Viral Coinfection of Children Hospitalized with Severe Acute Respiratory Infections during COVID-19 Pandemic

Abstract

The main pathogens of severe respiratory infection in children are respiratory viruses, and the current molecular technology allows for a rapid and simultaneous detection of a wide spectrum of these viral pathogens, facilitating the diagnosis and evaluation of viral coinfection. Methods: This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study. Results: The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of (p > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively. Conclusion: Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities.

Respiratory syncytial virus in children: epidemiology and clinical impact post-COVID-19

“…Similarly, a systematic review conducted by Li et al [45] concluded that overall viral co-detection did not result in significant differences in disease course compared to RSV alone; however, RSV-HMPV co-detection trended towards a longer length of hospitalisation. Previous studies examining RSV co-detection have not shown a consistent association between coinfection and severity [44][45][46][47][48].…”

Persistent Challenges to a Single Diagnosis

“…A recent analysis of children with severe respiratory infections is an example (Figure 1). 7 Many COVID-positive patients were also positive for a second virus (58/137 = 42%); indeed, co-infections were more frequent than among COVID-negative patients (102/469 = 22%). These data suggest viral infections can occur in clusters, contrary to the claim by Locke and Aberegg.…”

“…We believe, therefore, the conflicting debates around Occam's razor have endured for centuries and will not end soon. 7 Findings suggest a substantial frequency of co-infections, particularly in patients with COVID virus infection. Interpretation suggests a positive rather than inverse association between viral infections.…”

“…Data displayed as a contingency table stratified by COVID infection (yes, no) and infection multiplicity (single virus, multiple viruses). Numerical data based on Malveste Ito et al 7 Findings suggest a substantial frequency of co-infections, particularly in patients with COVID virus infection. Interpretation suggests a positive rather than inverse association between viral infections.…”

Emerging Trends in Complications Associated with SARS-CoV-2 Infection

“…Regarding pediatric cases, researchers have also investigated the prevalence of respiratory viruses and their coinfections in children with severe respiratory infections (SARIs) [28]. The five most frequent coinfections identified were human rhinovirus (hRV)/SARS-CoV-2 (17.91%), hRV/respiratory syncytial virus (RSV) (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/human bocavirus (BoV) (10.45%), and hRV/adenovirus (AdV) (8.21%) [29]. These findings offer valuable insights into the complexity of pediatric respiratory infections and the need for tailored interventions.…”