Characterization of rhinovirus/enterovirus complex infection in children living at high altitudes: A cross sectional study

Abstract

Background: Respiratory tract infections caused by the rhinovirus/enterovirus (RV/EV) complex have traditionally been considered to be minor, self-limited infections in children, with few complications. There are no previous studies of patients living at high altitudes that characterize severe cases of this infection.Methods: This was a cross-sectional study including patients from 1 month to 18 years old who had been hospitalized for acute respiratory tract infections between October 2015 and December 2019, and had had a viral panel with RT-PCR during their hospitalization.Results: During the study period, 645 RT-PCRs were performed, with the two main etiological agents identified being RV/EV (224) and respiratory syncytial virus (68). The median age of patients with RV/EV complex was 27 months (IQR: 8-70), 55.8% were boys and the average length of hospital stay was 12 days (IQR: 6-24). Severe RV/EV complex infections required more transfers to intensive care (11% vs 47%), showed more viral coinfection (OR: 2.13,95%, 95%CI: 1.42-4.64) and had less bacterial coinfection (OR: 0.55, 95%CI: 0.31-0.98) than RSV infections, with no difference in mortality ( 2.4% vs. 2.1%, P:0.09). Post-transplant patients (OR: 3.35, 95%CI: 1.10-11.34) and those with comorbidities (OR: 3.97, 95%CI: 2.23-7.08) had the highest risk of RV/EV infection. The RV/EV group had a higher risk of presenting acute respiratory distress syndrome (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). Conclusions: Respiratory infection due to RV/EV in children who live at high altitudes can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with viral coinfection and the development of ARDS, especially in risk groups such as those with prematurity, heart disease or inborn errors of metabolism. It is important to see RV / EV as a virus that can have an unsatisfactory course as or more severe than that of other viruses that affect the respiratory tract in children.

Assessment of the Clinical Course of Human Rhinovirus/Enterovirus Infections in Pediatric Intensive Care

“…Smith et al, 10 in their study, compiling HRV/EV (+) cases admitted to the PICU over a year, found that the highest rate of admissions occurred in March–May and September–October, with a PARDS frequency of 14%. In another study conducted by Jaime et al, 11 which evaluated high-amplitude HRV/EV infections, the incidence of PARDS was found to be higher in HRV/EV (+) cases compared to RSV (+) cases (11% vs. 1%; P = 0.003). The lower incidence in our study may be attributed to the fact that the study covered a specific period of the year, resulting in a lower number of cases.…”