and tested for the prevention of RSV infections or reduction of disease severity. Passive immunization of high-risk children with RSVIG during the respiratory disease season effected significant reductions in RSV infections, hospitalizations, days of hospitalization, intensive care unit admissions, days in the intensive care unit, and ribavirin use. Studies in cotton rats and owl monkeys show that RSV infections can also be treated with inhalation of immune globulin at doses substantially smaller than required for parenteral treatment. Therapeutic trials of parenteral RSVIG have been completed and are pending analysis. The use of polyclonal, hyperimmune globulins and perhaps human monoclonal antibodies provides an additional approach to the prevention and perhaps the treatment of certain viral lower respiratory tract infections such as those caused by RSV.

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Epidemiology of Respiratory Syncytial Virus-Related Hospitalization Over a 5-Year Period in Italy: Evaluation of Seasonality and Age Distribution Before Vaccine Introduction

Vaccines ◽

10.3390/vaccines8010015 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15

Author(s):

Federica Barbati ◽

Maria Moriondo ◽

Laura Pisano ◽

Elisa Calistri ◽

Lorenzo Lodi ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Syncytial Virus ◽

Age Distribution ◽

Vaccine Introduction ◽

Herd Protection ◽

Infection Risk Factors ◽

Rsv Infection ◽

Syncytial Virus ◽

Italian Children ◽

Tract Infections

Respiratory Syncytial Virus (RSV) is associated with most of the acute viral respiratory tract infections causing hospitalization with a peak during the first months of life. Many clinical trials of RSV vaccine candidates are being carried out. The aim of this study was to obtain epidemiologic information to give suggestions on target populations and prevention strategies before the introduction of new vaccines or monoclonal antibodies. We retrospectively evaluated, over a 5-year period (September 2014–August 2019), a population of hospitalized Italian children aged 0–6 years with a laboratory confirmed diagnosis of RSV infection. Risk factors, seasonality of RSV infection, distribution according to age, cases of coinfections and reinfections and cases needing Intensive Care Unit were evaluated. Hospitalizations due to RSV were 624 in the period under study. The peak was found between November and April, with 80.4% of cases recorded between December and February. 62.5% of cases were found in children under three months of age and 41% in children under 30 days old. The need for intensive care was associated with younger ages, with 70.9% of cases in children below three months of age. Unless the incoming vaccines demonstrate a strong herd protection effect, preventive strategies should be aimed at newborns or at maternal immunization.

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RESPIRATORY SYNCYTIAL VIRUS MORBIDITY AND MORTALITY ESTIMATES IN CONGENITAL HEART DISEASE PATIENTS: A RECENT EXPERIENCE

PEDIATRICS ◽

10.1542/peds.92.4.642 ◽

1993 ◽

Vol 92 (4) ◽

pp. 642-642

Author(s):

J. F. L.

Keyword(s):

Congenital Heart Disease ◽

Intensive Care ◽

Heart Disease ◽

Respiratory Syncytial Virus ◽

Congenital Heart ◽

Pediatric Intensive Care ◽

Mortality Rates ◽

Recent Experience ◽

Duration Of Hospitalization ◽

Syncytial Virus

In conclusion, present respiratory syncytial virus mortality rates in pediatric patients with congenital heart disease are much less than those described nearly a decade ago. Patients with pulmonary hypertension have increased mortality rates as measured by duration of hospitalization, need for and duration of intensive care, and requirement and duration of mechanical ventilation. However, greatly increased mortality risk is not currently seen in congenital heart disease patients with pulmonary arterial hypertension compared with those congenital heart disease patients without this diagnosis. The substantially reduced mortality rate differences observed between the present congenital heart disease patients and patients of a decade ago are probably due to advances in pediatric intensive care medicine and surgical management of heart disease. It is unlikely that the availability of ribavirin alone has been responsible for the marked reduction in respiratory syncytial virus congenital heart disease mortality rates. Appropriately designed studies addressing efficacy, cost-effectiveness, and short- and long-term safety of ribavirin use in patients with congenital heart disease are still needed.

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Palivizumab compliance in congenital heart disease patients: factors related to compliance and altered lower respiratory tract infection viruses after palivizumab prophylaxis

Cardiology in the Young ◽

10.1017/s1047951120001092 ◽

2020 ◽

Vol 30 (6) ◽

pp. 818-821

Author(s):

Kutay Sel ◽

Ebru Aypar ◽

Yasemin Nuran Dönmez ◽

Emil Aliyev ◽

Hakan Hayrettin Aykan ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Respiratory Syncytial Virus ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Congenital Heart ◽

Respiratory Tract Infections ◽

Lower Respiratory Tract Infections ◽

Syncytial Virus ◽

Tract Infections

AbstractBackground:Lower respiratory tract infections caused by respiratory syncytial virus can be severe during infancy, which requires admission to the hospital. These infections may be more severe especially in patients with congenital heart disease. Passive immunisation with palivizumab, a monoclonal antibody, is recommended in high-risk infants. We tried to determine the compliance rates, factors affecting compliance, and also other microorganisms responsible for lower respiratory tract infections after palivizumab prophylaxis in these patients.Methods:We evaluated patients’ compliance to prophylaxis with palivizumab in two consecutive respiratory syncytial virus seasons from pharmacy records. We also investigated factors affecting compliance and the frequency of hospitalisations for lower respiratory tract infections. We investigated the causative microorganisms detected in hospitalised patients.Results:In this study, 86.7% of the desired number of injections was achieved in 176 patients in two seasons. Out of these, 117 patients (66.4%) received all the doses they were prescribed. Although not statistically significant, compliance to prophylaxis was higher in male patients, cyanotic patients, those who started under 1 year old, and who lived in the city centre. Human metapneumovirus, parainfluenza type 3, and bocavirus were detected in the hospitalised patients.Conclusion:Patients with congenital heart disease can survive the period of infancy with less problem by making palivizumab prophylaxis more effective, and awareness about non- respiratory syncytial virus factors may be a guide for the development of new treatments.

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Respiracinio sincitinio viruso infekcijos aktualumas vaikų kardiochirurgijoje

Lietuvos chirurgija ◽

10.15388/lietchirur.2007.3.2227 ◽

2007 ◽

Vol 5 (3) ◽

pp. 0-0

Author(s):

Solveiga Umbrasaitė ◽

Kęstutis Versockas

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Respiratory Syncytial Virus ◽

Congenital Heart ◽

Severe Form ◽

University Hospital ◽

Rsv Infection ◽

Syncytial Virus ◽

One Year ◽

Tract Infections

Solveiga Umbrasaitė, Kęstutis VersockasVilniaus universiteto ligoninės Santariškių klinikos, Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Respiracinis sincitinis virusas (RSV) yra dažniausia apatinių kvėpavimo takų infekcijos priežastis, ypač naujagimiams ir kūdikiams. Tarp vaikų, kuriems yra padidėjusi sunkios RSV infekcijos formos rizika, yra turinčių įgimtą širdies ydą. Ši rizika yra dar didesnė atliekant širdies operacijas. Šio tyrimo tikslas buvo išsiaiškinti, kiek yra infekuotų RSV vaikų tarp patenkančių į stacionarą operaciniam gydymui. Metodai ir rezultatai Specifiniai RSV imunoglobulinų testai buvo atlikti 32 vaikų grupėje (iš kurių 9 naujagimiai ir 23 kūdikiai). Teigiamų IgG antikūnų rasta 12 atvejų (41%), teigiamų IgM antikūnų – vienu. Išvados RSV infekuotų vaikų yra gana daug; dėl to tikslinga tęsti tyrimus. Kitas žingsnis būtų išsiaiškinti RSV infekcijos įtaką perioperacinei pacientų būklei ir pasyvios imunoprofilaktikos palivizumabu tikslingumą. Pagrindiniai žodžiai: respiracinis sincitinis virusas, įgimtos širdies ydos, imunoprofilaktika Relevance of RSV infection in children’s cardiac surgery Solveiga Umbrasaitė, Kęstutis VersockasVilnius University Hospital „Santariškių klinikos“, Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections, especially in newborns and children under one year of age. Among children at a higher risk of a severe form of RSV infection are children with congenital heart disease. This risk is higher in case of heart operation.The purpose of this research was to reveal the incidence of RSV-infected patients among those admitted for surgical treatment. Methods and results Specific RSV immunoglobulin tests were performed for a group of 32 children (9 newborns and 23 infants). Positive IgG antibodies were found in 12 cases (41%) and positive IgM antibodies in one case. Conclusions The incidence of RSV-infected children is quite high; therefore, it is purposeful to continue research. The next step would be to reveal the influence of RSV infection on the perioperative condition of patients and the expediency of passive imunoprophylaxis with palivizumab. Key words: respiratory syncytial virus, congenital heart disease, imunoprophylaxis

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Extracellular amoebal-vesicles: potential transmission vehicles for respiratory viruses

npj Biofilms and Microbiomes ◽

10.1038/s41522-021-00201-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Rafik Dey ◽

Melanie A. Folkins ◽

Nicholas J. Ashbolt

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Respiratory Viruses ◽

Environmental Persistence ◽

Viral Dissemination ◽

Acute Respiratory Tract Infections ◽

High Concentrations ◽

Syncytial Virus ◽

Tract Infections

AbstractHuman respiratory syncytial virus (RSV) is a major cause of acute respiratory tract infections in children and immunocompromised adults worldwide. Here we report that amoebae-release respirable-sized vesicles containing high concentrations of infectious RSV that persisted for the duration of the experiment. Given the ubiquity of amoebae in moist environments, our results suggest that extracellular amoebal-vesicles could contribute to the environmental persistence of respiratory viruses, including potential resistance to disinfection processes and thereby offering novel pathways for viral dissemination and transmission.

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Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽

10.3390/vaccines9060624 ◽

2021 ◽

Vol 9 (6) ◽

pp. 624

Author(s):

Laura M. Stephens ◽

Steven M. Varga

Keyword(s):

Respiratory Syncytial Virus ◽

Disease Burden ◽

Elderly Population ◽

Vaccine Development ◽

The Elderly ◽

The United States ◽

Susceptible Population ◽

Age Related ◽

Syncytial Virus ◽

Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

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Bacterial and Viral Coinfections with the Human Respiratory Syncytial Virus

Microorganisms ◽

10.3390/microorganisms9061293 ◽

2021 ◽

Vol 9 (6) ◽

pp. 1293

Author(s):

Gaspar A. Pacheco ◽

Nicolás M. S. Gálvez ◽

Jorge A. Soto ◽

Catalina A. Andrade ◽

Alexis M. Kalergis

Keyword(s):

Respiratory Syncytial Virus ◽

Influenza A ◽

Human Respiratory Syncytial Virus ◽

Respiratory Pathogens ◽

Parainfluenza Viruses ◽

Starting Point ◽

The Social ◽

Syncytial Virus ◽

Tract Infections ◽

Polymicrobial Infections

The human respiratory syncytial virus (hRSV) is one of the leading causes of acute lower respiratory tract infections in children under five years old. Notably, hRSV infections can give way to pneumonia and predispose to other respiratory complications later in life, such as asthma. Even though the social and economic burden associated with hRSV infections is tremendous, there are no approved vaccines to date to prevent the disease caused by this pathogen. Recently, coinfections and superinfections have turned into an active field of study, and interactions between many viral and bacterial pathogens have been studied. hRSV is not an exception since polymicrobial infections involving this virus are common, especially when illness has evolved into pneumonia. Here, we review the epidemiology and recent findings regarding the main polymicrobial infections involving hRSV and several prevalent bacterial and viral respiratory pathogens, such as Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, human rhinoviruses, influenza A virus, human metapneumovirus, and human parainfluenza viruses. As reports of most polymicrobial infections involving hRSV lack a molecular basis explaining the interaction between hRSV and these pathogens, we believe this review article can serve as a starting point to interesting and very much needed research in this area.

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