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Is Viral Co-infection A Risk Factor For Severe Lower Respiratory Tract Infection? A Retrospective Observational Study
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  • Aykut Eşki,
  • Gökçen Kartal Öztürk,
  • Candan Çiçek,
  • Figen Gülen,
  • Esen Demir
Aykut Eşki
Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi
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Gökçen Kartal Öztürk
Ege University Faculty of Medicine
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Candan Çiçek
Ege Universitesi Tip Fakultesi
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Figen Gülen
Ege University Faculty of Medicine, Department of Pediatrics, Division of Pulmonology
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Esen Demir
Ege University Faculty of Medicine, Department of Pediatrics, Division of Pulmonology
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Abstract

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.

Peer review status:ACCEPTED

15 Jan 2021Submitted to Pediatric Pulmonology
18 Jan 2021Submission Checks Completed
18 Jan 2021Assigned to Editor
21 Jan 2021Reviewer(s) Assigned
03 Feb 2021Review(s) Completed, Editorial Evaluation Pending
04 Feb 2021Editorial Decision: Revise Major
13 Mar 20211st Revision Received
15 Mar 2021Submission Checks Completed
15 Mar 2021Assigned to Editor
15 Mar 2021Reviewer(s) Assigned
29 Mar 2021Review(s) Completed, Editorial Evaluation Pending
31 Mar 2021Editorial Decision: Revise Minor
04 Apr 20212nd Revision Received
05 Apr 2021Reviewer(s) Assigned
05 Apr 2021Submission Checks Completed
05 Apr 2021Assigned to Editor
06 Apr 2021Review(s) Completed, Editorial Evaluation Pending
07 Apr 2021Editorial Decision: Accept