Respiratory Pathogens in Children with and without Respiratory Symptoms

Zalm, Marieke M. van der; Ewijk, Bart E. van; Wilbrink, B.; Uiterwaal, Cuno S.P.M.; Wolfs, Tom F. W.; Ent, Cornelis K. van der

doi:10.1016/j.jpeds.2008.08.036

Cited by 128 publications

(133 citation statements)

References 23 publications

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“…The interpretation of a viral detection is complicated by the fact that infections with multiple viruses are common in children with ARI and that many viruses have lately been reported to be found also in asymptomatic children. [12][13][14][15][16][17] Numerous case series investigating respiratory viruses in hospitalized children with ARI have been published. [18][19][20] However, data are available from only a few case-control studies that examined to what extent specific respiratory viruses cause disease.…”

Section: Resultsmentioning

confidence: 99%

“…[18][19][20] However, data are available from only a few case-control studies that examined to what extent specific respiratory viruses cause disease. 12,14,15,21 Furthermore, these studies had limitations in that they used hospital-based control subjects, which might have biased the results. To address these issues, we conducted a matched case-control study outside the influenza season to compare viral qPCR findings in nasopharyngeal aspirates from children with ARI versus population-based asymptomatic control subjects matched on age and calendar time.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Quantitative real-time polymerase chain reaction allows sensitive detection of respiratory viruses. The clinical significance of detection of specific viruses is not fully understood, however, and several viruses have been detected in the respiratory tract of asymptomatic children. WHAT THIS STUDY ADDS:Our results indicate that quantitative real-time polymerase chain reaction is limited at distinguishing acute infection from detection in asymptomatic children for rhinovirus, bocavirus, adenovirus, enterovirus, and coronavirus. abstract BACKGROUND: Acute respiratory illness (ARI) accounts for a large proportion of all visits to pediatric health facilities. Quantitative real-time polymerase chain reaction (qPCR) analyses allow sensitive detection of viral nucleic acids, but it is not clear to what extent specific viruses contribute to disease because many viruses have been detected in asymptomatic children. Better understanding of how to interpret viral findings is important to reduce unnecessary use of antibiotics. OBJECTIVE:To compare viral qPCR findings from children with ARI versus asymptomatic control subjects.METHODS: Nasopharyngeal aspirates were collected from children aged #5 years with ARI and from individually matched, asymptomatic, population-based control subjects during a noninfluenza season. Samples were analyzed by using qPCR for 16 viruses. RESULTS:Respiratory viruses were detected in 72.3% of the case patients (n 5 151) and 35.4% of the control subjects (n 5 74) (P 5 .001). Rhinovirus was the most common finding in both case patients and control subjects (47.9% and 21.5%, respectively), with a population-attributable proportion of 0.39 (95% confidence interval: 0.01 to 0.62). Metapneumovirus, parainfluenza viruses, and respiratory syncytial virus were highly overrepresented in case patients. Bocavirus was associated with ARI even after adjustment for coinfections with other viruses and was associated with severe disease. Enterovirus and coronavirus were equally common in case patients and control subjects.CONCLUSIONS: qPCR detection of respiratory syncytial virus, metapneumovirus, or parainfluenza viruses in children with ARI is likely to be causative of disease; detection of several other respiratory viruses must be interpreted with caution due to high detection rates in asymptomatic children. Although acute respiratory illness (ARI) in childrenaccountsfora large part ofall visits to pediatric health facilities and is a great economic burden on society, 1,2 our tools to diagnose the etiologic agents have until recently been limited. 3 Treatment with antibiotics induces development of antibiotic resistance in bacteria 4 and has a negligible effect on most ARIs, which generally are of viral origin. 5,6 Nevertheless, antibiotics are frequently prescribed due to lack of clinically valid diagnostic tests verifying a viral etiology. 7 Sensitive methods, such as quantitative real-time polymerase chain reaction (qPCR) analyses on nasopharyngeal samples, for a number of viru...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

et al. 2014

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“…Previous reports suggested that co-infection with viral respiratory diseases may result in a more severe clinical manifestation than infection with only one virus (Aberle et al 2005, Cilla et al 2008, van der Zalm et al 2009). Richard et al (2008) suggested that dual infection is a risk factor for more severe illness, which is independent of the host's condition.…”

Section: Discussionmentioning

confidence: 99%

“…According to van der Zalm (2009), younger children may be more prone to co-infection because they have a less developed immune system. In conclusion, our results indicate that HRV co-infection with a second respiratory virus is not responsible for more severe LRTI in young children.…”

Section: Illnessmentioning

confidence: 99%

Human rhinovirus in the lower respiratory tract infections of young children and the possible involvement of a secondary respiratory viral agent

Paula

Carneiro

Yokosawa

et al. 2011

Mem. Inst. Oswaldo Cruz

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“…1 Recent studies have shown an increasing prevalence of asymptomatic rhinovirus infections. [2][3][4] Picornavirus nucleic acids are typically shed from the upper respiratory tract for 1 to 3 weeks after infection. 4,5 A study in adult volunteers showed that cultivatable rhinoviruses were routinely recovered for ∼2 weeks after infection.…”

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confidence: 99%

Duration of Rhinovirus Shedding in the Upper Respiratory Tract in the First Year of Life

Loeffelholz¹,

Trujillo

Pyles

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Rhinoviruses are commonly detected in both acutely ill and asymptomatic infants and children. The finding may represent new infection or prolonged presence of rhinovirus RNA in the respiratory tract. WHAT THIS STUDY ADDS:In young, otherwise healthy infants, shedding of RNA from the same rhinovirus strain rarely persisted longer than 30 days. abstract BACKGROUND: Current molecular diagnostic methods have detected rhinovirus RNA in a high proportion of asymptomatic infants and children, raising the question of the clinical significance of these findings. This study investigates the prevalence of prolonged rhinovirus RNA presence in the upper respiratory tract of infants during the first year of life. METHODS:In a longitudinal study, infants were followed from birth up to 12 months. Nasopharyngeal specimens were collected monthly (months 1-6 and month 9) and during an upper respiratory infection. Rhinoviruses were detected by quantitative reverse-transcription polymerase chain reaction. Presence of repeated rhinovirus RNA was evaluated by nucleotide sequence analysis. RESULTS:A total of 2153 specimens from 362 infants were studied; 341 distinct rhinovirus infections in 216 infants were identified. Follow-up specimens were available within 30 days for 179 infections, creating the sample set to assess prolonged rhinovirus presence. Of the 179 infections, 46 involved the detection of the same rhinovirus strain in repeated specimens, including 8 events of prolonged presence of the same strain (detected in specimens collected .30 days apart), representing 4.5% of the evaluable rhinovirus infections. There were 26 events in which a rhinovirus strain was replaced by a different strain within a 30-day interval, representing 14.5% of the 179 infections. CONCLUSIONS:Although rhinovirus infections are common in healthy infants, prolonged presence of rhinovirus RNA in the respiratory tract after an upper respiratory infection was uncommon (,5%). Detection of rhinovirus RNA in an infant most likely represents an infection within a 30-day period. Dr Loeffelholz co-conceptualized and co-designed the study and wrote the initial manuscript; Dr Trujillo coordinated data collection; Dr Pyles conceptualized and supervised molecular virology studies and reviewed and revised the manuscript; Mr Miller performed molecular virology studies and provided interpretation of the data for inclusion in the manuscript; Dr Alvarez-Fernandez supervised data collection; Dr Pong performed molecular virology studies and performed data collection and analysis; Dr Chonmaitree conceptualized and designed the study, provided overall study supervision, and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. 4,5 A study in adult volunteers showed that cultivatable rhinoviruses were routinely recovered for ∼2 weeks after infection. 6 Recurrent rhinovirus infection has been described in patients with asthma 7 and in those at risk of developing...

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Respiratory Pathogens in Children with and without Respiratory Symptoms

Abstract: Respiratory pathogens are frequently detected in samples from children with no respiratory symptoms. Symptomatic cases occurred more often in younger children and with detections of more than 1 respiratory pathogen.

Cited by 128 publications

References 23 publications

Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

Clinical Utility of PCR for Common Viruses in Acute Respiratory Illness

Human rhinovirus in the lower respiratory tract infections of young children and the possible involvement of a secondary respiratory viral agent

Duration of Rhinovirus Shedding in the Upper Respiratory Tract in the First Year of Life

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